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

Kentucky (KENTUCKY OFFICE FOR PUBLIC ADVOCACY - P and A DIVISION) - H240A180018 - FY2018

General Information

Designated Agency Identification

NameKentucky Protection and Advocacy
Address5 Millcreek Park
Address Line 2
CityFrankfort
StateKentucky
Zip Code40601
E-mail Addresssusan.abbott@ky.gov
Website Addresshttp://www.kypa.net
Phone502-564-2967
TTY 800-372-2988
Toll-free Phone800-372-2988
Toll-free TTY800-372-2988
Fax502-564-0848
Name of P&A Executive DirectorJeff Edwards
Name of PAIR Director/CoordinatorSusan Abbott
Person to contact regarding reportSusan Abbott
Contact Person phone502-564-2967
Ext.0

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 areas31
2. Individuals receiving I&R outside PAIR priority areas247
3. Total individuals receiving I&R (lines A1 + A2)278

B. Training Activities

1. Number of trainings presented by PAIR staff10
2. Number of individuals who attended training (approximate)460

Kentucky P&A provided training to PAIR eligible clients at the Barren County ARC in Glasgow, Kentucky about the services of Kentucky P&A, long term care rights and guardianship, the ABLE ACT and how to set up a STABLE Account, the ARC Annual Conference in Louisville, Kentucky on guardianship, and securing protective orders, for the Western Kentucky University Department of Psychology students in Bowling Green, Kentucky about guardianship, the Kentucky School for the Deaf Family Learning Forum in Danville, Kentucky about the services of Kentucky P&A , Kentucky Guardianship Conference in Frankfort, Kentucky about supported decision making, the ABLE ACT and how to set up a STABLE Account, and to the Hearing Loss Association In Louisville, Kentucky about the ADA Title II about supported decision making, Information about the ABLE Act and STABLE Accounts was provided to residents of 15 personal care homes throughout the state. Kentucky P&A provided information about services for PAIR eligible clients Deaf Fest in Louisville, Kentucky, at the Attorney General’s Victim Assistance Conference in Frankfort, Kentucky, at Bark for Life in Frankfort, Kentucky, and at the Kentucky Commission Deaf and Hard of Hearing 35th Anniversary Event for caregivers and seniors in Frankfort, Kentucky, Kentucky P&A participated in monthly fundraising activities for Relay for Life and participates in the annual event in Franklin County.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles4
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website95,532
5. Publications/booklets/brochures disseminated1,000
6. Other (specify separately)0

Narrative

Bottom Dollars, a documentary by Rooted in Rights Kentucky Protection & Advocacy (P&A) with assistance from Kentucky’s Developmental Disability Network hosted five screenings of Bottom Dollars, a documentary by Rooted in Rights, which exposes segregated workplaces and low wages to people with disabilities. There were over 100 attendees including self-advocates, family members, providers of Developmental Disabilities services, local public officials, and others. The screenings took place in Paducah, Louisville, Lexington, and Erlanger, Kentucky. Collaboration with the Kentucky Department of Corrections In 2013, Kentucky P&A in collaboration with the Kentucky Department of Corrections (DOC) issued a Resource Reentry Manual that included resources about employment and vocational rehabilitation services. Kentucky P&A continues to collaborate with the DOC to update resources for the manual. Monitored four state prisons Kentucky P&A monitored the restrictive housing units of four state prisons: the Kentucky State Reformatory, the Kentucky State Penitentiary, Eastern Kentucky Correctional Complex, and the Kentucky Corrections Institute for Women. Kentucky P&A met interviewed inmates housed in restrictive housing units about their treatment, access to medical care, mental health care, and abuse and neglect. Kentucky P&A also met with the wardens of each of the facilities or their designee to discuss ADA compliance for deaf and hard of hearing inmates, inmates who have orthopedic disabilities, special diets for inmates who have a health concern and other PAIR eligible disabilities. Monitoring of four regional jails Kentucky P&A monitored four regional jails, focusing on the restrictive housing units for each facility. Inmates at each of the jails were interviewed about access to medical care, mental health care, and abuse and neglect. The jailer or designee were also interviewed about inmates’ access to medical care, ADA accommodations for inmates who are deaf and hard of hearing, inmates who have mobility concerns, special diets for inmates who have diabetes, and other PAIR eligible disabilities. Monitored 10 nursing facilities Kentucky P&A also monitored 10 nursing facilities, reviewed their compliance with PASSR, met with staff at the facilities and residents focusing on long-term care rights, abuse and neglect and guardianship. Public Comments Kentucky Protection and Advocacy distributed public comment forms addressing priorities for FY 2019. Participants were asked to comment on Kentucky P&A’s current priorities, identify areas of concern for individuals with disabilities, and concerns that Kentucky P&A should address. They were also asked to identify if they were a person with a disability or self-advocate an advocate on behalf of a person with a disability, an advocate on behalf of a family member with a disability a services provider, family member or other interested person. Participants were asked to comment on five of Kentucky P&A’s current priorities, identify areas of concern for individuals with disabilities, and concerns that Kentucky P&A should address. Abuse/Neglect, Community Supports, Healthcare, ADA/Section 504, and Education/Transition were identified as Kentucky P&A’s top five priorities. Other areas of concern also mentioned were juvenile justice, criminal justice, guardianship, affordable housing, transportation, employment, and exploitation of social security funds by family members. Persons with disabilities accounted for the majority of the respondents with the majority of respondents stating Kentucky P&A should continue to work on the current priorities. Social Media Kentucky P&A Kentucky P&A continues to maintain a Facebook Page and posts regional and national information about information of interest to PAIR eligible clients, such updated information about Medicaid, the Home and Community Based Waiver, abuse and neglect, guardianship, etc. Kentucky P&A has a Twitter account, https://twitter.com/kyadvocacy . In addition to these efforts, Kentucky P&A regularly updates its website and provides information about employment, benefits, fair wage and transition at www.ky.pa.net. The website hits for Kentucky P&A’s website was 95,532 in fiscal year 2018. Kentucky P&A also serves on the following Boards and Councils: Office of Vocational Rehabilitation Interagency Council State Child Fatality Review Committee State Mortality Review Committee Kentucky Partnership for Families and Children State Elder Abuse Committee Jefferson County Regional Interagency Transition Team Kentucky Voices for Health State Help America Vote Act (HAVA) Advisory Committee Kentucky Assistive Technology Service (KATS) Advisory Board Medicaid Advisory/Technical Assistance Board Project Safe and Accessibility for Everyone Project State Olmstead State Planning Committee Olmstead Committee and Continuity of Care Meetings at the four public state hospitals Kentucky Interagency Transition Council &Youth/Family Involvement/Leadership Committee Volunteer Organizations Active in Disaster (VOAD) Alternate Assessment Advisory Board Up in Kentucky State Interagency Council (SIAC) Quarterly regional meetings of the Long Term Care Ombudsman, Office of the Inspector General (OIG), Department for Community Based Services (DCBS), Department for Aging and Independent Living (DAIL), and the Attorney General’s office: Crisis Intervention Training Advocates for Community Options Kentucky Prevention Advisory Committee Trauma Group in Jefferson County 843 Region VI Council Statewide Olmstead Meetings Amended Settlement Agreement meeting with the Cabinet for Health and Family Services RevUp Kentucky

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)27
2. Additional individuals served during the year31
3. Total individuals served (lines A1 + A2)58
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 27

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment1
3. Program access2
4. Housing2
5. Government benefits/services2
6. Transportation0
7. Education8
8. Assistive technology0
9. Voting0
10. Health care14
11. Insurance0
12. Non-government services1
13. Privacy rights1
14. Access to records0
15. Abuse6
16. Neglect17
17. Other4

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor20
2. Other representation found1
3. Individual withdrew complaint5
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.5
6. PAIR withdrew from case0
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit0
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

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

1. Technical assistance in self-advocacy6
2. Short-term assistance8
3. Investigation/monitoring8
4. Negotiation5
5. Mediation/alternative dispute resolution2
6. Administrative hearings0
7. Litigation (including class actions)2
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 - 41
2. 5 - 2211
3. 23 - 5917
4. 60 - 6414
5. 65 and over15

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females20
2. Males38

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race0
2. American Indian or Alaskan Native0
3. Asian0
4. Black or African American8
5. Native Hawaiian or Other Pacific Islander0
6. White35
7. Two or more races1
8. Race/ethnicity unknown13

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent6
2. Parental or other family home15
3. Community residential home2
4. Foster care0
5. Nursing home23
6. Public institutional living arrangement2
7. Private institutional living arrangement2
8. Jail/prison/detention center6
9. Homeless0
10. Other living arrangements0
11. Living arrangements not known2

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment0
2. Deaf/hard of hearing2
3. Deaf-blind2
4. Orthopedic impairment11
5. Mental illness0
6. Substance abuse0
7. Mental retardation0
8. Learning disability5
9. Neurological impairment10
10. Respiratory impairment7
11. Heart/other circulatory impairment7
12. Muscular/skeletal impairment3
13. Speech impairment0
14. AIDS/HIV1
15. Traumatic brain injury0
16. Other disability10

