RSA-227 for FY-2020: Submission #1153

Massachusetts
09/30/2020
General Information
Designated Agency Identification
Naomi Goldberg
MOD, One Ashburton Place, #1305
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Boston
MA
02108
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800-322-2020
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Operating Agency (if different from Designated Agency)
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Additional Information
Naomi Goldberg
Naomi Goldberg
617-979-7327
naomi.goldberg@mass.gov
Part I. Non-case Services
A. Information and Referral Services (I&R)
332
279
0
370
1669
236
2886
B. Training Activities
106
232
CAP’s plans for training for FFY20 did not materialize as anticipated with the onset of the coronavirus. Several events at which we planned to provide trainings/presentations on VR/IL CAP were postponed and eventually cancelled, including a disability mentoring event and a gathering of disability services offices from all the community colleges in Massachusetts. Since many VR clients attend our public community colleges, this connection would have provided a great opportunity to reorient schools to CAP, navigating VR, and Title I, as well as for CAP to learn how to best be a resource to schools that are advocating for their students. We are in the process of rescheduling this training/presentation.

With fewer opportunities to appear at in person events, CAP spent a lot of time developing a new training series that will be available virtually during FY21. The first two modules of the series will cover disclosure and reasonable accommodation and will be offered to VR consumers. These workshops for consumers will take place in small groups allowing participants to fully engage in interactive exercises and get their questions answered. A third module will cover how to navigate the VR system and will be offered to service providers and advocates working with VR consumers. The workshops will be held one day per month.

CAP continued to hold “listening sessions” (presentations) with four area VR offices. In these sessions we provide an overview of CAP, explaining the various ways that our involvement in cases earlier in the process can be helpful to VR, while simultaneously seeking guidance from the VR staff as to how we can best work together to serve consumers. CAP considers VR to be our best source of referrals and therefore is committed to consistently working at building and maintaining our relationship with them with the understanding that we have different roles and will sometimes disagree. CAP also held a similar listening session with the largest center for independent living in the state.

During FFY20, Massachusetts Office on Disability (MOD), the agency in which CAP is housed provided four trainings on Title I of the ADA to Title II entities. MOD also provided a range of trainings on the following topics Titles II and III of the ADA, Section 508 and technology usability, emergency preparedness, service animals, and architectural access. The attendees of these trainings included state and municipal employees, people with disabilities and their family members, local disability commissions, human resource professionals, and title III entities. At each training conducted by MOD, regardless of the subject,. MOD prefaces with a brief explanation of CAP and its role with respect to VR and IL and provides informational brochures (or links). The total number of trainings and attendees reflects the number for all MOD trainings.
C. Agency Outreach
CAP’s outreach activities changed substantially because of working remotely. Most of the conferences and events at which we normally exhibit were canceled and the in-person outreach that we typically try to organize with schools and service providers was very challenging to schedule in consequence of the pandemic. Many organizations and schools were not initially prepared with the necessary technology to even perform their work remotely. We mostly found that even when agencies and organizations obtained the tools to resume their typical work, most were focused on catching up and just trying to maintain their core functions and were not receptive to scheduling outreach/trainings. Nevertheless, CAP continued to reach out to entities across the state to inform them of VR/IL, CAP, and Title I and our interest in meeting with them remotely. These entities included community action and community development programs, school districts in unserved and underserved areas, agencies that serve youth in transition, disability related nonprofits including centers for independent living, and agencies that contract with VR. When contacting these agencies we asked for the opportunity to meet and share how we could be of assistance to their constituencies. We also shared a link to our CAP video and a short article about CAP and invited them to post the video on their website and/or to use our article in their newsletter. We continued to follow up with these entities to attempt to schedule trainings/presentations.

