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

North Dakota (PROTECTION and ADVOCACY PROJECT) - H240A170035 - FY2017

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 areas109
2. Individuals receiving I&R outside PAIR priority areas212
3. Total individuals receiving I&R (lines A1 + A2)321

B. Training Activities

1. Number of trainings presented by PAIR staff35
2. Number of individuals who attended training (approximate)521

1. 10/3/2016 - Individual Justice Planning (IJP) in North Dakota - The Annual Autism Spectrum Disorder Conference was held and P&A staff provided a training regarding the use of the Individual Justice Planning process for children who are on the Autism Spectrum. This model provides for a preventative response or a response to involvement in the criminal justice system for people with disabilities. 15 people participated in the training.

2. 10/4/2016 - Prairie St. John’s - Monthly throughout the fiscal year, P&A staff provides training on abuse, neglect and exploitation and mandatory reporting to the newly hired staff at Prairie St. John’s (PSJ). PSJ is a private facility within the eastern part of the state who provides mental health and chemical dependency inpatient and outpatient treatment. These efforts ensure that all staff within the facility are aware of their responsibilities to prevent ANE from occurring and to mandatorily report suspected ANE as part of their professional positions within the facility. 14 trainings were held and 114 new employees participated in the training.

3. 10/6/2016 - ND State Hospital New Staff Training - Each month P&A staff provides training to new staff who have been hired to work at the ND State Hospital. Staff work in both the acute mental health portion of the facility and the addiction and recovery programs. Training content focuses on abuse, neglect and exploitation, mandatory reporting, risk management and conducting investigations. 12 trainings were held and 93 new employees participated in the training.

4. 10/26/2016 - Rehab Services, Inc. (RSI) Abuse, Neglect & Exploitation Training - RSI provides a number of services within the developmental disabilities and transition services for students who have other types of disabilities. As a provider, the staff are mandatory reporters and are also responsible to ensure that they prevent ANE whenever possible. Through this training, provider staff are educated on prevention, risk management and mandatory reporting requirements of abuse, neglect and exploitation. 28 people participated in the training.

5. 12/1/ 2016 - Fargo/Moorhead Special Needs Support Network - To increase the knowledge base of parents regarding their children’s rights to special education, P&A provided training. Topics included the IEP process, the difference between Special Education & 504 supports and student’s rights under these two laws. 16 people participated in the training.

6. 2/1/2017 - Northwest Human Service Center - P&A provided training to Northwest Human Service Center staff on P&A services, agency priorities and protective services. This training was targeted to new staff who had not yet development a working knowledge of P&A and our services. 7 people participated in the training.

7. 2/7/2017 - Edgewood Vista Therapeutic Responses Training - As part of the Therapeutic Responses training curriculum P&A provided training to the three Edgewood Vista staff who oversee the employee development programs within the Edgewood Vista network. The training was specifically geared towards the Dementia Units who serve residents who are experiencing behavioral and emotional difficulties as the disease progresses. This training curriculum will be very useful to assist with early intervention and de-escalation in the support of the residents within these three units within the facilities. 3 people participated in this training.

8. 3/9/2017 - School to Prison Pipeline - Through a collaborative effort with the National Disability Rights Network, P&A hosted a statewide Interactive Video Network Training on the School to Prison Pipeline. This concept identifies the growing number of students with disabilities who are experiencing challenges with behavior within school settings and as a result, are becoming involved in the juvenile justice system. The purpose of this training was to inform parents, advocates and other professionals of practices to address the needs of students with disabilities in alternative ways other than the justice system. 140 people participated in this training.

9. 5/1/2017 - Devils Lakes District Social Services -- P&A provided training to Devils Lakes District Social Services staff on P&A services, agency priorities and protective services. This training was targeted to County Social Services staff who work with people with disabilities so they would have an increased knowledge of P&A and our services. 30 people participated in the training.

10.5/9/17 - Elks 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 seniors is given regarding P&A, our services and the role that the agency plays within state government in North Dakota. 30 students were trained as part of this activity.

11.7/11/2017 - Advocates Leading Their Lives (ALL) Statewide Self-Advocacy Conference -- To increase the knowledge of people with disabilities in disability rights, P&A staff provided education regarding the rights of people with disabilities, self-determination and self-advocacy, along with ways to have a voice within the state. Information regarding P&A services and priorities was also provided. 45 people participated in the training.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles1
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website22,335
5. Publications/booklets/brochures disseminated424
6. Other (specify separately)11

Narrative

1. Radio and TV appearances by PAIR staff - 0

2. Newspaper/magazine/journal articles - 1

In an effort to increase the public’s awareness of the physical accessibility issues that impact people with disabilities, the Jamestown Sun newspaper ran a story on accessibility and the inclusion needs of people with disabilities. The City Council was in the process of developing a community plan to address accessibility needs of the community and the article was part of the public input process. P&A staff provided information and guidance regarding the importance of accessibility both of the public streets and the landscape, but also the need to ensure that buildings and public places are fully accessible. P&A also recommended that people with disabilities in the community be formally included to provide input on the accessibility issues. Daily circulation of the Jamestown Sun is 7,134.

3. PSAs/Videos aired - 0

4. Hits on the PAIR/P&A website - 22,335

5. Publications/booklets/brochures disseminated -

6. Other

Other Dissemination Activities

10/12/16 - ND Department of Public Instruction Fall Educator’s Conference - P&A sponsored a booth at the event. Participants included regular education and special education teachers, school counselors, educational support personnel, and school administration. - 200 participants.

10/13/2016 - Business Accessibility Workshop - P&A sponsored a booth at the statewide event. The purpose of the event is to help business owners, agencies and community members to have an increased understanding of the ADA, Building Accessibility Guidelines, Accommodating Consumers with Hearing or Visual Impairments and Service Animals. P&A ensured the participants were aware of agency services and the role that P&A could play with enforcement of these issues. - 22 participants.

2/2/2017 - ND Council for Exceptional Children 2017 Conference - P&A sponsored a booth at this annual statewide conference. The main audience of this conference are educators, both from the general education and special education realms. P&A provided information and resources to ensure that educators were aware of potential ways in which P&A could support the needs of their students. - 300 participants.

2/16/2017 - Disability Awareness Day at the Capitol - P&A, in collaboration with the Client Assistance Program, Department of Human Services, University Center for Excellence (ND Center for Persons with Disabilities at Minot State University) and the State DD Council, sponsored the event. P&A sponsored a booth to share information regarding P&A services. One of the highlights of the days’ events was lunch with legislators and a wonderful vocal performance by “Blind Joe” from The Voice. -- 300 participants.

4/4/2017 - Consumer & Family Network Conference - P&A sponsored a booth at the annual Consumer & Family Network Conference. Special attention for this conference is provided to ensure that consumers with disabilities are in attendance, with an emphasis on rural communities. - 65 participants.

4/21/2017 - Fort Totten Student & Parent Fair - There were 800 community members, parents and students who attended the parent and student fair (from Fort Totten and surrounding communities and schools). There were 80 agencies who sponsored booths from Fort Totten and surrounding communities (Devils Lake, Minnewaukan, Maddock, Warwick, and Jamestown) that provided information on their services and programs. - 800 participants.

6/20/2017 - World Elder Abuse Awareness Day - This year’s event was held in an urban community and was hosted as part of the World Abuse Awareness Day across the nation. P&A sponsored a booth at the event, along with Aging Services Vulnerable Adult Protective Services staff, ND Attorney General Consumer Protection Division, ND Securities Department and the Emmons County Sheriff’s Department. 30 participants.

7/11/2017 - North Dakota Indian Education Summit - P&A sponsored a booth at the event to ensure that educators and other professionals who serve North Dakota’s four Native American reservations have knowledge of P&A services. - 130 participants.

8/17/2017 - Bismarck Project Service Connect - P&A sponsored a booth at the event. Project Service Connect is a one day event providing individuals and families experiencing homelessness, and those in need, with access to vital services in our community. It is a one stop shop of service providers offering resources regarding housing, employment, medical/dental care, benefits, haircuts, food, and self- advocacy. - 180 participants.

11/16/2017 - Minot Independent Living Fair - P&A sponsored a booth at the Minot Independent Living Fair. Participants included Legal Assistance of ND, ND Military Outreach Program, Opportunity Foundation, Lions Club, Vocational Rehabilitation, P&A and the Independent Living Center. - 180 participants.

Other Events/Activities

Outreach efforts by Disabilities Advocates also resulted in a number of entities being provided information regarding P&A and our services. These included Options Center for Independent Living, Lake Region Human Service Center, Lake Region Public Health, Lake Region Corporation, Spirit Lake Tribal 121, Spirit Lake Employment and Training Office, Freedom Psychological Rehabilitation Center, Lake Region Public Health Office, HAV-IT, Benson County Social Services, Indian Health Services, Spirit Lake Senior Center, Lonetree Special Education, Community Options, Eddy County Social Services, DD Program Management, DD Division staff, Public Defenders, Partnership Care Coordinators, post offices, school counselors, Kalix, county courthouses, clinics, and tribal buildings. Through these activities, 114 people were provided with information regarding P&A and the services provided for people with disabilities.

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)32
2. Additional individuals served during the year54
3. Total individuals served (lines A1 + A2)86
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)1

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 51

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment16
3. Program access10
4. Housing0
5. Government benefits/services1
6. Transportation0
7. Education37
8. Assistive technology0
9. Voting0
10. Health care17
11. Insurance0
12. Non-government services5
13. Privacy rights0
14. Access to records0
15. Abuse1
16. Neglect1
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor31
2. Other representation found0
3. Individual withdrew complaint0
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case2
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit2
9. Other1

Please explain

The client was supported with attending a hearing in which he appealed the repayment of Medicaid buy-in premiums. He did not prevail at the hearing; however, was able to then negotatiean agreement with ND Medicaid regarding a monthly amount that he would pay towards the premiums that had been paid during a period of time when was ineligible for the program.