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities5

2. Number of individuals potentially impacted by policy changes874,000

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

Systemic Activities Patient Liability Between May and June 2018, the Kentucky Department for Medicaid Services sent letters to approximately 20,000 Kentucky long-term care waiver recipients detailing the amount of ‘patient liability’ they were expected to pay each month to maintain their Medicaid eligibility. After a Medicaid Oversight and Advisory Committee meeting and testimony from advocates in July, Medicaid officials announced they were not going to change patient liability and would provide further guidance after review. In late May 2018, the Department for Medicaid Services mailed letters to approximately 20,000 Kentucky long-term care waiver recipients detailing the amount of ‘patient liability’ they were expected to pay each month to maintain their Medicaid eligibility. Patient liability, also called ‘post-eligibility treatment of income’, refers to the amount of a waiver recipient’s income that a person must pay towards their cost of care (after deductions for a ‘personal needs allowance’ and other specified expenses). Many of these recipients were surprised to learn the monthly amount they were expected to pay would increase dramatically, or that they owed a patient liability at all. There was no explanation given for the changes, but phone numbers were provided. In early June, Medicaid mailed follow-up letters to recipients explaining that many of the original letters were not right or were sent to the wrong people. They stated the letters could be ignored for the time being. In late June, corrected letters were mailed to those who, in fact, owed a patient liability and stated the changes would be implemented starting August 1, 2018. These letters created considerable confusion among recipients and providers alike and generated hundreds of calls to Medicaid, state legislators, and advocacy organizations, including Protection and Advocacy. On July 18, 2018, representatives from Medicaid appeared before the legislative Medicaid Oversight and Advisory Committee in Frankfort to address the changes. They explained that for many years Medicaid had not been collecting full liability from all waiver recipients and these changes were needed to comply with federal regulations and the existing waivers. Five waiver recipients, several of whom would have to pay over $1,000 per month, testified before the Committee and vividly described the detrimental impact this would have on their lives and health. All said they would have to choose between trying to stay in their homes without services and ending up in a nursing facility, or worse. After pointed questioning by members of the Committee, Medicaid officials agreed to review the proposed changes to patient liability and explore all available options surrounding the issue. They acknowledged that each state has discretion to set the ‘personal needs allowance’ for long-term care waiver recipients at any level and they would review current policies as part of their ongoing waiver redesign efforts. Two days later, on July 20, 2018, Medicaid announced they were not going to change patient liability and would provide further guidance after review. This was followed up by a letter telling Medicaid recipients who pay patient liability of this decision. Monitoring Monitored four state prisons Kentucky P&A monitored the restrictive housing units of four state prisons: the Kentucky State Reformatory, the Kentucky State Penitentiary, Eastern Kentucky Correctional Complex, and the Kentucky Corrections Institute for Women. Kentucky P&A met interviewed inmates housed in restrictive housing units about their treatment, access to medical care, mental health care, and abuse and neglect. Kentucky P&A also met with the wardens of each of the facilities or their designee to discuss ADA compliance for deaf and hard of hearing inmates, inmates who have orthopedic disabilities, special diets for inmates who have a health concern and other PAIR eligible disabilities. Monitoring of four regional jails Kentucky P&A monitored four regional jails, focusing on the restrictive housing units for each facility. Inmates at each of the jails were interviewed about access to medical care, mental health care, and abuse and neglect. The jailer or designee were also interviewed about inmates’ access to medical care, ADA accommodations for inmates who are deaf and hard of hearing, inmates who have mobility concerns, special diets for inmates who have diabetes, and other PAIR eligible disabilities. Monitored 10 nursing facilities Kentucky P&A also monitored 10 nursing facilities, reviewed their compliance with PASSR, met with staff at the facilities and residents focusing on long-term care rights, abuse and neglect and guardianship. Monitored facilities in Five Surrounding Counties of State Capital Kentucky P&A monitored the five counties that surround the state’s Capital, including Franklin County, the location of Kentucky P&A’s office. These counties include Scott, Woodford, Owen, Franklin, and Anderson. The facilities monitored included adult day training programs, supports for community living programs, family care home providers, nursing facilities, psychiatric hospitals or hospitals with a psychiatric unit, jails, juvenile detention facilities and alternative schools. The focus was on abuse/ neglect and other rights violations. Abuse and Neglect violations were reported to Adult Protective Services and to the Office of Inspector General if it was a facility licensed by the OIG. Another focus of the monitoring visits were to continue to inform the facility administrator and staff know about the services of Kentucky P&A. Department of Community Based Services Policy/Regulation regarding investigation of allegations of abuse /neglect arising out of the use of restraint and seclusion in schools. Kentucky P&A has conducted a review and analysis of the DCBS policies and procedures related to allegations of abuse and neglect at school; the agency does not have a policy specific to restraint and seclusion. Agency policy does contain guidelines for investigation allegations of abuse and neglect by teachers and/or school staff. In 2017, Kentucky P&A released a publication “The Near-Death of Brennan Long: Autopsy of an Abusive Restraint”. This publication was released, in part, in response to DCBS’ re-opening an investigation into an incident in which a Kentucky student with autism suffered horrific, life-threatening injuries during a school restraint after initially declining to substantiate abuse in that case. The publication contained a detailed analysis of the facts and the law relating to the use of restraint and seclusion and provided a roadmap for the finding that the restraint was abusive. Significantly, the publication contained a detailed analysis of how the restraint violated state education law and was not protected under Kentucky’s criminal defense statutes. Kentucky P&A hoped that this guidance, combined with collaborative efforts and meetings with DCBS, would provide the necessary analysis for DCBS to adopt when reviewing cases of abusive use of restraint and seclusion in schools. Disappointingly, DCBS declined to adopt a policy or practice considered the restrictions placed on the use of restraint and seclusion under the state’s education law when reviewing injuries sustained during restraint and/or seclusion. On August 2, 2018, Kentucky P&A provided a formal written opinion to DCBS regarding the agency’s policies and practice regarding allegations of abuse arising out of the use of restraint and seclusion in schools. Kentucky P&A provided publications detailing the historical context and documenting the abusive use of these aversives in public schools both nationally and on the state level. It also documents our concerns regarding the ongoing abusive use of these aversives and the failure of DCBS to substantiate abuse or neglect in many of these cases. Kentucky P&A acknowledged the complexities involved in the school restraint investigations, but suggested DCBS use the same criteria when investigating claims arising out of corporal punishment (which remains legal in Kentucky). Under this analysis, DCBS finds abuse where the staff was unreasonable in the decision to use corporal punishment or uses excessive force in doing so. P&A suggests that adopting this analysis in cases of restraint and seclusion will allow DCBS to distinguish the lawful use of restraint and seclusion from the abusive use of these aversives. Kentucky P&A requested a follow-up meeting with DCBS to discuss this issue and our recommendations. At the beginning of September, P&A received a letter from DCBS acknowledging the receipt of the letter. The agency declined, however, to discuss the issue further as they are currently litigating an appeal of a finding of neglect in Brennan’s case. Kentucky Transitions Kentucky P&A will meet with Kentucky Medicaid and Kentucky Transitions regarding available services and the programs future. Kentucky P&A staff met with the director of Kentucky Transitions, Money Follows the Person program. Kentucky Transitions provides transitions from the nursing home to the community for individuals who are eligible to receive services through the Home and Community Based (HCB) waiver and the Acquired Brain Injury LTC waiver. Kentucky Transitions funding is allocated until 2019. The program will accept eligible participants until December 2018 for services during the 2019 year. After December 2018, the program will no longer accept applications. The director of Kentucky Transitions said that the program would continue if Congress reauthorizes Money Follows the Person and/or the redesign of Medicaid waivers makes individuals eligible for HCB waiver while in a facility. Educational Resources Kentucky P&A conducted an in-depth review of the resources available throughout the state to parents regarding educational rights. The review included internet searches, contacting local agencies, and informal surveys of parents. Kentucky P&A determined that there are significant resources available for parents on a wide variety of educational issues. There are significant resources available through Kentucky P&A, the Kentucky Department of Education, KY-SPIN, and private attorneys as well as numerous publications on issues from a wide variety of resources nationally (i.e. internet). Kentucky P&A analyzed the information obtained during this review and concluded access to information is not a barrier for parents. Rather, parents experience difficulty sorting through the vast amount information and are often overwhelmed with care needs for their child. At the same time, there is a lack of educational advocates who can provide direct assistance and attend ARC meetings with parents. Kentucky P&A has begun discussions with Kentucky child advocacy agencies on how to provide increased supports to parents, including parent trainings and direct representation. Every Student Succeeds Act Kentucky submitted its application for its new accountability system to the U.S. Department of Education at the end of September 2017. The U.S. DOE provided feedback and identified multiple issues at the end of December 2017. The Kentucky Department of Education revised the plan to address deficiencies and concerns identified by the U.S. DOE. Kentucky’s revised application was approved on May 7, 2018. Kentucky P&A had participated in advisory councils, provided feedback, and written comments regarding the elements of the system and concerns regarding the impact of the system for students with disabilities. Under the plan, Kentucky will publish assessment and accountability data on a website. Additionally, the plan requires systemic development of a “student growth trajectory”. This process utilizes a scientifically valid algorithm to analyze past performance measures and set a trajectory for expected student growth. The new accountability system will assess school performance not only on overall student achievement, but will also consider individual student progress along their growth trajectory. Kentucky P&A will use the system to monitor effectiveness at not only the school, district, and statewide levels, but believe the individual student growth data will provide a powerful tool assessing and monitoring school accountability. The Every Student Succeeds Act, as part of the accountability system, mandates a 1% state cap on students participating in the alternate assessment. States who do not anticipate complying with the cap may submit a Wavier Application to the U.S. DOE. On July 19, 2018, KDE published a public notice of its intent to submit a Waiver Application and soliciting public comment. On August 1, 2018, Kentucky P&A provided written comment on the Waiver Application noting non-compliance with data reporting and justification requirements and requesting additional parent training on the alternate assessment and implications for students of participating in the alternate assessment. Guardianship and Transitioning to Adulthood In the 2018 Kentucky Legislative Session, House Joint Resolution 33 was signed into law. This joint resolution recommended the creation of a Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS) group in Kentucky. WINGS is a court-community partnership that drives positive reform in the guardianship system. WINGS includes judges, court staff, the aging and disability networks, the public and private bar, mental health agencies, advocacy groups, medical and mental health professionals, services providers, and family member and individuals affected by guardianship. Within WINGS, there are multiple sub-committees tasked to identify needs and trends in the guardianship system and ways to address those needs. They include Finance & Organization, Legislation & Policy Review, Court Systems Liaison, and Education and Outreach. Kentucky P&A is a member on each of these sub-committees. One of the issues identified by WINGS is the need of information/publication on guardianship for individuals approaching adulthood to be used by educators, students, and families. WINGS will be working on creating a document and educating educators, students, and families about guardianship during the transition age, including alternatives to guardianship. Kentucky P&A and WINGS have identified that educators often promote guardianship to parents with children with disabilities without understanding the alternatives or the impact of taking away one’s rights. Juvenile Justice Reform Kentucky P&A staff attended Juvenile Justice Oversight Council meetings and various legislative committee meetings to track the progress of juvenile justice reform and the changes to the justice system. Kentucky P&A staff reviewed and commented on proposed changes to Department of Juvenile Justice (DJJ) policies relating to the care and treatment of youth in detention facilities. These changes are related to reforms in the juvenile justice system, but they also reflect a shift in the culture at the Department of Juvenile Justice toward treatment and positive interventions and away from a punitive mindset. Kentucky’s juvenile justice reforms have reduced the number of children entering the system. State leaders are now shifting their attention to racial disparities that exist in the juvenile justice system. There has been some recognition of the idea of disability-based disparities, but this attention has been minimal. Kentucky P&A has worked with DJJ to develop a pilot project that will allow Kentucky P&A and other stakeholders to work with youth involved in the juvenile justice system and assist with their transition from DJJ facilities back into their community. Partner agencies will provide trainings and support to both youth and their families. The goal is to provide education, supports, and services needed to reduce recidivism in these youth. Review of protocols of four local police departments and their interaction with people with disabilities Kentucky P&A has obtained agency policies from Louisville Metro Police Department and has reviewed those policies. The review revealed that those policies exclusively deal with individuals with disabilities as crime perpetrators rather than victims. The language of the policies indicates a bias against individuals with disabilities. The Kentucky Autism Training Center (KATC) has begun a partnership with various police departments and first responders regarding working with individuals with autism. While these trainings cover a variety of topics relevant to individuals with various disabilities, KATC has not reviewed department policies or evaluated the impact of those policies on those professionals’ responses to individuals with disabilities. Kentucky P&A is working with KATC to determine if these two efforts can be combined or if the agencies can work together to make reform in both policy and practice. ABLE Accounts State legislation passed in 2017 created ABLE accounts in Kentucky; soon after, the Kentucky State Treasurer’s office partnered with the Ohio State Treasurer’s Office to set up the apparatus for STABLE accounts. Since that time and during the last fiscal year, Kentucky P&A worked with CCDD, the state Treasurer’s office, other state agencies, and interested parties and stakeholders to roll-out STABLE accounts throughout Kentucky. This included monthly meetings, training by Kentucky P&A alone and in collaboration with the Treasurer’s office, and dissemination of Treasurer-developed written materials. Supported Decision Making Kentucky P&A collaborated closely with Developmental Disability Network partner, The Human Development Institute-University of Kentucky, University Center of Excellence on Developmental Disabilities on promoting and educating various groups on Supported-Decision Making (SDM) as an alternative to Guardianship. In addition, we represented approximately five individuals with developmental disabilities on implementing SDM. Kentucky P&A did not litigate any issues for PAIR eligible clients in FY 2018. Kentucky P&A staff reviews all draft legislation to determine the impact the legislation may have on the lives of individuals with disabilities. Where possible, P&A reviews proposed legislation before it is filed with the Legislative Research Commission (the first step in the legislative process). P&A staff provides comments to state agencies through both informal and formal processes; providing formal written comments or testimony as appropriate. P&A also provides information to consumers through posting information regarding proposed and draft legislation on the P&A website. Kentucky P&A commented on the following regulations: Regulation Comments 10/1/17-9/30/18 1. Education Professional Standards Board a. 16 KAR 1:015 Standards for Certified Teacher Leader (12/15/17)—inclusive culture; best practices; and collaboration 2. Justice Cabinet—Department of Corrections a. 501 KAR 6:030. Kentucky State Reformatory. (4/30/18) • KSR 13-00-04—motorized wheelchair repair • KSR 13-02-03—frequency of officer tours of CPTU/RHU • KSR 20-00-01—special education and re-entry programs b. 501 KAR 6:270: Probation and parole policies and procedures. (3/29/18) • CPP 28-01-03—PSI update for revoked probationers. c. 501 KAR 6:280. Risk and needs assessment (12/21/17) • CPP 29.1—addition of mental illness, brain injuries, and developmental disabilities • CPP 29.2 —addition of mental illness, brain injuries, and developmental disabilities 3. Justice Cabinet—Department of Juvenile Justice a. 505 KAR 1:120. Department of Juvenile Justice Policies and Procedures Manual: Health and Safety Services (5/30/18) • DJJ 405.2 Forced psychotropic medications: monitoring use • DJJ 405.3 Referral for Behavioral Health Services: times for referrals • DJJ 410 Orthosis, Prosthesis and other aides: addition of augmentative devices b. 505 KAR 1:140. Department of Juvenile Justice Policies and Procedures Manual: detention services (5/30/18) • DJJ 702 Intake, Reception and Orientation—information in admissions packet: inclusion of disability in admissions packets • DJJ 704 Alternatives to Secure Detention—format for alternatives information • DJJ 713 Restraints—reasons for the use of restraints • DJJ 718 Disciplinary Review—consideration of child’s disability on discipline • DJJ 725 Education Programming and Assessment—referrals for special education services 4. Education Cabinet a. 701 KAR 8:010. Charter schools student application, lottery and enrollment (11/30/17)—notifications b. 701 KAR 8:020. Evaluation of charter school authorizers (11/30/17)—students’ rights, including civil, disability and educational rights; restraint/seclusion policies; notices c. Charter school application (11/20/17)—inclusion of mental and behavioral health; restraint/seclusion practice 5. Cabinet for Health and Family Services a. 895 KAR 1:001 Definitions for 895 KAR Chapter 1 (8/31/18)—definitions of chronic homelessness and temporary vulnerable b. 895 KAR 1:010 Eligibility for Kentucky HEALTH program (8/31/18)—lockouts, clarifications, changing MCOs c. 895 KAR 1:015 Premium payments with the Kentucky HEALTH programs. (8/31/18)— d. 895 KAR 1:020. PATH requirement for the Kentucky HEALTH program (8/31/18) e. 895 KAR 1:030. Establishment and use of the MyRewards program. (8/31/18) f. 895 KAR 1:035. Covered services within the Kentucky HEALTH program (8/31/18) g. 895 KAR 1:055. Designation or determination of medically frail status or accommodation due to temporary vulnerability in the Kentucky HEALTH program (8/31/18) h. 900 KAR 5:020 State Health Plan (8/31/18)—transfers of private ICF/IID beds; PRTF (8/31/18) i. 907 KAR 17:010 Managed care organization requirements and policies related to enrollees. (12/28/17)—information in MCO handbooks, various MCO programs and practices, PCPs for state wards j. 907 KAR 17:015 Managed care organizations requirements and policies relating to providers. (12/28/17)—availability of behavioral health services, MCO education of providers k. 907 KAR 17:020 Managed care organization service and service coverage requirements and policies (12/28/17)—monthly meetings between DMS and MCOs l. 910 KAR 002:030. Accounting provisions for adult guardianship (3/29/18)—bed holds (P&A commented on this regulation prior to it being submitted to the Legislative Research Commission) m. 921 KAR 2:015. Supplemental programs for persons who are aged, blind, or have a disability. (?/?/18)—COLA increase should be given to PCH resident n. 922 KAR 2:100. Certification of Family Child-Care Homes. (3/28/18)—epi-pens o. 922 KAR 2:120E. Child-care center health and safety standards (3/28/18)—epi-pens p. 922 KAR 2:160. Child Care Assistance Program (11/29/18)—adding all waivers to excluded income Other Comments: 1. Centers for Medicaid Services (8/18/18)—1115 Waiver application 2. Navigant Recommendations (6/15/18)