Given the challenges to provide outreach during these difficult times, CAP focused on addressing the needs of unserved and underserved populations through its work on the SRC of the general VR agency. CAP actively participates in the work of all of the committees on this SRC including Policy, Business and Employment, Statewide Comprehensive Needs Assessment/Consumer Satisfaction, and Executive which each meet on a monthly basis.

During FFY20 the SRC committed to ensuring that the principles of Diversity, Equity, and Inclusion (DEI) are incorporated into all of its work and that we view each action or activity that we undertake through the lens of DEI. For example, the Policy Committee is currently working on a recommendation related to procurement. Specifically, the committee is concerned that the agency is prepared to offer sufficient and appropriate vendors to serve the needs of all consumers throughout the state and that when there is not a vendor currently on contract to meet a need, that there is a known mechanism in place to resolve the matter quickly so that the consumer is not delayed. As part of planning our work on this recommendation related to procurement, the Policy Committee met with members of the Bilingual Committee to learn about concerns that are particular to consumers who speak other languages. The Bilingual Committee is made up of VR counselors from across the state who work with consumers who have a first language other than English. Members of the committee relayed that there are a limited number of vendors that have sufficient staff who either speak other languages or who look like/represent the consumers they are serving. In consequence, these counselors often have to fill in as interpreters or work directly with the consumer to provide the services that the vendor is supposed to provide . This feedback alerted us to a different set of deficiencies about which we were previously unaware. Ultimately the recommendations that the Policy Committee will offer to the VR agency relative to procurement will surely address these concerns and hopefully shine further light on a problem that impacts unserved/underserved consumers. Again, in participating in each SRC committee, CAP along with other SRC members similarly consider each element of our SRC work through the DEI lens to determine whether we are adequately addressing the needs of unserved/underserved populations as we take on various issues .

Along with our colleagues on the SRC, CAP has requested updates on the VR agency’s DEI efforts and offered recommendations on how to better serve consumers from traditionally unserved/underserved populations. We will continue to monitor the agency’s progress, including efforts to hire more diverse staff, and hope that in addition to hearing about progress from the agency’s perspective that responses to needs and satisfaction surveys will reflect changes going forward.
D. Information Disseminated To The Public By Your Agency
1
0
0
60498
2
0
A staff member was interviewed by an organization that serves people with rare disorders. The segment was not specifically about CAP but an explanation of CAP services was provided during the introduction. It aired on a local cable access channel.
E. Information Disseminated About Your Agency By External Media Coverage
n/a
Part II. Individual Case Services
A. Individuals served
16
33
49
1
14
B. Problem areas
8
9
34
4
0
25
2
0
C. Intervention Strategies for closed cases
17
10
7
1
1
0
36
D. Reasons for closing individuals' case files
19
5
4
0
0
5
0
1
2
0
0
0
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E. Results achieved for individuals
14
2
0
0
10
5
2
3
0
0
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Part III. Program Data
A. Age
1
11
15
20
2
49
B. Gender
21
28
49
C. Race/ethnicity of Individuals Served
2
0
5
9
0
30
2
1
D. Primary disabling condition of individuals served
6
1
0
0
1
2
8
1
2
0
0
1
2
0
0
0
0
0
1
1
8
2
0
3
4
2
0
0
2
2
0
0
0
0
49
E. Types of Individuals Served
2
0
45
3
2
0
Part IV. Systemic Activities and Litigation
A. Non-Litigation Systemic Activities
0
During FFY20 CAP worked on several systemic issues, however we are unable to report that any of them have been successfully resolved.

