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RSA-227 for FY-2021: Submission #1190

North Carolina
09/30/2021
General Information
Designated Agency Identification
NC Department of Health and Human Services
2001 Mail Service Center
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Raleigh
NC
27699
http://www.ncdhhs.gov
984-236-5000
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Operating Agency (if different from Designated Agency)
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Additional Information
John Marens
John Marens
919-855-3500
John.Marens@dhhs.nc.gov
Part I. Non-case Services
A. Information and Referral Services (I&R)
336
56
0
0
322
247
961
B. Training Activities
8
1265
An electronic training course has been developed and all new DSB and DVRS employees must complete it as part of their new employee orientation. All existing employees must also complete the training annually.
We did presentations consisting of CAP history, our jurisdiction as it relates to programs that receive federal funding from the Rehabilitation Act, as amended, and due process information for the public rehabilitation agencies to: Easter Seals CRP, LifeSpan CRP, IPS Team Leads and Peer Mentors, Josh’s Hope Foundation, Autism Society and multiple DVRS and DSB local offices.
C. Agency Outreach
Due to the impact of COVID-19, conferences and trainings that the CAP historically attend were cancelled. There has been a trend in recent months to hold virtual conferences and trainings however CAP has determined that virtual exhibiting was not effective so our ability to reach the unserved/underserved population has been significantly reduced. We will continue to try to identify other methods of outreach in the coming months.
NCCAP engages in a number of outreach efforts. Our efforts are intended to reach professionals that deal with underserved/unserved populations and to the public. CAP has been attending the North Carolina Council on Developmental Disabilities (NCCDD) quarterly meetings where both professionals and consumers attend. CAP participates in both the general DVRS and the DSB Public Forums across the State to reach consumers, including those in rural areas. The CAP Director participates in the quarterly Statewide Independent Living Council meetings staffed by persons with disabilities and the directors of the Centers for Independent Living to educate members on CAP activities and services. The CAP director is a member and chair of the State Rehabilitation Council. We also present at the DVRS and DSB staff orientations when invited.
D. Information Disseminated To The Public By Your Agency
0
0
0
5000
0
0
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E. Information Disseminated About Your Agency By External Media Coverage
N/A
Part II. Individual Case Services
A. Individuals served
23
74
97
0
12
B. Problem areas
1
17
60
6
0
3
10
0
C. Intervention Strategies for closed cases
7
31
47
0
0
0
85
D. Reasons for closing individuals' case files
61
17
5
0
0
1
0
0
1
0
0
0
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E. Results achieved for individuals
12
2
1
3
49
16
0
2
0
0
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Part III. Program Data
A. Age
2
13
25
54
3
97
B. Gender
51
46
97
C. Race/ethnicity of Individuals Served
0
2
5
44
0
46
0
0
D. Primary disabling condition of individuals served
4
5
0
0
4
1
3
1
5
7
1
1
5
4
2
1
0
0
1
6
14
0
0
0
5
17
2
0
1
2
0
1
1
3
97
E. Types of Individuals Served
9
0
77
10
0
1
Part IV. Systemic Activities and Litigation
A. Non-Litigation Systemic Activities
0
On-going issues
• Co-pays for services for clients receiving SSI/SSDI - we continue to wait for RSA to issue an advisory.
• Assistance with client purchase of a vehicle for modification - we continue to advocate that DVRS change this policy and reinstate the former policy on assistance with up to 50% of the cost of the chassis for VR clients who qualify.
• DVRS agency vacancy rates - we hope the CAP and SRC can continue to look for ways to advocate for changes that will impact retention & recruitment
• We continue to monitor, report on obstacles, and work to positively impact the DVRS – IPS teams collaboration for the benefit of clients with significant mental illness. We do not see an end to the DOJ settlement monitoring activity until the systemic problems are resolved.
B. Litigation
0
0
0
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Part V. Agency Information
A. Designated Agency
Internal to the State VR agency
NC Department of Health and Human Services
No
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B. Staff Employed
Director
Two Client Advocates
Administrative Assistant
Part VI. Case Examples
Case Examples
Issue - Communication
• CAP received a call from a 53 year old female with spina bifida, a current recipient of DVRS, SSDI and a wheelchair user. She is in an Occupational Therapy Assistant Program and had hopes of completing her masters in Occupational Therapy with DVRS assistance. The issue she had was that her field work was scheduled to begin within two weeks and she didn’t feel that DVRS would be able to complete all the necessary steps quickly enough to provide her with tuition and maintenance as approved on her IPE. She shared that field work opportunities were difficult to find, so she had to take advantage of this opportunity and needed DVRS to help her make this happen as quickly as possible. The school nor the hotel were vendors. CAP began negotiating for the agency to make the client a vendor and pay her directly for tuition and maintenance in the form of hotel expenses, transportation and meals. Before that could happen the client informed CAP that she no longer required assistance with tuition. She did, however, need the maintenance. The agency approved her meals and transportation however, due to the hotel exceeding allowed amounts the counselor had to request an exception to policy. CAP worked with the client to determine the funds she needed up front to secure her room and transportation. CAP advocated for the agency to provide imprest cash to cover the first week so she could get started while the rest of the paperwork was being completed. DVRS approved the exception to policy for the hotel charges. They also provided the client with the first weeks expenditures with imprest cash while completing the vendorship approval process. They made the client a vendor and were able to provide her with maintenance for the duration of her stay. Due to CAP advocacy, the client was able to begin her fieldwork experience as planned without further delays.