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts0
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.

Kentucky P&A did not have any class/litigation activities for PAIR eligible clients.

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.

Abuse, Neglect, and Exploitation Kentucky P&A will investigate allegations of abuse and neglect, including allegations of restraint/seclusion, in institutional and community based programs providing services to PAIR eligible clients. Individual Advocacy (a)Kentucky P&A will investigate all suspicious deaths of PAIR eligible clients. The Internal Abuse and Neglect (IAN) Team will review all reports of suspicious deaths reported to Kentucky P&A or that P&A becomes aware via The Office of Inspector General, media outlets, monitoring efforts, etc. Kentucky P&A Internal Abuse and Neglect Team (IAN) received notifications of notices five deaths of PAIR eligible clients and conducted secondary investigations of these clients, all of whom lived in a nursing facility. (b)Kentucky P&A will investigate all serious injuries, including those sustained during the use of physical restraint/seclusion at schools and other facilities/community programs providing services to PAIR eligible clients. The IAN Team will review all reports made to Kentucky P&A or made by other entities, including The Office of Inspector General, media outlets, and monitoring efforts. Kentucky P&A IAN Team reviewed 37 Type A/B Citations issued by the Office of Inspector General, incident reports, and other notices of alleged abuse/neglect/exploitation to determine further action for PAIR eligible clients residing in long-term care facilities. The IAN Team conducted 13 investigations of PAIR eligible clients, including five death investigations. Case Summary Kentucky P&A received a copy of a citation issued by the Office of Inspector General (OIG) for failing to provide adequate supervision to a resident of a facility. RD, a 49-year-old male, resided in a nursing facility due to complications from a stroke. RD used a wheelchair. RD left the facility in a taxi unaccompanied for a doctor’s appointment. The taxi driver escorted RD to his appointment. The facility was aware RD’s girlfriend was going to meet him at the doctor’s appointment. However, due to a lack of transportation, she was not able to make the appointment. Several hours later, RD’s girlfriend called the facility to speak to RD. She was informed he had not returned to the facility. This was at 5:00 pm. The facility staff failed to contact the doctor’s office to inquire about RD. RD’s girlfriend called the facility at 9 pm to check on him. The facility staff did not check on RD until his girlfriend called a second time and he could not be located. Video surveillance of the doctor’s office showed he left the facility at 5:51 pm. RD was found dead, three days later, lying in bushes close to a railroad track about 11 miles from his doctor’s office. The Office of Inspector General initially issued a Type A Citation for failing to provide adequate supervision to one of its residents, however the Citation was later rescinded after another survey due to the OIG finding the policies of the facility were in place and did not place other residents in imminent danger. Kentucky P&A conducted a secondary follow up investigation and reported the incident to Adult Protective Services, who did not substantiate. Kentucky P&A also informed RD’s family the outcome of the investigation and informed them they could speak to an attorney due to the facilities alleged negligence placed RD at risk. The family is working with an attorney Systemic Advocacy (a) Kentucky P&A Internal Abuse and Neglect Team (IAN) will review Type A/B Citations, incident reports, and other notices of alleged abuse/neglect/exploitation of PAIR eligible clients to determine further action, including conducting primary or secondary investigations. Kentucky P&A IAN Team reviewed 37 Type A/B Citations issued by the Office of Inspector General, incident reports, and other notices of alleged abuse/neglect/exploitation to determine further action for PAIR eligible clients residing in long-term care facilities. The IAN Team conducted 13 investigations of PAIR eligible clients, including five death investigations. The IAN Team tracks referrals to identify trends of abuse/neglect in facilities and will select those facilities to monitor during monitoring efforts. (b) Kentucky P&A will participate in Project SAFE (Safety & Accessibility for Everyone) planning/educational/outreach efforts and implementation of the strategic plan and the Crisis Intervention Training (CIT) with the Louisville Metro Police and the statewide CIT program. Kentucky P&A continued participation in Project SAFE (Safety & Accessibility for Everyone), a multi-disciplinary network working to build the capacity of professionals throughout Kentucky to provide safe, accessible and comprehensive person-centered services to individuals with disabilities who have been subjected to sexual assault and/or domestic violence. During FY’18 Kentucky P&A: Kentucky P&A’s advocate representative continued role as co-chair of the statewide organization. To ensure balance in the collaboration leadership, one co-chair works in victim services while the other works in disability-related field. Worked with Project SAFE Executive Committee members on the 5th Annual statewide Advocating to End Abuse Against People with Disabilities Summit held in Frankfort. The focus was healthy relationships and people with disabilities. There were 60 attendees. Worked with Project SAFE Executive Committee members on a pre-conference session at the annual statewide Ending Sexual Assault & Domestic Violence Conference. Among other activities during FY 2018, Kentucky P&A had an informational table at the Kentucky Attorney General’s Victim Assistance Conference, served on a panel of professionals providing feedback regarding role-play to police officers participating in Crisis Intervention Team (CIT) training for Louisville Metro Police Department recruits & veteran officers and state-level CIT for veteran officers, participated in 12 trainings and provided feedback to 310 officers, participated in quarterly meetings of CIT Advisory Board for Louisville Metro Police Department. Kentucky P&A also served the Advisory/Steering Committee for the September, 2018 Kentucky Victim’s Assistance Academy. (c)Kentucky P&A will request and review quarterly all Psychiatric Residential Treatment Facilities (PRTF) serious occurrence reports. Kentucky P&A will compare reports provided with Office of Inspector General facility surveys and follow-up all failures to report with the facility and/or Centers for Medicare and Medicaid Services (CMS). Kentucky P&A previously submitted an annual request to PRTFs to provide copies of all serious occurrence reports on an ongoing basis. Due to the low volume of responses, P&A increased requests to quarterly and started making follow-up phone calls to administrators of all PRTFs regarding their reporting obligation. P&A also reviews facility surveys of PRTFs completed by Kentucky’s Office of the Inspector General to review for compliance with this federal requirement. This year, Kentucky P&A has reviewed 22 serious occurrences from two facilities. Underlying reason for report included: AWOL (3); accident leading to injury during play/chores (4); injury to self or others while escalated (9); illness (1); and use of restraint. (d)Kentucky P&A will monitor ALL service providers to PAIR eligible children and/or adults with disabilities in Anderson, Franklin, Owen, Scott and Woodford counties. Kentucky P&A monitored the five counties that surround the state’s Capital, including Franklin County, the location of Kentucky P&A’s office. These counties include Scott, Woodford, Owen, Franklin, and Anderson. The facilities monitored included adult day training programs, supports for community living programs, family care home providers, nursing facilities, psychiatric hospitals or hospitals with a psychiatric unit, jails, juvenile detention facilities and alternative schools. The focus was on abuse/ neglect and other rights violations. Abuse and Neglect violations were reported to Adult Protective Services and to the Office of Inspector General if it was a facility licensed by the OIG. Another focus of the monitoring visits were to continue to inform the facility administrator and staff know about the services of Kentucky P&A. (e)Kentucky P&A will review the Department of Community Based Services (DCBS) policy/regulation regarding investigation of allegations of abuse/neglect arising out of the use of restraint and seclusion in schools and make recommendations on how to identify the abusive use of restraint. Kentucky P&A has conducted a review and analysis of the DCBS policies and procedures related to allegations of abuse and neglect at school; the agency does not have a policy specific to restraint and seclusion. Agency policy does contain guidelines for investigation allegations of abuse and neglect by teachers and/or school staff. In 2017, Kentucky P&A released a publication “The Near-Death of Brennan Long: Autopsy of an Abusive Restraint”. This publication was released, in part, in response to DCBS’ re-opening an investigation into an incident in which a Kentucky student with autism suffered horrific, life-threatening injuries during a school restraint after initially declining to substantiate abuse in that case. The publication contained a detailed analysis of the facts and the law relating to the use of restraint and seclusion and provided a roadmap for the finding that the restraint was abusive. Significantly, the publication contained a detailed analysis of how the restraint violated state education law and was not protected under Kentucky’s criminal defense statutes. Kentucky P&A hoped that this guidance, combined with collaborative efforts and meetings with DCBS, would provide the necessary analysis for DCBS to adopt when reviewing cases of abusive use of restraint and seclusion in schools. Disappointingly, DCBS declined to adopt a policy or practice considered the restrictions placed on the use of restraint and seclusion under the state’s education law when reviewing injuries sustained during restraint and/or seclusion. On August 2, 2018, Kentucky P&A provided a formal written opinion to DCBS regarding the agency’s policies and practice regarding allegations of abuse arising out of the use of restraint and seclusion in schools. Kentucky P&A provided publications detailing the historical context and documenting the abusive use of these aversives in public schools both nationally and on the state level. It also documents our concerns regarding the ongoing abusive use of these aversives and the failure of DCBS to substantiate abuse or neglect in many of these cases. Kentucky P&A acknowledged the complexities involved in the school restraint investigations, but suggested DCBS use the same criteria when investigating claims arising out of corporal punishment (which remains legal in Kentucky). Under this analysis, DCBS finds abuse where the staff was unreasonable in the decision to use corporal punishment or uses excessive force in doing so. P&A suggests that adopting this analysis in cases of restraint and seclusion will allow DCBS to distinguish the lawful use of restraint and seclusion from the abusive use of these aversives. Kentucky P&A requested a follow-up meeting with DCBS to discuss this issue and our recommendations. At the beginning of September, P&A received a letter from DCBS acknowledging the receipt of the letter. The agency declined, however, to discuss the issue further as they are currently litigating an appeal of a finding of neglect in Brennan’s case. (f)Kentucky P&A will monitor facilities to ensure abuse/neglect reporting numbers are posted for residents as required by law and will review documents provided to PAIR eligible children/youth in facilities (psychiatric hospitals, Psychiatric Residential Treatment Facilities (PRTFs), and Department of Juvenile Justice (DJJ) facilities) on how to report allegations of abuse or neglect and make recommendations on how to ensure PAIR eligible children/youth are able to report. The Prison Rape Elimination Act (PREA) requires Department of Juvenile Justice facilities to post phone numbers for the reporting hotline. P&A monitored five DJJ facilities. All five facilities had numbers clearly posted in multiple locations. Additionally, 100% of youth interviewed reported knowing what PREA was and knowing how to contact both the PREA hotline and Child Protective Services. There is no other state or federal law that requires postage of specific information relevant to abuse and neglect reporting, but Kentucky P&A asked both staff and residents of all facility types (psychiatric hospitals, PRTFs, Private Child Care facilities, and nursing homes) whether they were aware of reporting requirements and how to report abuse and neglect. While there were different administrative procedures in the facilities, 100% of residents and staff were aware of mandatory reporting requirements and were able to articulate those requirements and the steps to reporting abuse or neglect by staff or peers. (g)Kentucky P&A will provide technical assistance to parents/guardians of PAIR eligible children/youth regarding responding to allegations of misuse of restraint and seclusion in schools. Kentucky P&A provided technical