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 assistance29
3. Investigation/monitoring0
4. Negotiation5
5. Mediation/alternative dispute resolution0
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 - 42
2. 5 - 2241
3. 23 - 5937
4. 60 - 643
5. 65 and over3

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females36
2. Males50

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race2
2. American Indian or Alaskan Native12
3. Asian1
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White66
7. Two or more races4
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent29
2. Parental or other family home48
3. Community residential home0
4. Foster care0
5. Nursing home2
6. Public institutional living arrangement0
7. Private institutional living arrangement3
8. Jail/prison/detention center2
9. Homeless2
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 hearing4
3. Deaf-blind1
4. Orthopedic impairment9
5. Mental illness4
6. Substance abuse2
7. Mental retardation0
8. Learning disability18
9. Neurological impairment15
10. Respiratory impairment3
11. Heart/other circulatory impairment3
12. Muscular/skeletal impairment5
13. Speech impairment0
14. AIDS/HIV0
15. Traumatic brain injury3
16. Other disability17

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities27

2. Number of individuals potentially impacted by policy changes8,037

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.

Therapeutic Responses through Positive Behavioral Supports

In collaboration with the ND Center for People with Disabilities (NDCPD), DD providers and the state of ND, the Therapeutic Responses training program to support the behavioral needs of people with disabilities in the DD system continues to be implemented. P&A continues to ensure that the curriculum is consistent with client rights and that restrictive procedures were implemented in a consistent manner across providers. P&A provided staff expertise as part of the training team and a “Train the Trainer” curriculum was developed and was part of the ongoing trainings that were offered throughout the year. At the conclusion of this year, providers have identified that full implementation of this training curriculum has now been accomplished across the provider network. The updates that were completed during the previous fiscal year were now implemented, which included some additional prohibited procedures per the Council on Quality Leadership’s (CQL) position. This process has resulted in the training of approximately 3,600 staff who support 5,200 people in the system.

In addition to the DD system utilizing this training curriculum, during FY 2017 there were also three Long Term Care providers trained and two school systems.

This activity resulted in one policy change and impacted 200 PAIR eligible people.

Ruth Meiers Hospitality House

Ruth Meiers is a homeless shelter in Bismarck providing emergency shelter and a residential program. In August 2017, it was reported that Ruth Meiers was not allowing people diagnosed with mental illness into the shelter and that an elevator in the men’s shelter was not working limiting people with physical disabilities from staying at the shelter. P&A visited with Ruth Meiers Interim Executive Director and Director of Client Services and Community Outreach regarding the report. They advised that there is not a screening tool for admission to the emergency shelter and that if people do not appear to be under the influence they can stay at the emergency shelter. The Interim Executive Director acknowledged the elevator in the residential program was inoperable for ½-day for maintenance, but that is the only issue there has been with the elevator. The Director of Client Services and Community Outreach indicated the only population excluded from the residential program is sex offenders as there are children in the building. She advised that most of their clients have some type of behavioral health need and they have a contract with West Central Human Service Center to house people with serious mental illness. Ruth Meiers was in the process of revising their intake process and resident handbook. Ruth Meiers advised that once the revisions were completed the documents would be shared with P&A. P&A will follow-up in fiscal year 2018 to confirm the revisions were completed and that they are not discriminatory towards people with disabilities.

This activity resulted in two policy changes and impacted 140 PAIR eligible people.

ND State Hospital Governing Board

P&A staff continue to be very involved in activities related to people who are served in programs at the ND State Hospital. P&A staff attend the ND State Hospital Governing Board meetings, provide routine feedback on activities relating to patient rights and overall quality assurance. P&A staff frequently work directly with treatment teams to ensure that patient treatment plans are recovery-based and that the facility as a whole and the Governing Board are consistent in their vision and service delivery process.

This activity resulted in one policy change and impacted 167 PAIR eligible people.

Money Follows the Person Stakeholder’s Group

The ND Money Follows the Person program, funded by CMS, targets the movement of individuals with physical disabilities living in nursing facilities and individuals with developmental/intellectual disabilities in ICF’s/IDD, to community placements. Funds are also made available to patients moving from the State Hospital and private psychiatric placements to community settings 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 2017 transitions totaled 34 individuals as of Oct. 1, 2017, a decrease of 10 from the previous year.

This activity resulted in one policy change and impacted 23 PAIR eligible people.

Early Periodic Screening Diagnosis and Treatment

Through ongoing referrals and in collaboration with other advocacy entities, discussions regarding EPSDT and coverage for needed services and equipment for children within state plan Medicaid began. Very quickly it was identified that issues were present regarding EPSDT and Medicaid approvals within the state. In an effort to educate policymakers, families, advocates and healthcare providers, P&A sponsored a statewide IVN training with professionals from the Bazelon Center. This training resulted in a significant number of people being educated on EPSDT and the state’s requirements to provide Medicaid coverage for children.

Following this training, further discussion continued with the State (Dept. of Human Services or DHS) as they worked to move services from the Medicaid Waiver to the Medicaid State Plan. Areas of focus included the requirements under EPSDT, along with more systemic ways in which approvals could be obtained when services, supports and equipment were medically necessary under the EPSDT provisions. When needed, additional subgroups were formed to continue these efforts so that issues could be resolved. The outcomes resulted in improved coverage for children within the state, in a more timely manner.

This activity resulted in one policy change and will affect 20 PAIR eligible children.

ND State Capitol Accessibility & Accessible Parking

In the weeks leading up to the 65th legislative assembly in North Dakota, a security measure was taken at the ND state capitol. All entrances, other than two main sets of doors were locked and electronic key cards were distributed to capitol and state employees who routinely entered the building. The general public and all others were then required to enter through two sets of doors that were designated for public entrance. These two entrances were equipped with electronic walk-through scanning capability for security and safety purposes. Unfortunately, these public entrances had very limited parking that was accessible and did not have adequate parking to allow for full participation in the legislative process for people who had physical disabilities. P&A immediately identified the concern and contacted capitol plan services staff to address the concern. A formal request was identified to add accessible parking; however, plant services staff identified that this was not a viable option due to the snow and weather conditions as the pavement could not be painted to comply with the ADA requirements for the marking of accessible parking places. Discussions ensued to address the lack of accessible parking, which then centered around a different lot that had a large number of parking spaces that were accessible, yet the doors closest to these spaces are not open to the general public. Plan services did agree to install an electronic intercom system that ran from the locked door by this large parking lot to the security area by the public entrance. The capability to unlock the door from the security area was established so that a person could then be allowed to enter where the locked door was located. This then allowed for a security guard to meet the person inside the door and clear them for entrance into the capitol building.

This activity resulted in one policy change and impacted 1,000 PAIR eligible people.

Autism Spectrum Disorder Services

P&A, along with a coalition of agencies, was very active during the 2017 Fiscal Year in advocating for an expansion of available services for individuals with a diagnosis on the autism spectrum.

During FY 2009 the Autism Spectrum Disorder Task Force was established and identified in law. Official appointments to the Task Force are made by the Governor. Along with P&A, appointments by the Governor include the following entities: ND Dept. of Human Services (DHS); ND Center for Persons with Disabilities; parents; Pathfinder Parent Center; a Legislator; Special Education Director; Dept. of Public Instruction; Development Homes; Anne Carlsen Center; an insurance company; Dept. of Health; and a pediatrician. The Task Force met four times during FY 2017. Major items:

1) The Department of Health has made more progress with the ASD database (registration). The last report says they now have over 300 individuals signed up and DoH is starting to pull out trends, etc. to help with decision-making and direction of services. There remain concerns however, that some professionals are not complying with State law to submit information to the database. In response, DoH has revamped the “form” to make it more expedient to complete and more user-friendly.

2) As submitted in a bill by a Senator on the Task Force, the Legislature approved additions to the task force membership of a Native American, as well as an adult with a diagnosis on the spectrum.

The NDASDAC began to work together during the 2013 Legislative Session and has

become a tight-knit group since then. During FY 2017, it met frequently (often monthly) to

strategize on related legislative issues.

As the State (Dept. of Human Services or DHS) worked to move services from the Medicaid Waiver to the Medicaid State Plan, serious discrepancies began to arise in terms of “allowed costs” by DHS and what providers were saying they needed in order to be able to deliver services. P&A’s concern, along with other advocates, was that there would not be providers willing to deliver services under DHS’ stated policies.

P&A became involved in two ways. First, P&A was part of an informal group that had discussions with an attorney (from another state) with expertise in ASD services and EPSDT issues. CMS, and ND DHS, were also brought in to the discussion for at least one call. Following this, P&A took the lead to set up meetings with the Acting Executive Director of DHS and providers interested in providing ABA therapy, but only if changes could be made to DHS’ policy on reimbursement. These meetings were very productive and ultimately successful in realizing changes to more acceptable reimbursement schedules for providers. While not all issues are resolved (e.g., services to those in more rural areas of the state), this was a big step.

This activity resulted in five policy change and impacted 1,174 PAIR eligible student.

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 regarding the outcomes of the State Systemic Improvement Plan. Concerns and issues regarding seclusion & restraint and shortened days were raised in committee meetings with P&A advocating for prioritization of these matters for this committee.

The issue of shortened days continues to be addressed at the committee level with leadership and direction from the SPED Directors.

This activity resulted in two policy changes and impacted 5,162 PAIR eligible students.