Issue - Delay in Counselor Action
• A 38 year old female with orthopedic issues applied to DVRS. She was found eligible and she and her counselor agreed on the services of the IPE, however, before the plan was signed the counselor left the agency. The client stated she thought she was approved for assistance with Law School for Spring semester of 2020. She started school, took out loans. The same scenario happened a second time, in that, her counselor left the agency and her case was left unattended. She contacted CAP and an investigation began. CAP learned that all the preliminary paperwork was completed on client's end so that she could begin school in the Spring 2020. All documentation gave client indication that she would be sponsored by the agency. The client discovered that the school was not a vendor but DVRS did not notify her of this until months into the program. As a consequence, the school was not paid by DVRS and the client had to take another loan. Vendorship was established in July 2020 and the process for supporting Fall 2020 began again with assurances that everything was in place. There were further delays as DVRS still didn't put her into a plan. Documentation did not indicate any reason for the delays.
In November 2020, client began working on getting information to DVRS to support her for the Spring 2021 semester. DVRS then required updated medical records. Due to DVRS completing the consent for release of information incorrectly, the medical provider did not send the records. The provider did not notify DVRS. DVRS then notified the client that they would have to close the case by December 13, 2020 (which was a Sunday) if they did not get records. Our client called the provider, was notified of the issue, notified DVRS, and a correct form was sent. Client informed DVRS that the provider would not fax the file and that it was in the mail. It did not arrive until the following Monday, December 14th. DVRS had already closed the case on Friday, December 11th based on the Extension for IPE Development expiring. It is of note that there had been 10 extensions in this case. The client now owes $20,000 in loans and will have to stop school as she cannot afford more loans. CAP contacted the DVRS counselor and the Chief of Policy. A new case was opened that day. The agency is moving toward sponsorship for Spring 2021 (this starts in March). CAP advocated for reimbursement for Spring and Fall 2020. The Chief of Policy (COP) would not consider reimbursement for the Spring 2020 semester as the school was not a vendor at that time. The COP did approve reimbursement for Fall 2020. The client was satisfied with the reimbursement of one semester and chose not to appeal the agency decision. She plans to pursue her degree with DVRS assistance.

Issue - Application/Eligibility
The daughter of a 69 year old man with a diagnosis of an intellectual disability called CAP to seek help for her father. Her father currently works as a janitor for the Coast Guard through Skills, Inc. Skills Inc. is a DVRS supported employment vendor.
The daughter felt her father was being mistreated on the job. He had been written up several times and had also been sent home due to minor infractions. She felt he had not been given adequate supports or accommodations for his challenges nor was he being given adequate supervision. For example, he was written up for taking candy from a desk when he was told by the person who had the candy he could have some. Her father has difficulty making situational distinctions, and these write-ups did not take his disability into consideration. The supervisor also had him cleaning the toilet with a toothbrush as punishment at one point.
She made an appointment to meet with her father and with the supervisor at Skills Inc. She also called CAP. The meeting with Skills did not go well. In the daughter's opinion, it seemed the Director was more worried about their reputation and losing the contract with the Coast Guard than helping her dad. They informed her that if he was written up one more time he would be fired. The CAP advocate asked if her father was a client of DVRS. Upon getting the release of information signed the advocate reached out to the DVRS Unit Manager to discuss the case. CAP learned that his case had been closed for some time. CAP educated the family again about DVRS services and encouraged them to get the process going for whichever was ultimately appropriate – job retention or finding a new job. She agreed. Upon learning the case had been closed the daughter needed clarification as to why. The CAP advocate explained the closure policy. CAP again reached out to the Unit Manager to facilitate an application for services. At first CAP got no response and had to follow up to make sure the client’s family was contacted, but eventually DVRS made the connection and took an application.
CAP emphasized the need for quick turnaround, given the nature of the concerns, so DVRS quickly did an intake, found the client eligible, and referred him for job retention services. An IPE was created that included job coaching and on-the-job supports. Due to CAP advocacy and facilitation, the client is now armed with the appropriate supports to assist him keeping his job.


Issue - Vehicle/Residence Modifications
A 52 year old female with orthopedic issues contacted CAP stating that DVRS had lead her to believe they would purchase a lift for her vehicle to accommodate the scooter they had previously purchased in May 2020 for her. Her vehicle needed repairs before it would meet the DVRS inspection and approval for the modifications for the lift. Although she is a SSDI recipient, she paid for the repairs herself. A few months later she was told the Chief of Policy (COP) had denied the modifications. CAP investigated the case, which was poorly documented, and found that there was significant lack of communication. CAP contacted the Unit Manager to try to negotiate but the Unit Manager declined to investigate. She felt that due to the ruling of the COP the matter was closed. During the investigation the CAP advocate found that the COP had made the ruling in July. The email thread documents the repairs having been made in June, July and August of 2020. She was not notified that the COP had denied the modifications until September. DVRS did not respond to the clients multiple emails letting them know the repairs had been completed. CAP contacted the COP to provide the details, documentation and timelines of miscommunication as well as the list of repairs that had been completed. CAP argued that the scooter that DVRS had purchased would be useless without a mode of transportation for it. The COP reconsidered and reversed her decision. The modifications were completed and the client is now able to move forward with job seeking.
Certification
Approved
Tara Myers
Deputy Secretary for Human Services
2021-11-29
OMB Notice

OMB Control Number: 1820-0528, approved for use through 07/31/2023

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