assistance to five parents of students with disabilities regarding allegations of misuse of restraint and seclusion in schools. Technical assistance related to state regulatory requirements for schools on the use of restraint and seclusion and required steps after a student is restrained or secluded; reporting requirements (including state statutory and regulatory requirements); next steps for parents; and expectations regarding law enforcement, school, and child protective services investigations. Kentucky P&A has created a one-page publication with this information to provide to parents/guardians. Olmstead Kentucky P&A will represent PAIR eligible adults and children institutionalized or at risk of institutionalization to ensure they have access to services and supports in the most integrated living arrangement. Individual Advocacy (a)Kentucky P&A will provide technical assistance to hospitals, DJJ workers, CDWs, nursing home workers, and DCBS workers regarding denial of or inability to access community services that lead to or increase a PAIR eligible child risk of institutionalization. Kentucky P&A did not represent a PAIR eligible child/youth regarding denial of access to community services that would lead to or increase the child/youth with disabilities risk of institutionalization. (b) Kentucky P&A will provide technical assistance to a parent/guardian of PAIR eligible children or represent PAIR eligible children who are institutionalized or at risk of institutionalization due to denial of or inability to access community services. Kentucky P&A did not represent a PAIR eligible child/youth who was institutionalized or at risk of institutionalization due to denial or unable, to access community services. (c)Kentucky P&A will represent or provide technical assistance to two parent/guardians of PAIR eligible children and/or PAIR eligible adults living in or at risk of placement in a nursing home regarding services and supports available to allow them to live in a more integrated living arrangement. Strategies include filing OCR complaints. Kentucky P&A represented and/or provided technical assistance to four PAIR eligible adults living in nursing facilities seeking to receive services and supports in a more integrated living arrangement (d)Kentucky P&A will represent or provide technical assistance to2 PAIR eligible adults with disabilities at risk of institutionalization and in need of community services and supports under Olmstead, who do not meet the above individual advocacy priorities. Kentucky P&A represented one PAIR eligible adult at risk of institutionalization and in need of community services and supports. Case Summary Kentucky P&A advocate met DM while visiting a personal care home in eastern Kentucky. DM has had multiple strokes and had lived in the facility for over five years. He expressed to the Kentucky P&A advocate he would like to live in the community. He felt he was not able to live in the community because he had a state appointed guardian. He also stated he would like to have his rights restored. Kentucky P&A’s advocate contacted the community mental health center to explore community resources, however, was informed they would not be able to assist DM because he did not have a mental illness and did not qualify for services. Kentucky P&A advocated explained to he could apply for a Home and Community Based Waiver that would provide some community supports, however his state appointed guardian would have to support DM moving into the community. DM petitioned the Court on his own to have his rights restored and was successful. He then moved into a family member’s home, where an application was made for the Home and Community Based Waiver. DM is currently living with his family and accessing services through the waiver. Systemic Advocacy a) Kentucky P&A will meet with Kentucky Medicaid and Kentucky Transitions regarding available services and the programs future. Kentucky P&A staff met with the director of Kentucky Transitions, Money Follows the Person program. Kentucky Transitions provides transitions from the nursing home to the community for individuals who are eligible to receive services through the Home and Community Based (HCB) waiver and the Acquired Brain Injury LTC waiver. Kentucky Transitions funding is allocated until 2019. The program will accept eligible participants until December 2018 for services during the 2019 year. After December 2018, the program will no longer accept applications. Duff said that the program would continue if Congress reauthorizes Money Follows the Person and/or the redesign of Medicaid waivers makes individuals eligible for HCB waiver while in a facility. (b)Kentucky P&A will request the number of children, their location and the parents/guardian contact information of those children being served out of state and paid by Kentucky Medicaid. Kentucky P&A issued quarterly Open Records Requests for information regarding Medicaid-eligible children placed out of state by the Cabinet for Health and Family Services. This data supports the need for increased community based services in the state, particularly for children with intellectual disabilities and severe behavioral problems. Kentucky P&A uses this data to educate legislators and state policymakers on the outstanding need for services for this population within the state. For example, the Cabinet for Health and Family Services (the Cabinet) recently testified before the Child Welfare and Oversight Advisory Committee. This legislative committee is reviewing the state’s adoptive and foster care system to recommend legislative changes to that system. The Cabinet testified that children in the state’s custody were “rarely” sent out of state or remained for significant periods in facilities while waiting for a permanent placement. Kentucky P&A followed-up with one Senator (who has been a very strong children’s right’s presence on the legislature) regarding this data and our experience monitoring, which shows that there are not sufficient community-based resources for these children and, as a result, they remain in facilities, particularly psychiatric facilities, for significant periods of time and may remain there for years. III. Education PAIR eligible children/youth will be provided a Free and Appropriate Education (FAPE). Individual Advocacy (a)Kentucky P&A will represent at least one PAIR eligible child/youth in public schools who have inappropriate Individualized Education Program (IEP) or who are placed in an inappropriate educational setting. This priority will include children/youth who qualify for special education, but who are not receiving any special educational services; children for whom an IEP and or Behavior Intervention Plan (BIP) is not implemented as written; children for whom a district has failed to complete a Functional Behavioral Analysis (FBA) or manifestation determination Hearing (MDH); children inappropriately restrained or secluded; and children/youth who have not received appropriate transition planning (including psychiatric hospitals, vocational and technical school and supported employment). Kentucky P&A represented two PAIR eligible children and youth in public schools who had inappropriate IEPs and were placed in an inappropriate educational setting. (b)Kentucky P&A will complete reviews of the education records of ¬at least one child/youth in public schools with disabilities and determine if there has been a violation of the child/youth’s educational rights under state and/or federal law. Preference will be given to children/youth in institutions. Kentucky P&A reviewed the educational records of two PAIR eligible children and youth to determine if there was a violation of the child/youth’s educational rights under state and/or federal law. (c)Kentucky P&A will provide technical assistance to the parent/guardian/caseworker of two PAIR eligible children/youth with disabilities regarding addressing violations of the child’s educational rights. Kentucky P&A provided technical assistance to parents/guardians/caseworkers of four PAIR eligible children and youth regarding violations of the child/youth’s educational rights. Case Summary JT is a 15-year-old male with a diagnosis of ADHD. His mother contacted P&A Tyler was not receiving any services in the public school. Since contact, Tyler has had a 504 Plan developed. Once determined eligible for Specially Designed Instruction (SDI), the 504 was replaced with an Individual Education Plan (IEP). The ARC reconvened to review data and determine eligibility for extended school year. JT did not qualify; however, during the ARC meeting, teachers reported on some observed behaviors. The Admissions and Release Committee (ARC) decided a Behavior Intervention Plan (BIP) would help support Tyler. Kentucky P&A advocate six ARC meetings to address 504 Plan, consent, eligibility/IEP development, reviewing data to develop a BIP, revisions to the IEP and his transition to the high school setting. At the transition ARC, it was reported JT was passing all of his classes. JT wanted the BIP removed from his IEP and the ARC agreed. JT has not been taking any of his ADHD medications for approximately two months. He is more social and reports he is ready for high school. He has an appropriate IEP and is in good shape to transition to the high school setting. Case Summary JW is a 13-year-old l male in who attends public school with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). He has difficulty with attention and behaviors in the classroom. He currently has a 504, but this is not addressing issues. Kentucky P&A was contacted by JW’s grandmother because she observed JW becoming increasingly discouraged at school and was fearful he will "give up". Kentucky P&A advocate contacted JW’s mother who stated she would appreciate assistance. An Admissions and Release Committee (ARC) meeting was scheduled. Kentucky P&A advocate reviewed records and provided technical assistance to JW’s mother on supports and services available for children/youth kids with ADHD. She felt better after the ARC and felt they had determined appropriate supports for Jayden's success. Systemic Advocacy (a)Kentucky P&A will provide information to The Arc of Kentucky and KYSPIN to be included in trainings to parents/grandparents/foster parents on Special Education and related topics across Kentucky. Kentucky P&A provided information and materials to the Kentucky Special Parent Involvement Network (KYSPIN) on Special Education and related topics. The ARC of Kentucky no longer exists. (b)Kentucky P&A will investigate current resources available throughout the state to parents regarding educational advocacy, identify gaps in available resources, and strategize and implement ways to increase comprehensive access to information and resources necessary so parents can effectively advocate for the educational rights of their children. Kentucky P&A conducted an in-depth review of the resources available throughout the state to parents regarding educational rights. The review included internet searches, contacting local agencies, and informal surveys of parents. Kentucky P&A determined that there are significant resources available for parents on a wide variety of educational issues. There are significant resources available through Kentucky P&A, the Kentucky Department of Education, KY-SPIN, and private attorneys as well as numerous publications on issues from a wide variety of resources nationally (i.e. internet). Kentucky P&A analyzed the information obtained during this review and concluded access to information is not a barrier for parents. Rather, parents experience difficulty sorting through the vast amount information and are often overwhelmed with care needs for their child. At the same time, there is a lack of educational advocates who can provide direct assistance and attend ARC meetings with parents. Kentucky P&A has begun discussions with Kentucky child advocacy agencies on how to provide increased supports to parents, including parent trainings and direct representation. (c)P&A will work with Kentucky Department of Education to produce a publication on Guardianship and the transition to adulthood with a target audience of individuals with disabilities approaching adulthood and their parents. In the 2018 Kentucky Legislative Session, House Joint Resolution 33 was signed into law. This joint resolution recommended the creation of a Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS) group in Kentucky. WINGS is a court-community partnership that drives positive reform in the guardianship system. WINGS includes judges, court staff, the aging and disability networks, the public and private bar, mental health agencies, advocacy groups, medical and mental health professionals, services providers, and family member and individuals affected by guardianship. Within WINGS, there are multiple sub-committees tasked to identify needs and trends in the guardianship system and ways to address those needs. They include Finance & Organization, Legislation & Policy Review, Court Systems Liaison, and Education and Outreach. Kentucky P&A is a member on each of these sub-committees. One of the issues identified by WINGS is the need of information/publication on guardianship for individuals approaching adulthood to be used by educators, students, and families. WINGS will be working on creating a document and educating educators, students, and families about guardianship during the transition