In reporting for FFY19, CAP referenced two instances in which the VR agency committed to take action to resolve what CAP considered to be systemic problems. In both instances the VR agency agreed within the year to act on CAP’s recommendation, however we could not count them as systemic changes because the changes would not be officially implemented until FFY20. These changes were relative to consumer needs assessment/consumer satisfaction surveys and the SRC receiving fair hearing decisions. More specifically, in FFY19 CAP recommended via the SRC Statewide Comprehensive Needs Assessment/Consumer Satisfaction Committee that the general VR agency send out a short form consumer satisfaction survey and a short form consumer needs survey to consumers who did not have email addresses. Previously such individuals did not receive surveys at all and therefore their information was not tracked. The VR agency agreed to begin doing this as a pilot and then to implement the short form survey in FFY20. Unfortunately, they were not able to follow through on this commitment due to the pandemic as they were not in the office to do the mailing. CAP will resume discussion of this as VR staff returns to the office. Similarly, in FFY19 CAP informed the general VR agency of their obligation to share fair hearing decisions with the SRC. The VR agency eventually did acknowledge that this was an obligation per the regulations but had not come up with a specific solution for doing it before the end of the fiscal year. In FFY20 CAP and the SRC continued to discuss the matter but have not yet reached an agreement about how the decisions should be shared with the SRC. CAP recommended a way to publish redacted decisions via the Social Law Library, noting that other state agencies do the same with their administrative decisions. The VR agency is concerned about confidentiality and questions whether heavily redacted decisions would serve a purpose. They have suggested alternatively that they send the SRC a report summarizing fair hearing decisions. CAP has concerns that important information may be omitted with a general summary and maintains that if decisions were consistently written in a specific way, it would be possible to provide the important details without violating confidentiality. Further discussion is necessary to resolve this issue. CAP will continue to discuss it in hopes of resolving it during FFY21.

During FFY20 CAP continued to hear from VR consumers who are SSI/SSDI beneficiaries and have taken out substantial loans to attend college. With this in mind, during the prior fiscal year CAP recommended specific revisions to the VR agency’s financial eligibility policies as well as suggested that a simple fact sheet be created to explain that SSI/SSDI beneficiaries are not obligated to contribute to the cost of their VR services, how the waiver process works, and consumer appeal rights. Having heard no response to our recommendation from the prior year, during FFY20 CAP drafted such a fact sheet and forwarded it to the VR agency. To date, we have not received a response and our recommendations have not been implemented. CAP will attempt to revisit this issue in FFY21 through the Policy Committee of the SRC as well as continue to address this on behalf of individuals through the appeal process.

In the course of working with consumers during the year, CAP has found that the VR agency’s materials used for determining financial responsibility listed outdated financial figures. This was pointed out to the administrative office and it was acknowledged that the figures were out of date. CAP requested that the materials be updated immediately. CAP has been told that they will be updated and that in the meantime all of the offices would be provided with the updated figures. CAP has not seen updated materials and will continue to track this issue.

During the second half of FFY20 CAP has raised the following systemic concerns:
• Since many Community Integrate Employment Services vendors were/are having difficulty offering services remotely:
o How are pre-ets services taking place?
o Do consumers receiving services from vendors need revisions made to IPEs to reflect changes in service?
• Are consumers of color with autism being routed to the Department of Developmental Services rather than being steered toward education and training through the VR agency?
• How is VR meeting the technology gap for consumers during a time when access to computers is essential?

CAP is currently in the process of investigating these systemic issues in pursuit of a resolution. With various systemic issues on our radar, we are hopeful that we will make progress in resolving them during FFY21.