State Systemic Improvement Plan

As a state agency, the Department of Public Instruction (DPI) is responsible to implement the State Systemic Improvement Plan, which addresses the principles of special education law and critical elements that effect special education program improvement. DPI has utilized the state IDEA Advisory Committee as a mechanism to monitor these activities. A key principal that the group looks at is the state’s effectiveness with instruction and provision of supports within special education. P&A’s representation on this Committee has allowed for an evaluation of current practices, along with the ability to monitor the current performance of schools. Currently, careful attention is being given to graduation rates of students with disabilities, especially those with behavioral needs, social and emotional needs, social communication needs and also mental health needs. These efforts have resulted in school districts being required to collect data on graduation rates of students and more specifically, data regarding students with disabilities so that trending can be done.

More school districts are increasingly providing ongoing trauma care training to both general and special education teachers, administrators and other support staff. Two of the largest school districts in the State have implemented initial and ongoing training in best practices in the area of trauma based care. Several other districts are planning to include such training in the school training plan and some are seeking special grants to fund training.

This activity resulted in one policy change and impacted 5,162 PAIR eligible students.

Seclusion & Restraint in Schools

Following an interim legislative study on the use of seclusion & restraint in the schools, in FY 2017 the “Seclusion & Restraint Task Force” (SRTF), as initiated by P&A, continued with final meetings prior to the start of the Legislative Session in January 2017. P&A contracted with an independent consensus-building organization to facilitate the meetings which were made up of a variety of stakeholders including parents, advocates, the Dept. of Public Instruction, the Dept. of Human Services, special education directors, teachers, school administrators, psychologists, social workers, juvenile corrections, a school resource officer, and legislators.

In preparation for the Session, the SRTF focused its final efforts on drafting legislation. This was a difficult exercise as the school administrators and special education directors were not well aligned with other members in creating law that required shared definitions and minimal standards. However, through much angst, a bill was drafted and sponsored by a legislator participating on the SRTF.

Following a contentious hearing in the Senate Education Committee, the bill was amended to language that simply required each school district to have a policy addressing seclusion and restraint. It was hoped that this would pass the Senate however the ND School Board Association, who declined repeated requests to participate in the SRTF, came out in full force to oppose the bill saying, “no advocates will tell the schools what to do”. The bill was defeated. This was a huge disappointment to parents and advocates.

West Fargo Graduation Outcome Stakeholder’s Committee

A large urban school district within the state formed a Committee of twenty members to formally address graduation rates for students who were enrolled in special education services. P&A was asked to be a participant in the Committee as a partner, with specific attention in addressing when disability-related factors are impacting completion of coursework and timely graduation. West Fargo began completing Functional Behavioral Assessments (FBA’s) on all students in self-contained programs, as well as students who had behavior support plans but did not have FBA’s. No behavior support plan is being developed and/or implemented with a current FBA. This continues to be a priority in this district to reduce students dropping out of school and increasing the graduation rates of those students.

This activity resulted in one systemic outcome and impacted 179 PAIR eligible students.

ND Transition Application

P&A contracted with Disability Rights Kansas to adapt its transition tool for North Dakota. With input from youth with disabilities, the student survey was redesigned to target ND students who will be transitioning out of high school and moving on to higher education, employment, vocational training, etc. The work was completed in May 2017. A high school student created the logo for the tool which students can access through the Internet or by downloading the app. It is free. Once the student completes the survey, the individualized transition plan can be printed out or e-mailed. Information about the tool (T.ND) can be seen at http://ndpanda.org/. During the four months leading up to the end of FY 2017, over 250 students made use of the app.

This activity resulted in one systemic outcome and impacted 250 PAIR eligible people.

Mental Health Professional Review

In conjunction with 24 other disability professionals, P&A provided guidance to the Medical Director for the Department of Human Services regarding the definitions of mental health professionals in state law. Efforts were being initiated to broaden who could be considered a mental health professional and these professionals being able to initiate action as part of the mental health commitment process. P&A ensured that only those professionals who have the expertise and training to be considered mental health professionals was part of the recommendations to the medical director. As a result of these efforts, a tier system was established and a consensus was reached regarding the roles and responsibilities of the various professionals within each tier. This guidance was submitted as a bill to the Legislature during the 2017 Session and it ultimately passed.

This activity resulted in one systemic outcome and impacted 1,000 PAIR eligible people.

Sanford Pediatric Rehabilitation Forum

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 ND Assistive. Each month the group meets to discuss current issues and service barriers that are being encountered in the healthcare industry and with the provision of habilitative services. This group has been instrumental in the last three 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 the Department of Human Services requesting technical assistance from the Centers for Medicaid and Medicare Services to study current waivers within the state and to identify potential gaps in services. The group has also been instrumental in addressing funding issues for therapies and baclofen pump services for children who have physical and developmental disabilities with the expansion of this program statewide.

This activity resulted in two policy changes and impacted 75 PAIR eligible people.

ND State Hospital Human Rights Committee

In an effort to ensure that patient’s rights are protected, P&A does maintain representation on NDSH’s Human Rights Committee. P&A had direct input into decisions relative to client rights issues at NDSH regarding access to personal clothing, accommodations to respond to trauma resulting from sex trafficking, access to supplements in Sex Offender Treatment & Evaluation Program (SOTEP), bathroom access in Tompkins, and access to transgendered related clothing and products in SOTEP. P&A had direct input into the revision of NDSH policy to clarify where access to straight edge razors is allowed and to clarify the response to reports of sexual misconduct/assault and ensure timely and appropriate risk management and reporting by staff.

This activity resulted in two policy changes and impacted 167 PAIR eligible people.

ND State Hospital Search Policies

P&A worked collaboratively with a committee of NDSH personnel to combine all search related policies into one unified policy which applies to all programs on the NDSH campus. The resulting policy removed all searches without cause within the psychiatric program. Process for completing searches was clarified. Documentation requirements for all searches were specified. These changes will ensure protection of client dignity and privacy rights.

This activity resulted in one policy change and impacted 167 PAIR eligible people.

ND State Hospital Client Handbook

P&A worked collaboratively with NDSH to combine the handbooks used by various programs at NDSH into one Client Handbook to be used across all programs at NDSH. The resulting Client Handbook includes information regarding client rights and basic NDSH rules for individuals served in any of the programs at NDSH.

This activity resulted in one policy change and impacted 167 PAIR eligible people.

ND State Hospital policy - Elopement/Missing Person Response

P&A worked collaboratively with a committee of NDSH personnel to review & revise NDSH’s Elopement/Missing Person Response policy to ensure protection of patient rights. Policy was updated to include a revised definition of "elopement" which provides the client increased freedom of movement on NDSH campus before considered eloped while still ensuring safety/supervision needs are met. Policy update clarified steps to be taken in an elopement situation in order to provide better guidance to staff.

This activity resulted in one policy change and impacted 167 PAIR eligible people.

ND State Hospital policy - Client & Staff Personal Electrical Equipment

P&A worked collaboratively with a committee of NDSH personnel to review & revise NDSH’s Client & Staff Personal Electrical Equipment policy to ensure protection of patient rights. Policy was updated to ensure that all electrical equipment in client possession is in compliance with established safety standards. Guidance for staff was removed for inclusion in a separate policy.

This activity resulted in one policy change and impacted 167 PAIR eligible people.

ND State Hospital policy - Blizzard Response

P&A worked collaboratively with a committee of NDSH personnel to review & revise NDSH’s Blizzard Response policy to ensure protection of patient rights. Policy was updated to ensure all safety provisions were accurate and up to date.

This activity resulted in one policy change and impacted 167 PAIR eligible people.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts114
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 eight cases that are at the legal level of services during FY 2017. Three of these cases were closed during the fiscal year, with successful resolutions. The remaining five cases were pending at the end of the fiscal year and will be carried over to FY 2018.

Summary of cases:

The client is a 5 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. The primary issue was the ongoing funding needed to provide for 24-hour nursing care within the home. While the family’s private insurance did deny the coverage, and identified that it is not a covered services, P&A was successful in assisting the family with applying for a waiver within the state so that the Medicaid program could cover the cost of the in-home nursing services to meet the child’s needs. As a result of these efforts, the family now has access to funding to provide for the care in their family home that the child needs to maintain her health.

The client is a 15 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 filed Due Process to address the failure of the school district to provide a fair and appropriate public education. Filing Due Process resulting in a hearing and a settlement agreement that addressed the ongoing need for services and supports that would focus on a child who hears. P&A found an expert in teaching children with cochlear implants in another state and negotiated that the school contract with this expert to provide oversight of teaching for this child. P&A was also instrumental in ensuring that a new hearing-impaired teacher was hired so that the past challenges that had been experienced were not a factor in moving forward. The legal actions taken in this case resulted in a great outcome for the student. Efforts over FY 2017 focused on monitoring the implementation of the consultative services and the instruction being provided throughout the school day. Of great significance is the language development and speech growth that has been seen in just a short amount of time with this new instruction. As a result of these efforts, a teenager has been given her voice and will have the skills to move forward with her life in a positive manner.

The client is a 43 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 contracted with an attorney who specializes in ERISA law to formally review the case. Efforts were taken by the contracted attorney to work with the family regarding current services. A plan was identified and agreed upon with the family regarding steps that could be taken should the insurance company make any additional changes to the nursing services. The client’s family was very comfortable with the agreed upon plan, along with the insurance company’s agreement that further decreases were not anticipated. Fortunately, the client’s condition has remained stable and she was doing well at the time that her case was closed.