age, including alternatives to guardianship. Kentucky P&A and WINGS have identified that educators often promote guardianship to parents with children with disabilities without understanding the alternatives or the impact of taking away one’s rights. (d)Kentucky P&A will monitor the development of a charter school system in Kentucky and participate as appropriate to ensure equal access and participation by children with disabilities. On March 21, 2017, Govern Matt Bevin signed HB 520, legislation that allows charter schools in Kentucky, into law. The bill became effective at the end of June 2017. The Kentucky Department of Education (KDE) began drafting regulations to regulate the implementation of charter schools in the Commonwealth. P&A attended stakeholder meetings that informed the drafting of these regulations, including advisory panel meetings, to monitor draft language and to provide input where appropriate. Once draft regulations were filed with the Legislative Research Commission, P&A attended a public hearing regarding the draft regulations and provided written comment. The Kentucky Department of Education, in response to Kentucky P&A’s comments, confirmed that charter schools had an ongoing and equal obligation to ensure disability rights and to follow regulations regarding the use of restraint and seclusion in public schools as all public schools. KDE revised regulatory language to reflect inclusion of ASL as a “foreign language.” KDE would not revise regulatory language to clarify which party (authorizer, district, or charter school) would be considered the Local Education Agency for purposes of IDEA. Charter Schools were authorized to open as early as the 2018-19 school year. As of the application filing deadline, no applications had been received. (e)Kentucky P&A will monitor and participate in the development of a new accountability system in Kentucky under the Every Student Succeeds Act (ESSA). Kentucky submitted its application for its new accountability system to the U.S. Department of Education at the end of September 2017. The U.S. DOE provided feedback and identified multiple issues at the end of December 2017. The Kentucky Department of Education revised the plan to address deficiencies and concerns identified by the U.S. DOE. Kentucky’s revised application was approved on May 7, 2018. Kentucky P&A had participated in advisory councils, provided feedback, and written comments regarding the elements of the system and concerns regarding the impact of the system for students with disabilities. Under the plan, Kentucky will publish assessment and accountability data on a website. Additionally, the plan requires systemic development of a “student growth trajectory”. This process utilizes a scientifically valid algorithm to analyze past performance measures and set a trajectory for expected student growth. The new accountability system will assess school performance not only on overall student achievement, but will also consider individual student progress along their growth trajectory. Kentucky P&A will use the system to monitor effectiveness at not only the school, district, and statewide levels, but believe the individual student growth data will provide a powerful tool assessing and monitoring school accountability. The Every Student Succeeds Act, as part of the accountability system, mandates a 1% state cap on students participating in the alternate assessment. States who do not anticipate complying with the cap may submit a Wavier Application to the U.S. DOE. On July 19, 2018, KDE published a public notice of its intent to submit a Waiver Application and soliciting public comment. On August 1, 2018, Kentucky P&A provided written comment on the Waiver Application noting non-compliance with data reporting and justification requirements and requesting additional parent training on the alternate assessment and implications for students of participating in the alternate assessment. (f)Identify five topics related to special education and develop publications and or webinars on those topics to post online (i.e. addressing attendance/tardiness issues with BIP, IEP, 504, etc.). P&A has developed publications on the following five (5) topics related to special education for publication and/or webinars: School Threats, Guardianship, Denying Graduation (or extra-curricular activities) as Discipline, Reporting School Abuse, and Managing School Paperwork. IV. Health Care PAIR eligible clients will have the right to access health care, including physical and behavioral services. Individual Advocacy (a)Kentucky P&A will represent at least one PAIR Medicaid eligible adult, who is denied medical, dental, and other health services or whose services are reduced or terminated. Kentucky P&A represented one PAIR eligible adult whose healthcare services were denied or they were not able to access healthcare. (b)Kentucky P&A will represent at least one PAIR Medicaid eligible children/youth with disabilities relating to their denial of or inability to access healthcare services, including physical and behavioral health services. Priority will be given to those children/youth committed to or at-risk of commitment to DCBS solely for purpose of obtaining services. Kentucky P&A represented one PAIR eligible child to ensure they were discharged with appropriate plans. Case Summary SW, a 63-year-old male, was admitted to rehabilitation facility after hospitalization due to complications from a stroke. The case manager submitted paperwork through the Medicaid Waiver Management Application (MWMA) and he was approved for a waiver. After approval, his application for residential went before Residential Review Committee, which denied residential because he was in nursing with no maladaptive behaviors. No due process rights were contained in the denial letter and the only sentence he was denied residential by committee. SW is one of a series of waiver denial cases Kentucky P&A accepted because Medicaid had failed to provide due process/fair-hearing notice. During the course of getting this issue resolved, Kentucky P&A staff had several meetings with Medicaid and provided written explanation of their failure to provide appropriate notice. After a meeting with Medicaid on waiver notice issue, Kentucky P&A attorney was told by Medicaid that it had reissued letter to SW. Kentucky P&A staff contacted SW to inquire about the letter. He did not recall receiving the letter. Medicaid through their attorney sent a copy of reissued notice provided to SW to Kentucky P&A. A copy of the reissued letter with appropriate regulatory cite was included with letter. The letter was mailed to the correct address of SW to begin the process the appeal of the denial. Systemic Advocacy (a) Kentucky P&A will review interpretation, implementation, policies and procedures of PASSR in Kentucky. Kentucky P&A examined Kentucky’s PASRR policies as applied to individuals with cerebral palsy (CP) that reside in nursing facilities. Kentucky denied PASRR Level II services to this group because they did not have cognitive deficits. Kentucky P&A researched the issue and contacted the PASRR Technical Assistance Center. Kentucky P&A concluded that for individuals with CP, a cognitive deficit is not a prerequisite to Level II services. (b)Kentucky P&A will post an online training on the interplay between Medicaid Waivers and EPSDT under new Medicaid law. This priority is not finished and will continue in FY 2019. (c)Kentucky P&A will contact the 14 CMHCs to discuss procedure for obtaining specialized services for NF residents who have an intellectual or developmental disability. Kentucky P&A staff examined the process for obtaining Preadmission Screening Resident Review (PASRR) II, specialized services for nursing home residents who are individuals with an intellectual or developmental disability. After the PASRR I is completed, the 14 CMHC’s or their designee conduct PASRR II evaluations on the prospective nursing home resident. The PASRR II evaluation is sent to the Department of Behavioral Health, Developmental, and Intellectual Disabilities (DBHDID), where a committee meets to decide whether the resident’s is eligible for specialized services. During Kentucky P&A’s inquiry, it was discovered some individuals who had no intellectual impairment were being denied specialized services in contradiction of federal statutes. Kentucky P&A staff is pursing PASRR II specializes services issue through direct client representation. V. Criminal Justice The rights of PAIR eligible clients in the criminal justice system Individual Advocacy (a)Kentucky P&A will represent or provide technical assistance to two PAIR eligible adults with disabilities living in jail or prison whose rights are violated directly due to their disability. Kentucky P&A provided technical assistance to the Department of Public Advocacy (DPA) attorneys representing two adults with disabilities who interface with the criminal justice system. (b)Kentucky P&A will provide technical assistance on ALL cases to Department of Public Advocacy attorneys, Court Designated Workers, Parole Officers, and Cabinet Caseworkers representing youth or adults with disabilities who interface with the criminal justice system and request assistance. Kentucky P&A provided technical assistance to the Department of Public Advocacy attorneys on two PAIR eligible adults. Case Summary A public defender contacted Kentucky P&A on behalf of one of his clients, LM, a person with orthopedic disability. LM was placed at a halfway house, but left it due to the home was not accessible, other residents were drinking and using drugs and others residing in the halfway house threatened LM with physical harm. The public defender and LM were concerned about LM violating conditions of parole by leaving the halfway house and going to a homeless shelter. Kentucky P&A advocate reached out to the state coordinator for halfway houses and asked if LY could move. This coordinated effort resulted in a new placement for MY. Systemic Advocacy (a) Kentucky P&A will continue to monitor the implementation of juvenile justice reform and investigate the ongoing changes to the juvenile justice system. Kentucky P&A staff attended Juvenile Justice Oversight Council meetings and various legislative committee meetings to track the progress of juvenile justice reform and the changes to the justice system. Kentucky P&A staff reviewed and commented on proposed changes to Department of Juvenile Justice (DJJ) policies relating to the care and treatment of youth in detention facilities. These changes are related to reforms in the juvenile justice system, but they also reflect a shift in the culture at the Department of Juvenile Justice toward treatment and positive interventions and away from a punitive mindset. Kentucky’s juvenile justice reforms have reduced the number of children entering the system. State leaders are now shifting their attention to racial disparities that exist in the juvenile justice system. There has been some recognition of the idea of disability-based disparities, but this attention has been minimal. Kentucky P&A has worked with DJJ to develop a pilot project that will allow Kentucky P&A and other stakeholders to work with youth involved in the juvenile justice system and assist with their transition from DJJ facilities back into their community. Partner agencies will provide trainings and support to both youth and their families. The goal is to provide education, supports, and services needed to reduce recidivism in these youth. (b) Kentucky P&A will review all policies and protocols regarding interaction with people with disabilities of the Kentucky State Police, Louisville Metro Police Department, Lexington Police Department and Hopkinsville Police Department. Kentucky P&A has obtained agency policies from Louisville Metro Police Department and has reviewed those policies. The review revealed that those policies exclusively deal with individuals with disabilities as crime perpetrators rather than victims. The language of the policies indicates a bias against individuals with disabilities. The Kentucky Autism Training Center (KATC) has begun a partnership with various police departments and first responders regarding working with individuals with autism. While these trainings cover a variety of topics relevant to individuals with various disabilities, KATC has not reviewed department policies or evaluated the impact of those policies on those professionals’ responses to individuals with disabilities. Kentucky P&A is working with KATC to determine if these two efforts can be combined or if the agencies can work together to make reform in both policy and practice. (c)Kentucky P&A will coordinate and present at Department of Public Advocacy quarterly meeting on crisis services in the community. Kentucky Protection and Advocacy ‘s director met with leadership of the Department of Public Advocacy and presented information related to crisis services that are available to Kentuckians with a mental illness and the requirements of the Community Mental Health Centers. The presentation included the provision of services that are included in the Amended Settlement Agreement between Kentucky Protection and Advocacy and the Cabinet for Health and Family Services. Kentucky Protection and Advocacy also arranged for the same information to be shared at the statewide Crisis Intervention Training quarterly meeting for law enforcement, as well. (c) Kentucky