B. Litigation
0
0
0
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Part V. Agency Information
A. Designated Agency
External-other public agency
Massachusetts Office on Disability
No
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B. Staff Employed
CAP employees three full time employees in FFY2020.
Part VI. Case Examples
Case Examples
Client, an African American male in his 20s, was diagnosed with Autism. He had difficulty with verbal and written communication and often missed social cues. He was motivated and capable of learning with increased time and repetition. The young man was very polite and thoughtful towards adults, but he required verbal prompting during social interactions with adults. Therefore, client’s mom often accompanied him to his meetings with the VR Agency. The young man transitioned to VR services from his high school Pre-ETS. During the second year of client’s VR services, his counselor changed because his intial VRC transferred to another office. Client and his mom worked for a short time with the new VRC, but client and his mom felt that the VRC was dismissive of client’s goals, the service providers he and his mom proposed, and the involvement of his mom. After a contentious meeting with the VRC, her supervisor, client, and his mom, client requested a transfer to the office where his former VRC worked in order to work with him. Client stated that he had rapport with his former VRC who was more patient and listened well. His mom added that the VRC being a minority male helped the VRC better understand the client. She stated that the VRC understood the cultural context and the labor market for minorities. This combination allowed him to provide services through a lens which client’s current VRC (a middle-aged white female) did not seem to acknowledge. The current VR office serving the client approved the transfer, but the receiving VR Office rejected it. The rejection stated that client was outside of the catchment area, that it was against VR best practice to allow clients to choose their counselors, and client’s service options would be the same despite the VR office.
Client contacted CAP to appeal the denial. Reviewing the file, CAP discovered that client’s VR service delivery was subpar. When client’s VR services started in 2015 as a student under Pre–ETS, he was employed as a car wash attendant. As of 2019, client’s employment goal was listed as car wash attendant. Neither counselor did a vocational assessment to help client with an employment goal consistent with his interest, abilities, capabilities, etc. as required under the regulations and informed choice. Client’s interest in radio and TV production was documented throughout his file, yet this interest was neither explored through Pre-ETS nor educational opportunities. In talking with client and his mom about the purpose of VR services, his mom took partial ownership of client’s VR goal remaining the same as his current employment, but CAP also explained how VR should have been more proactive in discussing specific VR services available to client. CAP assisted client with the appeal in hopes of getting client’s case transferred and giving him a chance to work with his former counselor and to help him change his employment goal.
The key issues in this matter were that VR did not have a policy regarding clients choosing their counselors and there was no written procedure for requesting counselor/office transfers. After submitting questions to the VR Agency’s General Counsel about the standard practice for requesting a new counselor and transferring to another VR office, CAP and client were able to resolve the matter through an Administrative Review, the informal appeal for the VR Agency. During the Review, CAP emphasized that the Agency service delivery was unsatisfactory as client’s employment goal was not a goal at all because he was working as a carwash attendant before his VR service. We also discussed the lack of understanding of the cultural context for the delivery of client VR’s services in the office which was currently being served and how the office he requested could remedy that situation. This breakdown in communication because of the cultural differences had severely damaged the relationship client and his mom had with the current counselor and office. CAP explained that this would create tension which would hinder VR service delivery. Also, CAP discussed how the rapport and trust client had with his former VR counselor encouraged open communication in a way that would help client discover and attain a viable employment goal. CAP discussed how an office transfer and assignment to his former counselor was in the best interest of the client and would present the best opportunity for client to discover and achieve a viable employment goal. Ultimately, it was CAP’s assistance in helping client find his own voice to speak out about how he felt when the current office disrespected his mom, given her importance in helping him transition to independence. Also, in the Administrative Review, he spoke about his rapport with the former counselor and how he felt that the counselor listened to him and his mom, presented options, allowed client to choose, and supported client in that choice. The Area Directors of both VR offices agreed that the relationship with the current office was damaged and that a fresh start for client would be the best option. Both offices agreed to the transfer, but the receiving office was still undecided as to whether client would be assigned to the requested counselor. A few weeks after the Administrative Review, client also received written notice that he would be assigned to his former counselor. Currently, client is doing career exploration and taking a Communications course at a community college.