The client is an 8 year-old male with diagnosis of epilepsy and a neurological impairment. The client lives with his parents in an urban community in the state. Over the past two years, the client was seeing a pediatric neurologist in the state for treatment of his seizure disorder; however, the physician was struggling with finding medications or treatments to address his seizures. A consult was done with another pediatric neurologist in the state, who also was unable to provide any suggestions or answers. As a result, it was recommended that the child seek out-of-state medical services at a specialty clinic where he could see a Pediatric Epileptologist. It was also recommended that a more extensive brain MRI be done out-of-state as it was not something that could be done in the state of North Dakota. The child’s physicians sought approval from ND Medicaid for the out-of-state services and this request was denied by Medicaid. The physician with ND Medicaid identified that the MRI could be done in-state and if needed, a consult could be done with the physician out-of-state; thus making it unnecessary for the child to be seen formally in Minnesota. P&A appealed the Medicaid denial and provided written letters from the in-state specialists, which included the exhaustion of in-state options. The letters were also able to further explain why the MRI that was needed was more extensive than what could be done in the state or North Dakota. As a result of these efforts, the child did travel to the state of Minnesota and accessed the medical care that was needed to treat his unique neurological disorder and his seizures. The team of physicians out of state were able to identify the root cause of the seizures, which was an abnormal brain activity deep in the cortex of the brain. Upon receipt of this diagnosis and the recommendations regarding ongoing treatment, the family chose to move to the community so they could receive ongoing care from the team of physicians. P&A’s appeal was successful in obtaining the necessary Medicaid coverage so the child could obtain the diagnosis and treatment recommendations to address his unique healthcare needs.

The client is a 62 year-old veteran with diagnosis which include chronic kidney disease, vitamin K deficiency, hyperkalemia, peripheral vascular disease, hypertension, hyperlipidemia, and neuropathy. The client also has a history of alcohol dependence. At the time of referral, the client was hospitalized at the Veteran’s Administration hospital. Admission occurred as a result of alcohol use and victimization within the living environment, where he resided with his brother. P&A was contacted by the hospital Social Worker as the client was requesting assistance regarding a recent petition for guardianship that had been filed by Vulnerable Adult Protective Services. The client requested P&A legal representation to challenge the guardianship petition as he was not in agreement with having a guardianship and most definitely not a full guardianship. P&A gathered information regarding the client’s current situation and found that he was a victim of financial exploitation by his brother, who had assumed responsibility for his finances and other services. In addition, the financial difficulties that he was experiencing resulted in an inability of him to pay for his necessities, which was resulting in self-neglect. P&A did find that a great deal of the issues was a result of the client’s brother being in his life and the negative influence that this created. P&A did agree to represent the man in the guardianship hearing and made formal recommendations to the court regarding the options for a limited guardianship, to include support services in his home to help with the day-to-day needs of the client. At the hearing, the petitioner presented information that did not take into consideration the influence of the client’s brother on the situation and only focused on the end results as to the client’s situation. P&A ensured that the judge had all of the relevant information to ensure that he was making an educated decision regarding the petition. P&A also ensured that the client’s wishes were taken into consideration, along with his recent agreement to accept support services within his home. The client had also secured a new living arrangement without the negative influence of his brother prior to the hearing. The hearing has been scheduled and will be held shortly after the beginning of FY 2018.

The client is a 60-year old female who had orthopedic/physical disabilities related to a right ankle injury. After the injury, she had intermittent issues with the ankle for a number of years which she treated with over the counter pain relievers. The issues with her ankle persisted and worsened over the years and she eventually sought medical attention for the ankle after she had difficulty completing her job duties due to limited mobility. The treating physician prescribed TED hose and Meloxicam, but the pain and limited mobility continued. The client then sought medical consult with an orthopedic surgeon and was diagnosed with end stage right ankle arthritis, osteoarthritis of knee and osteoarthritis of ankle and foot. Treatment options were discussed which included fusion and total ankle replacement. The client underwent a total ankle replacement, which was successful in alleviating the pain and mobility issues. The insurance carrier for the client denied payment for services related to the total ankle replacement indicating the procedure did not meet criteria according to FDA guidelines and was investigational in nature. The total amount denied for coverage was in excess of $82,000. The client sought legal representation from P&A and an internal appeal to the insurance carrier was filed. The client’s final appeal was denied by the insurance carrier and they indicated total ankle replacement was not medically necessary for the client. P&A completed a request for external review to submit to the insurance carrier. P&A obtained documentation from the orthopedic surgeon supporting the medical necessity of total ankle replacement. An external review was conducted, but the entity conducting the external review upheld the insurance carrier’s decision and the request remained denied. The external review was the final option available to the client through the insurance carrier. After the results of the external review were received, the orthopedic surgery facility agreed to write-off their portion of the cost for the procedure, which was $4,500. $78,000 in costs remain payable to the hospital where the procedure was completed. P&A is currently working with the orthopedic surgery facility’s legal counsel and chief executive officer to determine if they will assist in meeting with the hospital to request that they forgive the $78,709.97 outstanding to the hospital. If these steps are not successful, P&A will then consult further with the client to determine if further legal action will be taken. This case will carry-over to FY 2018.

The client is a 42 year-old Caucasian female with diagnosis which include Fibromyalgia, Degenerative Arthritis, and Depression. The client contacted P&A as she had recently been terminated from employment with a company who is contracted to do healthcare case management for the military. The client reported upon intake that she was told verbally when she was terminated that she was overmedicated as a result of her healthcare issues. Prior to her termination the client had not been informed of any concerns with her work performance, nor had she received a formal performance appraisal. P&A provided representation level of services to the client initially to file a complaint with the ND Department of Labor (ND DOL) for unlawful termination. The client’s employer immediately requested that the client engage in mediation, to which the client agreed. P&A provided legal representation to the client to address the mediation request through a contract attorney who specializes in employment law. Before the formal mediation could occur, it became very clear that the defending party was not acting in good faith in the mediation process. Once this was determined, the ND DOL was asked to proceed with formal investigation, which was initiated at the close of the fiscal year. This case will be carried over to FY 2018.

The client is a 43 year-old Caucasian male with a diagnosis of Epilepsy. He moved to North Dakota to work in the Bakken oil field for a company who was doing business locally, but with their main office in a different state. When the client began employment, he had not experienced any seizures, nor a diagnosis; however, after working for the company for a year, he experienced his first seizure. Subsequently he was diagnosed with Epilepsy and was undergoing pharmacological treatment with a Neurologist. The client did not experience any further seizures and returned to work, at which time he was informed that his employment was being terminated. The client was not given a reason for his termination; however, the time frame coincided with the recent diagnosis and medical leave. The client had secured an attorney from his home state; however, his attorney required local counsel within North Dakota to serve so that he could pursue litigation on behalf of the client. P&A did agree to serve as local counsel and to assist with the case, if needed. At the present time, his case was served on the Defendant and it has been filed in U.S. District Court in the state capitol. P&A will continue to serve as local counsel and result with the out-of-state counsel as needed to ensure compliance with ND law and local federal practice. This case will be carried over to FY 2018.

P&A did not engage in any class action advocacy or litigation during FY 2018.

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.

ABUSE, NEGLECT & EXPLOITATION

Individuals with disabilities will be free from abuse, neglect, and exploitation.

2. The need, issue or barriers addressed.

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. 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, and systemic and collaborative activities in conjunction with the Long-Term Care Ombudsman and Vulnerable Adult Protective Services.

4. Objectives & Progress

Objective 1: P&A will investigate suspected abuse, neglect, and exploitation of individuals with disabilities where the reported incident or situation is not being address through VAPS or the LTC Ombudsman Program.

P&A provided information & referral services to thirty-two (32) people who contacted the agency regarding abuse, neglect and exploitation. P&A investigated nine reports of suspected abuse, neglect and exploitation regarding PAIR eligible clients with all nine resulting in a positive outcome for the person. P&A is also in the investigation phase of four additional reports of suspected abuse, neglect and exploitation that will remain open and carried over into FY 2018.

Objective 2: P&A will maintain a memorandum of understanding with VAPS and the LTC Ombudsman Program.

P&A maintains an ongoing memorandum of understanding with the Aging Services division of the Department of Human Services. This was established many years ago and continues to be current. P&A did establish a memorandum of understanding with the Long-Term Care Ombudsman in October of 2016.

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. To facilitate these collaborative efforts, P&A and the ND LTC Ombudsman established a formal memorandum of understanding that went into effect in October of 2016.

Aging Services and Vulnerable Adult Protective Services

ND state law requires mandatory reporting to the Department of Human Services, Aging Services Division, the Vulnerable Adult Protective Services (VAPS) when abuse or neglect of eligible individuals is suspected. This creates 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 2017, P&A and VAPS staff met to clarify and ensure that referrals being received were responded to by the appropriate entity per the protocols that had been established. Through this meeting process, examples of referrals were discussed using the protocol to ensure that both P&A and Aging Services staff were responding consistently. Discussion regarding self-neglect was also a topic as more reports are being received within this area of protective services.

P&A and VAPS will 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 2018 and P&A will continue to pursue administrative meetings with the Aging Services Division and VAPS program.

6. Case Summaries that demonstrate the impact of the priority

Case One:

The client is a 32 year-old male who lives in an apartment in an urban community in North Dakota. He receives case management services through the Money Follows the Person Transition Coordination Program and extended care services from a home and community based (HCBS) provider. The client has a diagnosis of Wilton’s Disease, which impacts him significantly physically. His mother is his limited guardian with authority in the areas of medical and financial. P&A received a report that the client’s HCBS provider administered medications to the client that were not consistent with physician’s orders. The report also identified that accurate records of medication administration are not maintained by the provider. P&A conducted an investigation regarding the report of suspected neglect. During the course of the investigation P&A was unable to determine if the medications were administered in error. However, P&A did become aware that the HCBS provider did not have any medication administration policies and procedures in place, nor were staff who were working with the client trained to administer medications. The investigation revealed that no documentation of medications administered were maintained by the provider. P&A did substantiate neglect regarding the provider’s failure to maintain adequate medication administration practices and documentation. Upon completion of the investigation, P&A did notify the state licensure entity and issued recommendations to the provider regarding the need to establish policies and procedures, along with training protocols for staff working within the provider. P&A did ensure that the proper licensure entities were notified of the recommendations to ensure that other clients served by the provider were not at risk of harm.