P&A will identify employment status of School Resource Officers (SROs) from five districts (Scott, Woodford, Owen, Franklin, Anderson) and review training requirements and policies and procedures for those SROs. KRS 158.441 authorizes the placement of school resource officers (SROs) in schools. SRO is defined to mean a sworn law enforcement officer who has specialized training to work with youth at a school site. The SRO can be employed through a contract between the school district and a local law enforcement agency or the Kentucky State Police. The statute requires SROs have “specialized training” to work with youth, but does not specifically enumerate that training. Kentucky P&A has identified the employment status of the SROs in the specified counties. Contracts between the districts and law enforcement agencies note generally that the SRO will complete training activities specified by the district, but there is no statewide curriculum or training requirement for SROs. The training requirement is fulfilled most frequently through basic training programs sponsored by the Kentucky Department of Criminal Justice Training or the National Association of School Resource Officers. Both organizations also offer advanced training courses. While it would be reasonable to expect that all SROs have taken at least the basic training offered by one of the two SRO organizations, there is no statutory requirement that precludes employment by a school without this training. As a result, review of individual personnel files would be the only method of obtaining individual credentials and level of training. VI. Protect, Promote, and Exercise Rights Individual Advocacy (a) Kentucky P&A will represent one PAIR eligible individual with disabilities, who are discriminated against related to their disability, in matters related to housing, post-secondary education, employment, and other, including access to goods/services/program provided by governmental agencies or entities. Kentucky P&A represented 2 PAIR eligible individuals. Case Summary: VB is a 44-year-old female who has an orthopedic disability. She contacted Kentucky P&A because due to the lack of accessible parking, sidewalks and restrooms at a music festival in her hometown. Case Summary Ms. Bland had spoken with the local Human Rights Commission and the Kentucky Commission on Human Rights, the local government, and the festival. Kentucky P&A attorney suggested VB take pictures and file a complaint with a Department of Justice (DOJ). The DOJ accepted the complaint and it was referred to mediation. The DOJ held two mediation sessions with VB, Kentucky P&A attorney and the music festival executive director, and festival attorney. The parties resolved the accessibility issues that were part of compliant filed with the DOJ. Issues resolved included: accessible parking spots, parking accessible signage, monitoring of accessible parking, no obstructions on sidewalks, accessible restroom, accessible port-a-potties, and signage for accessible restrooms. Systemic Advocacy (a) Kentucky P&A staff will monitor all draft and filed legislation (federal, state and local) that impacts Kentuckian’s with disabilities. Kentucky P&A staff reviews all draft legislation to determine the impact the legislation may have on the lives of individuals with disabilities. Where possible, P&A reviews proposed legislation before it is filed with the Legislative Research Commission (the first step in the legislative process). P&A staff provides comments to state agencies through both informal and formal processes; providing formal written comments or testimony as appropriate. P&A also provides information to consumers through posting information regarding proposed and draft legislation on the P&A website. (b) Kentucky P&A will update the webpage during the legislative. . Kentucky P&A posts information on its website regarding proposed and draft legislation during the legislative session. This includes advising the public when a committee heard (or is scheduled to hear) a bill and where the bill is in the legislative process. The website is updated daily during the legislative session. (c)P&A will collaborate with the Commonwealth Council on Developmental Disabilities to create disability-related information and referral system to develop resources and provide 6 trainings to 100 people regarding newly-created ABLE accounts available to Kentuckians State legislation passed in 2017 created ABLE accounts in Kentucky; soon after, the Kentucky State Treasurer’s office partnered with the Ohio State Treasurer’s Office to set up the apparatus for STABLE accounts. Since that time and during the last fiscal year, Kentucky P&A worked with CCDD, the state Treasurer’s office, other state agencies, and interested parties and stakeholders to roll-out STABLE accounts throughout Kentucky. This included monthly meetings, training by Kentucky P&A alone and in collaboration with the Treasurer’s office, and dissemination of Treasurer-developed written materials. (d) Kentucky P&A will collaborate with the Office for the Blind and other organizations to have assistance dogs included under KRS 525.200. BW and his assistance dog educated various legislators in the Kentucky General Assembly about the unintended consequences when the General Assembly removed assistance animals from the felony service animal assault law protections. Accompanied by Kentucky P&A staff and director, they were able to meet with members of both chambers. The 2017 General Assembly’s definition of service animal relates to police dogs and excludes assistance animals. The result is that even the most vicious assault on an assistance dog can now only be charged as a misdemeanor, whereas previously it could have been charged as a felony. Many of Kentucky P&A’s clients depend on assistance animals for mobility, safety and independence. Furthermore, the average cost of training a K9 patrol/narcotics dog is estimated at $8,000-$10,000. The average cost of training an assistance dog is estimated at varying between $7,000-$20,000. (e) Kentucky P&A will collaborate with the Human Development Institute, The Department of Aging and Independent Living and private guardians on implementation regarding Supported Decision Making as an alternative to guardianship. Kentucky P&A collaborated closely with Developmental Disability Network partner, The Human Development Institute-University of Kentucky, University Center of Excellence on Developmental Disabilities on promoting and educating various groups on Supported-Decision Making (SDM) as an alternative to Guardianship. In addition, we represented approximately five individuals with developmental disabilities on implementing SDM. VII. Employment Individual Advocacy There were not any PAIR eligible individual cases opened up under the priority for employment. Systemic Advocacy (a)Kentucky P&A will continue to participate as an active member of the Kentucky Interagency Transition Council. The Kentucky Interagency Transition Council (KITC) has representation from across the state from a variety of agencies supporting PAIR eligible students. Participants are from several departments of the University of Kentucky’s Human Development Institute (HDI), the Department of Vocational Rehabilitation, several departments within the Kentucky Department of Education, Educational Cooperatives, the Commission for Children with Special Health Care Needs, KYSPIN (a parent/community group), the Department of Juvenile Justice, Kentucky Post School Outcomes (KYPSO), and Kentucky Protection and Advocacy. KITC meets quarterly to discuss resources within the state to assist students transitioning from high school to higher education or to employment. Presentations are a typical part of the quarterly meeting. For example, the July 2018, meeting included a presentation by the KYPSO member about the measurement changes to Part B Indicator 14. Council members discussed the definition of competitive employment. We reviewed the suggestions from the National Technical Assistance Center on Transition (NTACT) and the focus to align the changes with the Rehabilitation Act of 1973. For Kentucky Protection and Advocacy, participation allows a broader knowledge of what is available for students across the state, how data is collected, and hear about any changes or proposed changes the Kentucky Department of Education may make in regards to transition services. This knowledge allows P&A to provide up to date guidance to those we serve. VIII. Self-Advocacy Individual Advocacy There were not any PAIR eligible cases opened up under the priority for Self Advocacy. Systemic Advocacy (a)The PADD Board and Kentucky P&A staff will research how other states have effectively passed a resolution by their state legislature that apologizes to citizens for the treatment they endured in the past, due to disability, in hopes of having a similar resolution passed by 2018. Kentucky P&A worked together with a Kentucky Representative to create a resolution for 2018 that apologizes to citizens for the treatment they endured in the past, due to disability. The Representative met multiple times with staff and PADD Advisory Chair. It was determined that they would not be able to draft a resolution at this time, but will consider doing so in the future. (b)P&A advisory bodies will work with members of the Legislative and Executive branches to adopt the new icon for accessibility in all state properties and encourage local/county governments, colleges/universities and private business to do the same. Kentucky P&A PADD Advisory Board met with approximately 15 members of the state legislator to encourage the Legislative and Executive branches to adopt the new icon for accessibility. The Legislative bodies have not chosen to move forth with this recommendation at this time. The PADD Advisory board will continue to encourage the Kentucky Legislative body and private businesses to adopt this icon when they have the opportunity. Outreach Outreach to underserved areas and populations that serve PAIR eligible clients Individual Advocacy (a) Kentucky P&A will represent two PAIR eligible individuals from underserved disability, minority, or geographic groups/populations (i.e. Appalachia, LGBTQ, Latino, Deaf/hard of Hearing). Kentucky P&A represented two PAIR eligible individuals from underserved disability, minority, or geographic groups/population. Case Summary Long-term care ombudsmen regarding a 36-year-old male, DB, who is living in a nursing facility, contacted Kentucky P&A. DB, a Medicaid recipient and paralyzed due to complications from HIV. For over 5 years, DB had a private room. He stated when he first entered the facility; he was placed with older residents who eventually died. He stated this was very depressing. The nursing facility just hired a new administrator, and the administrator explained to DB that he could only have a private room if he paid the difference. DB also suffers from seizures. He stated stressful situations provoke his seizures. Kentucky P&A attorney researched the regulations and found one that stated a Medicaid recipient could have access to a private room if ordered by the attending physician or requested by the resident or the resident’s family/responsible party. The NF cannot charge the resident if the private room is by order of the attending physician. DB’s attending physician wrote a letter to support DB’s request for a private room. DB continues to live at the nursing facility in his private room. Systemic Advocacy (a) Kentucky P&A will participate in fundraising efforts to support Relay for Life and will participate in the annual Relay for Life Event in Frankfort. Kentucky P&A and the PAIMI Advisory Council participated in monthly fundraising efforts to support Relay for Life and participated in the annual Relay for Life event in Franklin County, Kentucky. (b)Kentucky P&A will participate in two non-disability related outreach events. Kentucky P&A participated in two non-disability related outreach events. One was presenting to psychology students about Kentucky P&A at Western Kentucky University and the other was presenting to Ending Domestic Violence Conference. (c)Kentucky P&A will collaborate with the Kentucky Commission for the Deaf and Hard of Hearing, the Department for Behavioral Health and service providers to create informative ASL videos with Closed Captions to inform the deaf and hard of hearing community of the services and resources available. Kentucky P&A continued its collaboration with the Kentucky Commission for the Deaf and Hard of Hearing and the Department for Behavioral Health in the creation of informative ASL videos with Closed Captions to inform the deaf and hard of hearing community of services and resources available through P&A. Videos, which have been posted on P&A and the Commission’s websites, included the following topics: Introduction to P&A, P&A Intake Procedure, P&A Education, P&A Advocating for Youth, P&A Advocating for Adults, and Nursing Home Ombudsman Agency: Senior Care Facilities. New to 2018 are P&A Voter Fraud and Voting Explained. (d) Kentucky P&A will participate in four outreach efforts to underserved communities, including the Deaf/Hard Hearing and Latino communities. Kentucky P&A participated in outreach efforts, the Kentucky Commission of Deaf and Hard of Hearing 35th Anniversary Conference, Deaf Fest, and outreach events in underserved geographical areas of the state, Paducah and eastern Kentucky.

