RSA-227 for FY-2018: Submission #1014

North Carolina
9/30/2018
General Information
Designated Agency Identification
Department of Health and Human Services
2801 Mail Service Center
{Empty}
Raleigh
NC
27699
http://nc.dhhs.gov/dvrs/
{Empty}
{Empty}
Operating Agency (if different from Designated Agency)
Department of Health and Human Services
2801 Mail Service Center
{Empty}
Raleigh
27699
{Empty}
{Empty}
http://nc.dhhs.gov/dvrs/
{Empty}
{Empty}
Additional Information
John Marens
John Marens
(919) 855-3600
{Empty}
Part I. Non-case Services
A. Information and Referral Services (I&R)
389
107
1
4
453
361
1315
B. Training Activities
1
11
CAP director was asked to present at the COAST training. The training was an overview of CAP services and was presented to the newly hired Vocational Rehabilitation counselors. <P><p>
C. Agency Outreach
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 staff consistently exhibit at conferences where those who serve individuals who are identified as potentially underserved/unserved can be educated about both CAP and the VR agencies services. This year this includes: the Addiction Professionals of NC Annual Conference, National Association for the Mentally Ill (NAMI) Conference, the Annual National Association of Social Workers (NASW) Conference, North Carolina Rehabilitation Association (NCRA), and the Area Health Education Centers for various conferences that focus on substance use. <p><p>CAP has also been attending the North Carolina Council on Developmental Disabilities (NCCDD) quarterly meetings where both professionals and consumers attend. CAP regularly exhibits at the NC Vocational Evaluators, Work Adjustment Specialists Annual Conference. This is of interest as many graduate students in rehabilitation counseling usually attend. All these conferences are held in different parts of the State so that CAP reaches across the geography of the State in its efforts. CAP participates in both the General VR and the DSB Public Forums across the State to reach consumers, including those in rural areas. To reach the transition population, NCCAP exhibits at the NC Annual Exceptional Children's Conference which parents and teachers attend, the NC Works Conference and the NC Division on Career Development and Transition Conference, the NC School Counselors Association, as well as local Transition Conferences when invited. 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. <p><p>
D. Information Disseminated To The Public By Your Agency
0
0
0
7630
21
0
<P><p>
E. Information Disseminated About Your Agency By External Media Coverage
Vocational Rehabilitation Agency Program Specialists often request CAP brochures to disseminate to the audiences for trainings and conferences they attend. The specialists attend various community activities throughout the state targeting the deaf and hard of hearing, mental health populations as well as the population that utilize Spanish as their first language. <P><p>
Part II. Individual Case Services
A. Individuals served
23
106
129
0
17
B. Problem areas
1
21
68
12
0
5
3
0
C. Intervention Strategies for closed cases
11
60
39
0
0
1
112
D. Reasons for closing individuals' case files
55
30
15
0
6
1
2
3
0
0
0
0
<P><p>
E. Results achieved for individuals
30
4
2
0
51
13
6
6
0
0
<P><p>
Part III. Program Data
A. Age
3
16
19
81
10
129
B. Gender
63
66
129
C. Race/ethnicity of Individuals Served
3
1
0
53
1
70
1
0
D. Primary disabling condition of individuals served
3
2
0
3
6
4
4
3
5
5
0
4
4
6
0
2
0
0
2
7
20
1
2
0
6
29
1
2
0
1
0
1
3
3
129
E. Types of Individuals Served
13
0
66
29
3
1
Part IV. Systemic Activities and Litigation
A. Non-Litigation Systemic Activities
3
1.1. Follow up: Around 2 years ago, the CAP had requested that the VR agency amend its policy on the ban it established on providing walk-in tubs as a service in its IL and VR programs. We understood that the policy would be amended to remove this ban. When the policy manual was revised, to our surprise, the language it contained still stated that the agency would not provide walk-in tubs as a service. The CAP argued that this policy violated federal regulations that stated that a VR agency cannot categorically state that it will not provide a particular service, or consider cost as a reason for denial. While we initially met with resistance, in the end this language was removed from the policy. <p><p>2.The second follow up is related to the blanket requirement that all applicants participate in a Group Orientation that is utilized by large offices to assist them in accommodating the large number of referrals they receive. Last year, we found that VR was not taking into consideration individuals with disabilities that might cause them to be uncomfortable in group settings (i.e. mood/anxiety disorders, schizophrenia), and thus, was not displaying an adequate understanding of mental illness, nor respecting &ldquo;informed choice.&rdquo; The VR administration agreed to discuss this with the Regional Managers. To our knowledge, this issue has been resolved in that we have had no new complaints in this regard. <p><p>New systemic issues: <p><p>3.In North Carolina, the Vocational Rehabilitation (DVR) counselor contacted CAP on behalf of one of his clients to obtain due process information. The client was a 20 year old with a diagnosis of a specific learning disorder who was working toward obtaining his employment goal of certified nursing assistant. The client did not have a high school diploma and was working on obtaining his general equivalency diploma (GED). His IPE development included DVR assisting him with maintenance (transportation mileage reimbursement) to and from class. At the time of his IPE development, there were no fees associated with taking the GED exam. The counselor was in support of paying for the exam, however, DVR policy stated that they would not pay for preparatory training. CAP advised the counselor on due process and suggested the client formally seek an exception to policy through the DVR unit manager and DVR Chief of Policy. CAP also contacted the Chief of Policy (COP) to advocate for the exception. CAP advocated that the client was asking for the agency to pay for the test, not the GED training; the GED training was listed as a service on the IPE; and at the time the DVR policy was written, agencies were not charging fees to sit for the exam. The COP granted the exception and approved the payment. The Chief of Policy also agreed with the CAP that the policy should be amended and brought it to the attention of the VR Policy Committee. The policy has since been amended to include GED testing. With CAP inte