Case Two:

The client is a 51 year-old Caucasian female who lives in an urban community within the state. The client has diagnosis which include Cerebral Palsy and Epilepsy. The client is her own legal decision maker and her own representative payee of her social security benefits. P&A received a report of suspected financial exploitation relative to a exploitation scam that occurred through social media. P&A conducted an investigation regarding the report and found that through a social media site the client had been contacted by a male who began asking her to send him money so that his son could obtain surgical care for a life-threatening healthcare condition. At the point of the report being received, the client was continuing to send him money despite her inability to pay her rent, utilities and her own medical bills. With the client’s consent, consultation with law enforcement was done and a formal police report was filed. Information obtained from the client’s computer allowed law enforcement to track the social media contacts and it was found that the account was linked to a person who was in another country and had done this same thing to numerous other people. Prosecution could not occur as law enforcement in the U.S. does not have jurisdiction. A tag was placed on the person’s account so law enforcement could further track activities, to hopefully minimize the risk to others and the client. P&A did provide supervised referrals to professionals to assist with emotional support and also facilitated meetings with the detective to ensure the client had the knowledge to make good decisions moving forward. Supervised referrals were also made to entities who could assist the client with the negative financial aspect of this situation.

Case Three:

The client is a 7 year-old male who lives in a large urban community in the state and attends a public elementary school within his home district. The client does have a diagnosis on the Autism Spectrum without intellectual impact and also ADHD. P&A received a report that the student was taken by a two-person carry from the art room and he was then placed in the “room with the pads”. It was also reported that the door was held by the teacher for 30 minutes for him to calm down. After the initial incident and report to P&A, there were two additional incidents, one of which also included the use of a physical transport. P&A conducted an investigation regarding the use of physical restraint and seclusion within the school setting. Through the course of the investigation, P&A did review the school’s seclusion and restraint policy, which prohibits the use of seclusion in any situation. P&A also reviewed very specifically the facts pertinent to each of the three incidents and found that danger was not imminent and school personnel could have left the area and allowed the student to calm versus intervening physically. In all three incidents, other students were not at risk of harm and the only person left in the room when the situation escalated was the primary teacher. P&A also found that the school did not maintain documentation when seclusion or restraint was used, therefore, a review of the incident and steps taken could not be done beyond what was verbally reported by the personnel involved.

Priority 2

1. A statement of the priority.

EMPLOYMENT

Individuals with disabilities will freely exercise their disability-related employment rights and their available options.

2. The need, issue or barriers addressed.

People with disabilities often have difficulty going to work due to barriers such as inadequate or inappropriate vocational services and supports, healthcare coverage, reasonable accommodations in the workplace and knowledge about working incentives. People with disabilities often encounter discrimination in the workplace and require support to address this issue.

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 provide outreach to inform individuals that P&A serves individuals with disabilities regarding their rights relative to employment to resolve their disability-related rights issues.

Case services were provided to fifteen clients relative to employment discrimination, unlawful termination based upon disability or denial of reasonable accommodations within an employment setting. Four of these cases were closed at the end of the fiscal year and all four were resolved in the client’s favor. Eleven cases will be carried over to FY 2018.

Objective 2: P&A will inform individuals with disabilities that employment may be a realistic opportunity for many individuals with disabilities.

Information & Referral services were provided to eighteen people regarding employment issues during FY 2017.

During FY 2017, two targeted education and training activities were funded within the PAIR program. One was part of a large urban community with an audience of parents of children who have disabilities. Topics included children’s rights to education, transition planning and employment opportunities. The second training was to County Social Services staff who support youth with disabilities through the county system. Through these two activities, 46 people received education and training regarding the rights of youth with disabilities.

5. Collaboration with other entities

Contact with Rehab Act Agencies

Throughout the fiscal year, P&A staff met with regional Vocational Rehabilitation Directors and staff, State Vocational Rehabilitation agency staff, Center for Independent Living staff, and Tribal 121 program staff to address concerns and systemic issues that may arise from the advocacy work that is being done across the state. Through these regular contacts, an improved uniformity in how service delivery is being done is occurring. In addition, concerns that are found in doing casework can be addressed in a collaborative manner and in a timely manner. These ongoing efforts to establish and maintain effective relationships has proven successful in addressing issues before they cannot be remedied or before they extend to others within the state.

State Rehabilitation Council

The purpose of the 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 FY 2017 in addition to sub-committee meetings. A P&A staff person participates on the SRC. She retired from P&A the end of July and the executive director of the agency has since been appointed by the Governor to serve on the SRC.

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 individuals about services that help young adults with disabilities move from high school into college, training, or a job. The NDTC includes: ND Center for Persons with Disabilities (Minot State University), ND Dept. of Public Instruction, P&A (including CAP), State Council on Developmental Disabilities, and ND Vocational Rehabilitation. The NDTC has continued to host a website called, "Launch My Life ND".

Governor’s Committee on the Employment of People with Disabilities

The purpose of the Governor's Committee on Employment of People with Disabilities was 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. P&A has a seat, appointed by the Governor, to serve on the Committee. During the 2017 Legislative Session, unbeknownst to the Committee, the director of Vocational Rehabilitation (VR) had legislation introduced to dissolve the Committee. It was promoted that this would save money and said that the Committee’s work is a duplication of what is done by VR’s State Rehabilitation Council. The legislation passed.

6. Case Summaries that demonstrate the impact of the priority

Case One:

The client is a 51 year-old male of Asian descent. P&A was contacted by the client’s son, who often served as his language interpreter. The client had kidney disease and current hernias which impacted him physically. Prior to the referral to P&A, the client had been working in a bakery; however, due to his healthcare issues was not able to climb stairs or tolerate the heat within the bakery. The client had requested reasonable accommodations at work and had been denied them by his employer. Following this request, the client was sent a letter of termination with an indication that he could no longer perform the essential functions of his job. In addition, the client had been denied unemployment compensation following his termination. P&A did work with the client to effectively communicate with ND Job Service regarding his unemployment benefits and it was found that his appeal did result in him being awarded benefits. One thing that was evident is that the client’s language and healthcare challenges were making it difficult for him to follow through and address things in a timely manner. P&A also supported the client in a supervised referral to Vocational Rehabilitation as he did not want to return to his previous employment. These efforts ensured that he received unemployment benefits while seeking new employment opportunities so that he could move forward with future employment.

Case Two:

The client is a 31 year-old man who is a military veteran and works at the FDIC as a bank examiner. He suffered a spinal cord injury and had requested reasonable accommodations as a result of his injury. He requested a standing desk and to work from home stating that if he could work from home he could take pain medication during the day. At the time of referral to P&A, the client had not received a response from his employer regarding his request. P&A assisted the client with corresponding with his employer, which resulted in an understanding that they were not going to act on his request. The client was informed of additional steps that he could take to file a complaint with his employer with the formal request to respond to his request for reasonable accommodations at work. The client was informed of his rights and upon further discussion, did identify a desire to relocate out-of-state so that he could live closer to his family. Upon the client making this decision, information was provided regarding supports he could pursue after his relocation to obtain employment with the supports and accommodations that he required.

Case Three:

The client is a 54 year-old male who was working in an organization doing Case Management services. The client sustained a back and lower extremity injury and as a result, had received written notification from his employer that he was to work partial days after surgical treatment had been completed. It was identified that further progress needed to be made, along with some additional therapy before it was thought that he could tolerate full days. The client’s position and employment with the company was terminated and the client believes that it was due to his physical disability and that his employer was unwilling to provide reasonable accommodations for him. While his employer identified in his termination that he was unable to perform the essential functions of the job, his employment file did not contain any identified concerns, nor had any previous action been taken regarding these concerns. P&A assisted the client with filing an employment discrimination claim with the state Department of Labor and also EEOC. Both were pending at the end of the fiscal year with additional activities and follow-up in FY 2018.

Priority 3

1. A statement of the priority.

EDUCATION

Students with disabilities will receive a free appropriate public education including needed accommodations.

2. The need, issue or barriers addressed.

Educational Services for children are not provided consistent with requirements of the Individuals with Disabilities Education Act or Section 504 of the Vocational Rehabilitation Act. One barrier is a lack of understanding of the process by both the parents and professionals in the educational system. A second barrier occurs because there is sometimes a conflict between the needs of individuals which are to be addressed by each IEP team and the collective needs of all students. These issues are exacerbated by a divided system of education that views students as two separate populations: students with disabilities and students without disabilities. There is a need for education and understanding of the intent of the law by all parties involved in the identification, evaluation, child-find activities, behavioral supports, implementation of IEPs, and transition of students with disabilities. There is also a need for individual support and representation for students whose rights are being violated.

3. Indicators used to determine successful outcome of activities pursued under this priority.

Activities within this priority will include individual casework completed by P&A advocates and attorneys, education and training activities, and public information and outreach activities.

4. Objectives & Progress

Objective 1: P&A will represent students with disabilities to achieve a favorable outcome when they are denied appropriate supports or accommodations in order to benefit from their education.