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.

I. Abuse, Neglect, and Exploitation Individual Advocacy (a)Kentucky P&A will investigate all *suspicious deaths. The Internal Abuse and Neglect (IAN) Team will review all reports of suspicious deaths reported to P&A or that P&A becomes aware via The Office of Inspector General (OIG), media outlets, monitoring efforts, etc. The IAN Team will send, as appropriate, to team leaders for case opening/assignment. (b) Kentucky P&A will investigate all serious injuries, including those sustained during the use of physical restraint/seclusion at schools and other facilities/community programs providing services to individuals with disabilities. The IAN Team will review all reports made to P&A or made by other entities, including The Office of Inspector General, media outlets, and monitoring efforts. The IAN Team will forward, as appropriate, to team leaders for case opening/assignment. Systemic Advocacy (a)IAN will review Type A/B Citations, incident reports, and other notices of alleged abuse/neglect/exploitation to determine further action, including conducting primary or secondary investigations. (b) Kentucky P&A will participate in Project SAFE (Safety & Accessibility for Everyone) planning/educational/outreach efforts and implementation of the strategic plan and the Crisis Intervention Training (CIT) with the Louisville Metro Police and the statewide CIT program. (c)Kentucky P&A will request and review quarterly all PRTF serious occurrence reports. P&A will compare reports provided with OIG facility surveys and follow-up all failures to report with the facility and/or Center for Medicare and Medicaid Services. (d)Kentucky P&A will provide technical assistance and publish a guide for parents/guardians regarding responding to allegations of misuse of restraint and seclusion in schools. (e)The IAN Team will review all past referrals, including OIG Type A Citations and other incident reports, to identify trends of abuse/neglect in facilities. II Olmstead/Community Integration Individual Advocacy (a)Kentucky P&A will provide technical assistance to at least one hospitals, Department of Juvenile Justice workers, Court Designated Workers (CDW), nursing home workers, and Department of Community Based Services(DCBS) workers regarding denial of or inability to access community services that lead to or increase a child with disabilities risk of institutionalization. (b)Kentucky P&A will provide technical assistance to at least one parent/guardian of children with disabilities or represent children with disabilities who are institutionalized (including the Department of Juvenile Justice) or at risk of institutionalization due to denial of or inability to access community services. (c) Kentucky P&A will represent or provide technical assistance to two individuals living in or at risk of being placed in a nursing home due to lack of community resources. (d)Kentucky P&A will represent or provide technical assistance to 2 adults with disabilities who are institutionalized or at risk of institutionalization and in need of community services /supports under Olmstead, and who do not meet the above individual advocacy priorities. Systemic Advocacy (a) Kentucky P&A will request on a quarterly basis the number of children/youth, including diagnosis and location, placed out of state. (b) Kentucky P&A will collaborate with Long Term Care Ombudsman, Kentucky Commission on Deaf and Hard of Hearing, Department of Behavioral Health Intellectual Disabilities, private entities and citizen volunteers to identify and address issues associated with older deaf and hard of hearing individual through education and outreach, development of a resource guide, creation of a volunteer phone visiting program and explore grant opportunities under Civil Monetary Penalty funds. (c)Kentucky P&A will continue to monitor individuals under state guardianship who have been involuntarily remained in any of the state psychiatric hospitals for longer than 365 days. Monitoring will include meeting with state guardianship, Department of Behavioral Health Intellectual Disabilities, and hospital staff, and advocating for placement in the least restrictive environment. III. Education Individual Advocacy (a) Kentucky P&A will represent at least one child/youth in public schools or living in an Intermediate Care Facility for Individuals with Intellectual Disabilities who have inappropriate Individual Education Plan or who are placed in an inappropriate educational setting. (b)Kentucky P&A will provide technical assistance to the parent/guardian/service provider for two children/youth with disabilities regarding addressing alleged violations of the child’s educational rights. Systemic Advocacy (a) Kentucky P&A will monitor the implementation of a charter school system in Kentucky and participate as appropriate to ensure equal access and participation by children with disabilities. (b)Kentucky P&A will monitor the implementation of the accountability system in Kentucky under Every Student Succeeds Act. (c) Kentucky P&A will monitor the implementation of the settlement agreement between the Kentucky Department of Education and the Jefferson County Public Schools regarding the administration of the public school system and the impact on children with disabilities, including children with Severe Emotional Disturbance, in Jefferson County. IV. Health Care Individual Advocacy (a)Kentucky P&A will represent or provide technical assistance to at least one Medicaid eligible adult, who are denied medical, dental, and other health services or whose services are reduced or terminated. (b)Kentucky P&A will represent at least one Medicaid eligible child/youth with disabilities relating to their denial of or inability to access healthcare services,including physical and behavioral health services. Priority will be given to those children/youth committed to or at-risk of commitment to Department of Community Based Services solely for purpose of obtaining services. Systemic Advocacy (a)Kentucky P&A will closely monitor the 1915 waiver redesign, provide comments, and attend all public meetings. P&A will also advocate for the continual input by people with disabilities who access those services. (b)Kentucky P&A will monitor 5 long term care facilities across the state for abuse and neglect, Preadmission Admission Screening and Resident Review (PASRR) screening, assistive technology, transition to community and barriers to voting with facilities to include the Kentucky State Reformatory, facilities cited for deficiencies, facilities where P&A has existing clients and referrals from other agencies. V. Criminal Justice Individual Advocacy (a)Kentucky P&A will represent or provide technical assistance to two adults with disabilities living in jail or prison whose rights are violated directly due to their disability. (b)Kentucky P&A will provide technical assistance on at least case to Department of Public Advocacy (DPA) attorneys, Court Designated Workers, Parole Officers, and Caseworkers representing youth or adults with disabilities who interface with the criminal justice system and request assistance. Systemic Advocacy (a)Kentucky P&A will continue to monitor the implementation of juvenile justice reform and investigate the ongoing changes to the juvenile justice system, including monitoring system of care. (b)Kentucky P&A will work to reduce and eventually eliminate solitary confinement by continuing to gather and organize information regarding Department of Correction’s practice of placing inmates with disabilities mentally ill individuals in isolation and using that information to pursue and promote systemic changes to relevant policies and regulations. (c)Kentucky P&A will collaborate with the Department of Juvenile Justice to identify children with disabilities and their families that would benefit from additional services/supports in the community. VI. Protect, Promote, and Exercise Rights Individual Advocacy (a)Kentucky P&A will represent or provide technical assistance to at least one individual with disabilities, who is discriminated against related to their disability, in matters related to housing, post-secondary education, employment, and other, including access to goods/services/program provided by governmental agencies or entities. Systemic Advocacy (a)Kentucky P&A staff will monitor all draft, filed legislation, and proposed regulations (federal, state and local) that impacts Kentuckian’s with disabilities. (b)Kentucky P&A will update the webpage during the legislative session. (c)Kentucky P&A will collaborate with interested organizations to have assistance dogs included under KRS 525.200. (d)Kentucky P&A will participate in Working Interdisciplinary Networks of Guardianship Stakeholders. (e)Kentucky P&A will collaborate with Human Development Institute to educate people with disabilities, families, teachers, and attorneys and other on Supported Decision Making. VII. Employment Systemic Advocacy (a)Kentucky P&A will continue to participate as an active member of the Kentucky Interagency Transition Council. VIII. Self-Advocacy Systemic Advocacy (a) The Protection and Advocacy for Developmental Disability (PADD) advisory board will document the limited and difficult physical access to Kentucky’s Capitol. They will educate their legislators and advocate for modifications to the building to provide better access for all individuals, regardless of their mobility needs. IX Outreach Individual Advocacy (a)Kentucky P&A will represent or provide technical assistance to two individuals from underserved disability, minority, or geographic groups/populations (i.e. Appalachia, LGBTQ, and Latino, Deaf/hard of Hearing). Systemic Advocacy (a)Kentucky P&A will participate in fundraising efforts to support Relay for Life and will participate in the annual Relay for Life Event in Frankfort. (b)Kentucky P&A will participate in nine non-disability outreach events with a focus on underserved communities. (c)Kentucky P&A will collaborate with the Kentucky Commission for the Deaf and Hard of Hearing, the Department for Behavioral Health, other interested agencies and service providers to create informative ASL videos with Closed Captions to inform the deaf and hard of hearing community of the services and resources available.