B. Litigation
1
0
1
A Division of Services for the Blind (DSB) client in her 30&rsquo;s contacted the CAP due to a delay and denial of services from the DSB. <p><p>The client&rsquo;s IPE was developed in October 2013 and she had been working with the DSB for a few years, pursuing job searching both on her own and through the DSB. She had work experience as a teacher and had only been able to find either part-time or temporary positions in academia over the course of her DSB case. Her DSB record showed that she had engaged in significant efforts to find sustainable employment. Unable to do so, she began to think outside the box and used her ingenuity and connections to develop a viable plan for employment. The client wanted to become a teacher abroad - in Greece. She researched the necessary requirements to achieve this goal, developed a detailed plan, and she had the personal contacts in Greece that could assist her in being successful. She requested DSB assistance to achieve her goal, which included air fare, and training costs to obtain certification in TEOSL / TESL / TEFL from Oxford Seminars. This training would give her the credentials to teach English in Athens & the TEFL certification will give her the credential to teach English anywhere in the world. We noted that this training is shorter, more condensed, and less expensive than pursuing a graduate degree in teaching ESL, which is what the DSB was recommending. She also requested orientation and mobility training related to immersion in a new culture and language. While the client spoke Greek, she was not fluent to the degree needed for her job goal. The DSB denied the client&rsquo;s request and the CAP assisted her in filing for an Administrative Review (AR) and Appeal Hearing (AH). The DSB agency assigned the same person who denied the client&rsquo;s request for services to do the AR, in violation of NC General Statutes. When we were not successful at the AR level, the CAP represented the client in an Appeal Hearing. The DSB agency assigned the same Hearing Officer (HO) it had been using solely for years, also violating regulations that require that the agency must assign HO&rsquo;s &ldquo;from a random pool.&rdquo; The CAP instructed the client to request a new, different HO. When the Hearing Officer (HO) found in favor of the client, the DSB agency filed for a review of the HO&rsquo;s decision with the office of the Secretary of DHHS. The attorney representing the Secretary&rsquo;s office overturned the HO&rsquo;s decision. Past history gave evidence that this attorney has never decided in favor of a client. The CAP determined that this decision was without reasonable cause, and the CAP engaged an attorney on behalf of the client, who at that time had already moved to Greece at her own expense, and without any DSB assistance. When legal negotiations failed, and it became apparent that the DSB was not acting in good faith, the CAP filed a lawsuit on behalf of the client against the Director of the
Part V. Agency Information
A. Designated Agency
Internal to the State VR agency
NC Department of Health and Human Services
No
N/A
B. Staff Employed
Four full-time positions occupied 100% of the year. Director Two Client Advocates Program Assistant <P><p>
Part VI. Case Examples
Case Examples
1.Reason: Appropriate communication was established to help a client with deafness move forward with his case. A 58-year-old male, who is deaf, contacted CAP because he was frustrated with the lack of timely communication he was receiving from his counselor and lack of progress with his case. The Client Advocate (CA) contacted the Unit Manage (UM) and discovered that the agency was at a standstill due to concerns about the client&rsquo;s conduct. CA discussed those concerns with the client and let him know that before he could move forward, VR would like to meet with him to discuss conduct expectations. The client was not receptive to meeting with the current UM due to lack of rapport and wanted to have his case transferred to another VR office closer to his home. We were successful in getting this transfer. The CA discovered that the client struggled with untreated ADHD. The CA, having worked with people to manage ADHD symptoms through coaching techniques, was able to identify that the client needed to have procedures and explanations broken down for him in order to alleviate some of the frustrations he was experiencing in understanding and completing the process. CA suspected these challenges contributed to the lack of structure and direction of his VR case, and shared those insights with the client and VR. CA then communicated with all parties to arrange a meeting with the Regional Director, and the Unit Managers of the new VR office, prior to them formally accepting his case. The meeting took place at the new VR office with an interpreter present and the CA facilitating the conversation to help create structure and identify steps to move forward. The code of conduct was discussed, and the client was given an opportunity to express his frustrations with the lack of progress. As a result of better communication, the UM agreed to accept the case. During the meeting, CA advocated for the client to be given an opportunity to pursue an employment goal of starting his own small business in hemp farming. All agreed that more data was needed, and the interpreter shared that two interpreters may be beneficial in the future because the client and his wife seemed to share a short-hand version of ASL that was unique to them, and some of the translation was being lost in picking up the nuances in body language. CA noted that the client had a very expressive style in using his hands and body to convey meaning, noting that this may have been interpreted by staff as aggression as the client became more demonstrative when frustrated. CA shared these observations and the client&rsquo;s challenges with ADHD, suggesting that the client be allowed to take a break for an agreed-upon amount of time when frustrated to allow him to calm down and then come back to the conversation. Two interpreters were assigned, the client received a new counselor with a more structured approach, and the client agreed to complete the psychological and vocational evaluations to info
Certification
Approved
Chris Egan
Senior Director
2018-12-12
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