Thirty-four people were provided with advocacy services to address their disability-related educational rights violations. Twelve of these cases were closed during the fiscal year with eleven of them being resolved in the client’s favor. One case was opened while a youth was inpatient in a private psychiatric facility and was experiencing educational challenges. Initial contact with P&A included providing some information to the parent regarding steps to take regarding seeking assessment for special education service. After this initial contact, P&A was unsuccessful in connecting with the parent and case closure occurred. Information regarding P&A services was provided in the closure letter with the option to re-open the case in the future should there be further disability-related educational rights issues. Twenty-three (23) cases will be carried over into FY 2018.

Objective 2: P&A will inform individuals that P&A serves students with disabilities.

Twenty-seven (27) people were provided with information and referral services by P&A within this area of the education priority.

P&A sponsored a booth and three events relative to the education priority during FY 2017. These events included the ND Department of Instruction Fall Educators conference with 200 attendees, the ND Council for Exceptional Children Conference with 300 attendees and the West Fargo Career Fair with 150 attendees. Through this activity, approximately 650 people received information regarding P&A and the services offered by the P&A, along with disability-related rights topics.

Objective 3: P&A will train students with disabilities that they have disability-related rights to receive an education without discrimination based upon the student’s disabilities.

P&A provided two education & training opportunities regarding student’s educational rights. The two audiences included the Fargo Moorhead Special Needs Support Network and Lakes District Social Services office. Through these activities 46 people were trained regarding student’s rights to education.

Objective 4: P&A will inform students with disabilities that they have disability-related education rights even in tribal schools and other schools on Indian Reservations.

P&A sponsored a booth at two events during FY 2017 for students on Native American Reservations. One event was part of the Fort Totten Student & Parent Fair and there were 80 attendees. The second event was a statewide ND Indian Education Summit with 30 attendees. Through these activities, 110 people received information regarding P&A and the services offered by P&A, along with disability-related rights topics.

Objective 5: P&A will train students with disabilities that they have rights to reasonable accommodations and reasonable modifications for their disabilities in schools.

This area of training was done in conjunction with Objective 3, which included two education & training activities to 46 people.

5. Collaboration with other entities

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 Mandan, Fort Yates, Minot, Fargo, West Fargo and Grand Forks, Morton and Sioux Counties and the Upper Valley Special Education Consortium.

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 Disabilities Advocates 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.

In collaboration with the Behavioral Health Division of the ND Department of Human Services, ongoing efforts to identify unmet needs on the Native American reservations is continuing. These efforts included a focus meeting in New Town, ND to begin developing additional services on the reservation.

School to Prison Pipeline

The issue of students being pushed into the juvenile justice system by schools, because of “inappropriate behavior” is high on the priority list for P&A in ND. P&A hosted a statewide training on the “School to Prison Pipeline” via the Interactive Video Network (IVN) on March 9, 2017. The presenter, Diane Smith Howard, works for the National Disability Rights Network and is highly regarded as an expert in this area. Across the state, 12 sites were connected to the training with most sites being at universities/colleges. The 140 participants included people with disabilities, family members, advocates, teachers, school administrators, related professionals and at least one law enforcement officer. P&A is looking to pilot a program focused on this issue in an least one rural and one urban school.

6. Case Summaries that demonstrate the impact of the priority

Case One:

At the time of referral, the client was age 17 years-old and attending high school in a small town in the northeast part of the state. He has diagnoses of ADHD; Depressive Disorder; and Central Auditory Processing Disorder. At the time of referral, he lived with his parents and sister. The client was referred to P&A based on a concern that the district was implementing systemic responses of not providing special education services which was negatively affecting a significant number of students with disabilities. It was alleged that the clients’ Section 504 accommodations were not being provided. The school principal has reportedly said that the Section 504 Plans are optional and the school does not have to follow them and it is up to the teachers if they want to implement the plans. P&A supplied the client’s mother with a sample letter that she used to write her own letter requesting that the school evaluate her son for special education services. School staff responded by holding an assessment planning meeting within ten days of receiving the letter. The parents and P&A attended this initial meeting and several subsequent meetings. The student was determined eligible for special education services (initially under the category of Other Health Impaired) and an IEP was developed. The school paid for the outside evaluation by a pediatric neuropsychologist who diagnosed the youth with Depressive Disorder. The final IEP developed contained a Transition Plan and a referral for Vocational Rehabilitation was made. As a result of P&A involvement the client achieved the goal of being identified for special education. Afterward an appropriate plan of educational services was developed and implemented. The youth graduated in May 2017 and went on to pursue his education in a post-secondary setting.

Case Two:

The client is an 18-year-old Caucasian female living in her mother’s home in a rural town in the state. She attends the local public high school where she receives educational supports under an IEP. Her mother serves as her court appointed guardian. The client has been diagnosed with CHARGE Syndrome, which stands for Coloboma of eye, Heart defects, Atresia of choannae, Retardation of development and/or growth, Genital or urinary abnormalities, and Ear abnormalities with deafness. The client’s severe to profound hearing loss was diagnosed when she was about a year old. She received a cochlear implant in her left ear at four years of age, which has required re-implantation multiple times since then due to medical and mechanical issues. The client also has the diagnosis of Chorioretinal Colobomas; this includes colobomas, farsightedness, astigmatism, and sensitivity to light (sun). She does wear glasses. The client was also born with a heart condition and had multiple surgeries to correct the hole in her heart. She has only one kidney on the left side. She has a history of seizures which are currently controlled with medication. The client’s mother/guardian contacted P&A with concerns about her daughter’s educational supports at the high school. It was reported that the school removed almost all access to sign language even though it was documented to be the client’s first language. It was also identified that the student is spending most of her day in the resource room rather than having access to an FM system within the classroom. P&A provided advocacy representation to the student to assist her and her mother to bring their concerns to the IEP team. Advocate assisted parent to request review of educational placement and request additional accommodations for her daughter. Advocate provided information regarding dispute resolution to parent as an option to resolve differences with team decisions. As a result of P&A involvement, the student’s placement was reviewed to ensure that she was receiving educational services in the most appropriate setting. The school did complete additional assessment as part of this process which did impact the manner in which services were provided to the student. The student’s parents also gained knowledge regarding the special education dispute resolution options that were available should they experience future obstacles or concerns with their daughter’s educational rights.

Case Three:

The client is a 16 year-old sophomore at a large public high school in the eastern part of the state. He has good grades but due to a severe asthma condition, he is often absent from school or arrives tardy. The absences and tardiness are due to the medical treatment his asthma requires. He has 3 different inhalers, has a nebulizer at home and takes at least 3 other medications including prednisone. He is often up all night with his asthma attacks and subsequent treatments. Since the 7th grade he and his mother face this issue each spring with the school as this is the time of year that he experiences chronic and severe asthma attacks. When this occurs, his mother brings in medical documentation to support his absences and tardiness, which has then resulted in him being able to make up late assignments, quizzes and tests. At the time of the referral to P&A, the student’s mother had continued in this same manner; however, the assistant principal called the student into her office and had him sign a paper stating that if he was absent from school anymore he would be dropped from classes. Throughout this period of time his mother had requested a formal 504 plan for him but the school had identified that he wouldn’t qualify and did not need one. P&A provided guidance, support and advocacy relative to the student’s need and right to a formalized 504 Plan. A meeting was held with the school team so that he and his mother could participate in the development of the Plan. Additionally, they were given tools and information to advocate for him at school. As a result of these efforts, the student will be supported when his asthma keeps him away from school and will ensure that he is able to complete all of his classes successfully to complete his high school education with his same age peers.

Priority 4

1. A statement of the priority.

INCLUSION

Individuals with disabilities will reside in the least restrictive environment of their choice with necessary services and supports.

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. In addition, 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.

3. Indicators used to determine successful outcome of activities pursued under this priority.

Activities within this priority will include advocacy and legal services along with systemic and collaborative activities which will be carried out by P&A staff throughout the agency.

4. Objectives & Progress

Objective 1: Individuals with disabilities who are at risk of institutionalization will receive the disability-related supports necessary to remain in the community.

P&A provided information and referral to eighteen (18) people regarding P&A’s inclusion priority during FY 2017. In addition, advocacy services were provided to ten (10) people who were at risk of institutionalization. Three of these cases were closed during the fiscal year and all three were closed in the client’s favor. Seven of the cases were pending at the end of the fiscal year and will be carried over to FY 2018.

Objective 2: Individuals with disabilities who are in an institution and able to live in the community will receive the disability-related supports necessary to meet their needs in lesser restrictive settings in the community.

During FY 2017 P&A received three contacts related to situations where people with disabilities were unnecessarily remaining institutionalized. In these three situations, P&A conducted supervised referrals to entities that could provide the needed advocacy to address their needs. These three situations were handled as I&Rs.

P&A did receive one request for advocacy services during FY 2017. It was identified that a woman was being denied the opportunity to return to her previous living environment after a swing bed stay post-surgery. P&A provided case representation to the woman to establish a plan to support her ability to return to her home. At the end of the fiscal year activities were taking place, but placement had not yet occurred. The client’s case will carry-over to FY 2018.

5. Collaboration with other entities

ND 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 (Oct. 2016 and May 2017). The planning subcommittee, of which P&A is a member, continued to meet to conduct research and to work on developing ideas and materials… including structures for a more independent Commission.

Community Elder Service Network (CESN)

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. In addition, the group has continued to identify gaps in services across the aging and disability communities with the intent to support legislation and the development of services to meet the unmet needs. The group continues to sponsor people with disabilities so that they can attend education and training activities within the Bismarck and surrounding communities with the cost paid for by CESN.

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, Williston, New Town, and 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.