Client sought CAP assistance with an appeal of VR’s denial of financial support of LPN training. CAP reviewed client’s VR file and then spoke with client about her employment goal and the applicable regulations. CAP evaluation supported VR’s denial and explained to client our analysis. Client had multiple documented disabilities that hindered her ability to walk, lift, stand for long periods, and manipulate small objects. The doctor providing her care for the back and mobility-related issues discussed her condition in a letter that implied that her ability to perform any physically demanding job was extremely limited, even with reasonable accommodations. Further, client had submitted a letter to a WIOA funded LPN training program stating her need to temporarily withdraw due to her high-risk for COVID-19. In discussing our analysis with client, we explained that the documentation of her disabilities seemed to indicate that she could not work successfully as a nurse even with accommodations because of the severity of her physical limitations. Based on knowledge and research into nursing school clinicals and the likely available accommodations; on the physical limitations imposed by her degenerative medical conditions; and her own statements about her increased risk for COVID-19, we agreed that VR’s position was appropriate. We also explained that even if VR approved her employment goal, VR could require her to use the comparable benefits available through the WIOA training funds. We explained to client the regulations upon which we relied for our conclusion.
Client contended that the VR Agency’s denial was based on her already having a Bachelor’s degree, not on her inability to become an LPN. Client felt that CAP was missing the main issue and insisted that VR had her denial letter confused with another client’s situation. Client explained that she would never need to meet the physical demands of a nurse because she was seeking higher level positions in an Addition Recovery Center. She reported that the Administrative Nurse Management positions that she was targeting would not have heavy physical demands. Client reported that she needed both a Recovery Coach and the LPN licensure for her goal. She stated that her counselor would not allow both. We explained the VR regulation on which her VRC was likely relying. CAP discussed with client that while her contention maybe true, her degenerative medical condition called into question her ability to complete the clinical component of the training, even with accommodations. We discussed with client the type of proof that would change CAP’s analysis. Client asked for additional time to gather the documentation. CAP simultaneously researched the training and clinical requirements of the LPN program to which client applied and reviewed job descriptions client had submitted to the program. In CAP’s analysis, the new documentation client submitted was not plausible given the stark contrast it was to the initial documents. For example, her new doctor’s letter excluded her functional limitations and simply stated that she could work part time with reasonable accommodations. CAP explained why the documentation did not seem reliable. CAP was not persuaded to change its original conclusion. We encouraged client to spend time getting a medical assessment that is specific as to her abilities because the initial doctor’s letter detailed her limitations strongly and would be refuted best with an updated clinical assessment. Also, CAP recommended that client give some thought to what she would enjoy about being a managing a Recovery Coach Center and explore similar careers based on what she enjoys but would have less of a physical component.

Client was participating in a Job Driven Training (JDT) for cybersecurity. It was organized and funded by the VR Agency but conducted through the Community College workforce development program. The training started in-person but moved to a virtual platform due to COVID-19 State of Emergency Orders. After repeated attempts at self-advocacy to get the recommended computer and the assistive technology to participate in the class remotely, the client contacted CAP for assistance with addressing her technology and communication needs. In addition to technology and communication issues, CAP noted several deficiencies in VR service delivery: (1) the VR agency pressured the client into taking the class; (2) did not request a new learning accommodation assessment for the remote learning environment; (3) would not provide a sufficient time to allow client to catch up with the class due to the delays getting her the recommended equipment; and (4) client’s VRC was unaware of the existing issues and road blocks with the JDT which could have prevented some of the delays in service.
After a series of discussions with the VRC, Job Placement Specialist, and the Community College, CAP showed that the providers had not fulfilled their obligations toward client. CAP help client was able obtain an assistive technology evaluation which provided her with a computer and software that allowed effective participation in the course. Also, Disability Services at the Community College agreed to reevaluate client to determine the accommodations needed to support her as an on-line learner. CAP helped client revise the Communication Plan the VR Agency and Community College proposed. Client wanted it to address her concerns with misinformation and to add language about including her in the decision-making process for about her training and VR service needs. Finally, CAP supported client in her advocacy to continue the cybersecurity training as an independent study because the delays in getting the proper equipment. Client’s case is ongoing. However, the deficiencies in her case led to improvement of the JDT for all the VR consumer enrolled.
Certification
Approved
Naomi Goldberg
CAP Director
2020-12-23
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