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

Part VI. Narrative A. Kentucky P&A received $200, 897 in funds for FY 2018 from RSA to administer PAIR activities. The grant number is H240A190018. During FY 2018, $167,830 was spent on personnel costs, which includes staff salaries and wages (92,844.52) employer’ s FICA (6,997.67), employer’s health insurance (15,712.43), employer’s life insurance (22.56), employee training(317.50), employer’s retirement including payment for sick leave (51,936.25). Operating Expenses included food products (30.49), in-state travel (245.94), out of state travel (977.00), dues, and subscriptions (1,000) which totals $2,253.43. Out of the $200, 897grant award, $170, 084.36 was utilized and a remaining balance of $30, 813 will carry forward to FY 2019. B. Kentucky P&A has a staff of 18. This includes the Director, Legal Director, six attorneys, six advocates, three support staff and the fiscal administrator. During FY 2018, Kentucky P&A hired one attorney. There are not any vacancies. All employees bill to the PAIR grant with the exception of one support staff and the fiscal administrator. C. Kentucky P&A does not have a Board of Directors or a PAIR Advisory Board. D. During FY 2018, Kentucky P&A addressed one grievance. E. The Client Assistance Program (CAP) and the State Long Term Care Program are not a part of Kentucky P&A’s agency. There is a collaborative effort with both entities. Kentucky P&A refers clients to the CAP and provides the CAP with information and resources and Kentucky P&A make referrals to CAP to assist clients of the Office of Vocational Rehabilitation, Office of the Blind, Independent Living Centers, and employment programs in the state of Kentucky in identifying and receiving services. Kentucky P&A interfaces with the State Long Term Ombudsman’s Program through participation on meetings and councils and referrals to Kentucky P&A from the Long Term Car Ombudsmen concerning residents residing in long-term care facilities. A member of Kentucky P&A staff attends multiagency meeting chaired by the Long Term Care Ombudsmen that is held quarterly in four regions of the state. Kentucky P&A utilizes the Long Term Care Ombudsmen to address rights violations either observed by Kentucky P&A or brought to Kentucky’s P&A’s attention by residents of the facility. These rights violations are reported to the Office of Inspector General and to Adult Protective Services if there is a concern of abuse or neglect.

Certification

Signed?Yes
Signed BySusan Abbott
TitleFederal Program Coordinator
Signed Date12/18/2019