Human Service Advisory Committee

Through a partnership with the Division of Mental Health and Substance Abuse, Human Service Advisory Committees have been formed in each region of the state to address the treatment needs of people with disabilities both from a behavioral health perspective and with addiction and chemical dependency. Aging Services staff and Vulnerable Adult Protective Services staff have also been included to identify proactive supports that can be put in place to support community living and supported employment for people with disabilities. Ongoing information regarding gaps in services and community needs is provided to the advisory committee so they can continue to plan for appropriate supports and services.

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.

BisMan Transit Board & Bismarck City Commission Accessibility

Bis/Man Transit operates the bus services and para-transit services for the community & surrounding area. It reported early in the summer that, due to forecasted financial shortages, it planned to make significant changes to transportation services mostly targeting the para-transit system that services individuals with disabilities & the elderly. The para-transit system was started in Bismarck first, with the buses for the rest of the public being added years later. Due to the potential impact of the changes (e.g., cutting para-transit hours from 24x7 to early morning through early evening; no services on Sundays or holidays; discontinuing services to the community of Lincoln), the Bismarck City Commission held a public hearing 7/12/16. The event was well attended with more than 100 citizens coming forth to express concerns with the proposed changes. The Commission put the requested changes on hold & directed Bis/Man Transit to go back & have more dialogue with its riders - a good intermediary outcome. Through the next few months, P&A staff and many other organizations such as the AARP & the Dakota Center for Independent Living, along with a good contingency of individuals with disabilities: 1) met in small groups to strategize on the proposed changes; 2) attended Bis/Man Transit board meetings; 3) attended and spoke out at public meetings convened by Bis/Man Transit. Riders voluntarily accepted a 50 cent/ride increase. The majority of the Transit Board, as well as its director, made it clear that the issue was not just money; that it wanted to shift more resources to the public bus system; that it was providing a “platinum service”, that it need not do, for people with disabilities & the elderly. A City Commission meeting was held on 12/29/2016 at which the Executive Director of Bis/Man Transit presented the transit board’s proposal which included para-transit services available Monday through Saturday between 5:30am to midnight and Sundays from 7:30am to 2:30pm. The proposal also included a guaranteed ride home for qualifying individuals between non-transit hours from 12 a.m.-5:30 a.m. in all situations to include holidays. The proposal was approved by the City Commission and implemented by Bis/Man Transit on 7/1/2017. Although the service was reduced from 24x7 service, individuals who use para-transit are guaranteed a ride home outside of normal operating hours.

ND Self-Advocacy Network/Advocates Leading their Lives

To strengthen the voice of self-advocates across the state, P&A has partnered with the ND Center for Persons with Disabilities (NDCPD-ND’s UCEDD) and the State Council on Developmental Disabilities to develop a statewide self-advocacy network. Self-advocacy groups from across the state have also been brought into the process to ensure that all self-advocacy groups are represented.

The group adopted the name “Advocates Leading their Lives” and have continued to meet on a regular basis throughout the year. Self-advocates are very engaged in this process and are excited to be the ones to make the decisions regarding membership, structure, group name, logo, etc.

The group has determined that they will be including people with all types of disabilities in the membership as they want to ensure that the group is as strong as it can be. During FY 2017 the group elected its officers and created formal bylaws that will govern the group. Meetings have been held on a quarterly basis throughout the year. The membership continues to expand and has grown to almost 100 self-advocates at the end of the fiscal year.

The ALL group also continues to be very active with community self-advocacy groups and has partnered to plan and coordinate a statewide self-advocacy conference. The group will continue to meet into FY 2018 and will continue to strengthen as the process unfolds. What is significant in this group is that self-advocates are leading all aspects of the process and are being empowered to do so by the various advocacy organizations that are involved.

North Dakota Disabilities Advocacy Consortium

P&A is an active member of the North Dakota Disabilities Advocacy Consortium, (NDDAC), a non-profit organization representing about twenty disability-related entities from 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 at http://www.nddac.org/. NDDAC meetings are an effective vehicle for organizations to share information, resources, and ideas that may positively impact individuals with disabilities & their families.

The NDDAC’s overarching purpose is to positively impact public policy work. During the 2017 Legislative Session (January - May) Bremer grant funds supported weekly meetings of the Legislative Working Committees by paying for Interactive Video Networking (IVN) to allow people in communities across ND to participate in the meetings. P&A organized the meetings and facilitated discussion about disability-related bills and legislative hearings.

NDDAC sponsored Disability Awareness Day at the Capitol on February 16, 2017. This event filled the Memorial Hall at the ND capitol with over 20 vendor exhibits, over 200 people with disabilities and their families, and included lunch with ND Legislators. The evening prior, NDDAC offered a meal and a viewing of the documentary film “Bottom Dollars” regarding the “dirty little secret” of paying sub-minimum wage to people with disabilities. A panel discussion followed to strategize ideas with attendees about putting a stop to this practice.

6. Case Summaries that demonstrate the impact of the priority

Case One:

The client is a 51 year-old male who lives in an urban community in the state. He was involved in a motorcycle accident which resulted in paralysis from his neck down. P&A was contacted by a family member of the client while he was hospitalized following the accident. Through the referral process it was identified that hospital personnel were identifying that nursing home placement was recommended and that the client should not return home. P&A provided advocacy services to the client and his family to explore the various supports that he could obtain to allow him to return to his home once stabilized within the hospital. These efforts resulted in the client being transferred to a short-term rehabilitation center so that he could get additional therapy and learn the skills to allow for him to return to his home. The family was also provided with supervised referral to obtain support to make their home accessible so that the client could return home when he was able to leave the rehabilitation center. Upon completion of these services, the client was able to return to his home with waivered services and natural supports from his family.

Case 2:

The client is a 36 year-old Native American male. He has diagnosis which include Guillain Berre Syndrome, a Neurological Impairment, and Hepatitis C. The client does have a significant physical disability because of his healthcare conditions and utilizes a wheelchair for mobility. At the time of referral, the client was in the acute care hospital setting because of ongoing healthcare issues. Placement within a facility was being recommended; however, this was not what the client wanted as he wanted to continue to live with family. P&A provided advocacy services to the client and his family to include how to access the needed services and benefits to allow for him to obtain community-based waivered services. Upon discharge from the hospital the client did return to the community to live with his brother. P&A did provide information to the client after his discharge regarding the availability of services and supports to ensure that he remained healthy and that his needs were met within his community setting. These efforts were successful and he was able to avoid institutional placement.

Case 3:

The client is a 44 year-old female who at the time of referral was living at the Ruth Meyers Homeless Shelter and receiving support and services from the Abused Adult Resource Center. The woman was a recent victim of human trafficking and was rescued from this when she had to seek medical attention at a local hospital. The woman has several health issues, most critical is her diagnosis of stage IV lung cancer. P&A provided advocacy services to the client to assist her with obtaining the medical care that she required and secure a place to reside. With the acute healthcare issues that she presented with, services were secured in a supported living arrangement which was intended to be temporary so that she could obtain the treatment and have access to the nursing services that she required to improve her health. P&A also ensured that the necessary protections were in place with the facility social services staff to ensure her safety through this transition process.

Priority 5

1. A statement of the priority.

HEALTHCARE

Individuals with disabilities will have the necessary healthcare coverage to meet their disability-related healthcare needs.

2. The need, issue or barriers addressed.

As federal dollars diminish for health care, there is a push within the state to limit and cut Medicaid services, when the opposite needs to occur. There is a need for greater and better health care services for Medicaid eligible individuals. Individuals with disabilities are often denied benefits without understanding the basis for the denial or the complex procedures required to effectively appeal those denials or obtain needed services. There is also a need for individuals with disabilities to access support in the initial application process to ensure that the application contains relevant information to support the right to the specific benefit.

3. Indicators used to determine successful outcome of activities pursued under this priority.

Activities within this priority will include advocacy and legal services along with systemic and collaborative activities which will be carried out by P&A staff throughout the agency.

4. Objectives & Progress

Objective 1: P&A will help individuals with disabilities to receive disability-related and medically necessary healthcare through Medicaid, Medicare, and private insurance.

P&A provided information and referral to twenty-four (24) people regarding P&A’s healthcare priority during FY 2017. In addition, advocacy services were provided to eighteen (18) people who had disability-related healthcare needs. Eleven of these cases were closed during the fiscal year and all eleven were closed in the client’s favor. Two cases did not end with rulings in favor of the clients; however, upon exhausting the administrative remedies that were available, other funding sources through the Great American Bike Race and the ND Association of the Disabled were obtained to ensure that the clients were able to receive the necessary healthcare that was being recommended by their physicians. Seven of the cases were pending at the end of the fiscal year and will be carried over to FY 2018.

5. Collaboration with other entities

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 2017, these topics included: proposed changes to the Medicaid HCBS waiver; the Medicaid Access Monitoring Plan; proposed changes to the Medicaid Autism Spectrum Disorder waiver; proposed revisions to the state Medicaid plan; pending and recent changes to the Administrative Rules; review of the DD payment system; Beneficiary Survey and Story Map, Primary Care Case Management program; Developmental Disabilities Division Updates; 2017-2019 Budget Review; 2017 Legislative Update; Tribal 638/IHS services; Medicaid Expansion and 1915 b waiver renewal; and updates on quality control (“program integrity”). Efforts will continue during FY 2018.

ND CARES

ND CARES is a group that addresses the needs of Veterans, Service Members, their Families and Survivors. The National Guard identified a need to bring disability-based partners together to address primarily the needs of Veterans and Service Members who have experienced brain injuries, physical disabilities and mental health issues because of their service. The group became a collaborative effort between the National Guard, Department of Human Services, the Governor’s office, P&A, Department of Corrections & Rehabilitation, and Center for Rural Health and veterans and family members. The group continues to identify potential needs for veterans and service members, but also identified the need for supports and services for family members and survivors. Significant efforts are taking place to create awareness of service-related needs for both veterans and their family members and to strengthen the services around this issue.

6. Case Summaries that demonstrate the impact of the priority

Case One:

The client is 6 year-old child who currently lives in an urban community in the state. He has a diagnosis of Epilepsy and at the present time is not controlled with medication. In addition, physicians have not been able to determine what the root cause of his epilepsy is, or where in the brain the seizures are originating from as they have not shown up on a typical EEG. The pediatric neurologist who has overseen the child’s previous three hospitalizations has recommended that the child be seen in Minnesota with MN Epilepsy Group. A visit was approved by Medicaid and occurred; at which time the team of physicians recommended further testing and medical follow-up to determine the root cause of his seizures. ND Medicaid denied the follow-up care and identified that the tests could be done in ND; however, the physicians in MN have indicated that the tests that can and are being done in ND are not sufficient and will not provide them with the information that they need to make the complicated diagnosis and follow-up plan that is needed for him due to the complexity of his seizure disorder. P&A provided advocacy and legal services to the client to address the Medicaid denial of out-of-state medical care. P&A worked extensively with the physicians in the state and his primary physician to build a case for medical necessity of the out-of-state care. The client did see a new neurologist in-state who identified an inability to provide for neurological care beyond what had been provided by the other pediatric neurologist. This was now the third neurologist who the child had seen, without success to determine what was occurring. There was still a discrepancy amongst the various physicians as to whether he was experiencing seizures, or potentially, another cause related to an unknown origin. P&A did file a formal appeal with the Department of Human Services-Medical Services Division to address the appeal of the Medicaid decision. At the point that the appeal was filed, P&A also provided information to ND Medicaid regarding the additional contact that the child had completed with the new neurologist that was in-state, as ND Medicaid was indicating a need to exhaust the in-state options. After the filing of the appeal, ND Medicaid did review the information that was submitted and agreed to allow him to be seen in Minnesota, with approval to do the testing that was being recommended. As a result of this decision, the appeal was withdrawn as the client was able to get the coverage from ND Medicaid that was needed. He did go to Minnesota and began the necessary follow-up to get the answers that he needed. As a result of these efforts, the client received the medical care that he needed. Upon case closure, his parents determined that it would be best for his care and treatment if they were to move back to Minnesota, where they had lived previously. His mother had recently completed college and the timing was right for them to re-locate. The client’s team of doctors in Minnesota will be resuming his care from this point forward.

Case Two:

The client is a 3 year-old white male with a diagnosis of congenital glaucoma. The client lives with his parents in an urban community in the northeast section of the state. He was recently determined eligible for special education and has started receiving preschool services in the public school. The client’s mother contacted P&A based on her concerns that Medical Assistance is slow to approve needed vision lenses, or indicates that they never obtained claims for which confirmation has already been given. Without approval and needed lenses, the child's eyes are worsening. P&A assisted by contacting the Medical Services/Medicaid division at the state level. It was identified that the claim and authorization did not match up on information. P&A provided this information to the parent so that she could share it with the optical provider. Once these forms were corrected, the claim was approved. As a result of P&A involvement the client’s first and second pair of eyeglasses were approved for payment. Since the parents had already paid for the first eyeglasses, after the correct information was provided to Medicaid and the forms were amended, they (the parents) were reimbursed for the first pair of eyeglasses. Throughout the time the youth did have needed corrective lenses as the parents ensured that he had them.

Case Three:

The client is a 28 year-old Native American male currently incarcerated at the state-run minimum-security prison in the state of ND. He is paralyzed below the waist as a result of an automobile accident. The client is his own legal decision maker. The client contacted P&A with a concern relative to the number of catheters that JRCC was providing for his daily use. P&A provided advocacy to the client to review steps that he could take to address health/medical requests and complaints at the prison. The advocate supported the client with pursuing an internal kite and grievance to ensure that he had a thorough understanding of how to exercise his rights within the prison system. As a result of these efforts, the client was able to pursue these remedies within the prison system to address and resolve his concerns.

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.

ABUSE, NEGLECT & EXPLOITATION

Individuals with disabilities will be free from abuse, neglect, and exploitation.

2. The need addressed.

The combination of the personal effects of a disability and associated factors, such as support of multiple caregivers, creates high levels of vulnerability. Therefore, the provision of protective services and responding to identified concerns in the service delivery system are necessary to ensure the health, safety, and quality of life for people with disabilities. The ND Department of Human Services has authority to address abuse, neglect, and exploitation under state statute through its Long-Term Care Ombudsman program and through funding to regional Human Service Centers for Vulnerable Adult Protective services. Overlapping authority, staffing changes, and funding issues have prevented a consistent approach to providing services to eligible individuals.

3. A description of the activities to be carried out.

Objective 1: P&A will investigate, or cause to be investigated, suspected abuse, neglect, and exploitation of individuals with disabilities.

Priority 2

1. A statement of the priority.

EMPLOYMENT

Individuals with disabilities will freely exercise their disability-related employment rights and their available options.

People with disabilities often have difficulty going to work due to barriers such as inadequate or inappropriate vocational services and supports, healthcare coverage, reasonable accommodations in the workplace and knowledge about work incidents. People with disabilities often encounter work place discrimination and need assistance with addressing this issue.

3. A description of the activities to be carried out.

Objective 1: P&A will conduct outreach and inform individuals with disabilities of their employment rights, including discrimination and reasonable accommodations.

Priority 3

1. A statement of the priority.

EDUCATION

Student with disabilities will receive a free appropriate public education, including needed accommodations.

2. The need addressed.

Educational services for children with disabilities are often not provided consistent with requirements of the Individuals with Disabilities Education Act or Section 504 of the Vocational Rehabilitation Act. One barrier is a lack of understanding of the process by both the parents and professionals in the educational system. A second barrier occurs because there is sometimes a conflict between the needs of individuals which are to be addressed by each IEP/504 team and the collective needs of all students. These issues are exacerbated by a divided system of education that views students as two separate populations: students with disabilities and students without disabilities.

There is a need for education and understanding of the intent of the law by all parties involved in the identification, evaluation, child-find activities, behavioral supports, implementation of IEPs, and transition of students with disabilities. There is also a need for individual support and representation for students whose rights are being violated.

3. A description of the activities to be carried out.

Objective 1: Students with disabilities inappropriately denied their rights to education through appropriate accommodations, behavioral support, transition, shortened school days, and seclusion & restraint will have a favorable outcome.

Priority 4

INCLUSION

Individuals with disabilities will reside in the least restrictive environment of their choice with necessary services and supports.

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.

3. A description of the activities to be carried out.

Objective 1: Individuals with disabilities who are at risk of institutionalization will receive the disability-related supports necessary to remain in the community.

Objective 2: Individuals with disabilities who are in an institution and able to live in the community will receive the disability-related supports necessary to meet their needs in less restrictive settings.

1. A statement of the priority.

HEALTHCARE

People with disabilities have the health care necessary to meet their disability-related needs.

2. The need addressed.

People with disabilities need appropriate health care and treatment to correct or ameliorate their disability-related health conditions. Public comment/forums, client contact, mailed surveys, and extensive staff experience have helped us determine that people with disabilities are often denied needed health care services.

3. A description of the activities to be carried out.

Objective 1: People with disabilities improperly denied coverage for their disability-related healthcare by Medicaid, Medicare, the Veteran’s Administration, or private insurance will have a favorable outcome as a result of P&A involvement.

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:

2017 PAIR federal grant $114,719

2016 PAIR federal grant $71,800

TOTAL: $186,519

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

Salaries 117,510.84

Temp Salaries 143.00

Benefits 48,146.29

Travel 1,657.91

Professional supplies 717.98

Office supplies 67.85

Postage 228.82

Printing 7.20

IT equipment < $5,000 36.38

Office leases 11,078.75

Repairs 20.46

IT data processing 4,975.02

IT communications 962.33

IT contractual services 179.59

Professional development 755.07

Fees-professional services 32.00

TOTAL: $186,519.49

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, two 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 & the Executive Director. Of the total 27.5 FTE’s (28 staff), 20 have some PAIR time.

POSITIONS PAIR % FILLED TOTAL

Disability Advocate - Williston 10% 100% .10

Disability Advocate - Minot 10% 100% .10

Disability Advocate - Devils Lake 10% 100% .10

Disability Advocate - Belcourt 10% 100% .10

Disability Advocate - Grafton 10% 100% .10

Disability Advocate - Grand Forks 5% 100% .05

Disability Advocate - Fargo 10% 100% .10

Disability Advocate - Fargo 10% 100% .10

Disability Advocate - Jamestown 10% 100% .10

Disability Advocate - Jamestown 5% 100% .05

Disability Advocate - Bismarck 20% 100% .20

Disability Advocate - Bismarck 10% 100% .10

Disability Advocate - Dickinson 10% 100% .10

Support Staff (.5 FTE) - Williston 10% 100% .05

Attorney - Bismarck 5% 100% .05

Attorney - Bismarck 10% 100% .10

Dir. of Program Services 15% 100% .15

Dir. of Program Services 10% 100% .10

Executive Director 10% 100% .10

Director of Policy & Operations 10% 100% .10

TOTAL: 1.95

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 2017.

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. P&A also established a formal Memorandum of Agreement with the ND Long Term Care Ombudsman program effective October 2016.

Certification

Signed?Yes
Signed ByTeresa Larsen
TitleExecutive Director
Signed Date12/11/2017