RSA-227 for FY-2025: Submission #28

Provide some examples of some interesting cases during the past fiscal year. VI. Case Examples:

PROFESSIONAL LICENSURE/MULTIPLE DISABILITIES/DELAYS IN SERVICE:

GG is a 62-year-old female, with a reported history of Retinitis Pigmentosa, Rheumatoid Arthritis, Fibromyalgia, Spondylosis(spine), Complex Regional Pain Syndrome, Major Depression, and Complex PTSD. Client requested assistance from CAP due to the delays in her VR services. She was seeking support to obtain her LPC-A counseling license. CAP attended meetings with the client and her assigned Texas Workforce Services-Vocational Rehabilitation Services (TWS-VRS) counselor, along with meetings with the unit support coordinator, manager, and the program management specialist at the VR Division, all in an effort to advocate for the approval of services that had been delayed. CAP facilitated the amendment to the Individualized Plan for Employment (IPE) to include services to support the client with prescription medication and nutrition services. CAP was also instrumental in successfully advocating for assistive technology-training, a sleep study, an assessment of her home work space, and job skills training related to ADHD coaching to help client with completing the LPC-A supervision hours. CAP successfully concluded the case once all VR service authorizations were issued.

ASSISTIVE TECHNOLOGY AND DELAY IN EVALUATION:

MK is an 18-year-old male who has been diagnosed with bilateral retinoblastoma at eight months old and is legally blind in his left eye. Upon contacting DRTx, client had an open case with TWS-VRS. Client contacted DRTx because he had been requesting assistance with an assistive technology evaluation since the summer of 2024 without success. CAP accepted the case, providing advocacy services to amend client’s IPE to include the long-awaited evaluation, as well as assistance with the purchase of the assistive technology that was recommended by the AT evaluation.

With CAP’s help, the client’s IPE was amended to include counseling and guidance, all recommend assistive technology items, including the following: an Optaro iPhone Video Magnifier and Optaro case for iPhone 13, a Dell Latitude 5540 laptop with a surge protector and Zoom Text. In addition, with CAP’s prompting, the client’s IPE was amended to also include VR funding and support for tuition, books, supplies, and room and board fees while the client attends out-of-state college at Henderson State University in Arkansas.

SELF-EMPLOYMENT DELAYS:

LB is a 53-year-old female, with a hearing impairment, nerve damage, autoimmune disorder, Crohn disease, and lupus. The client sought CAP services to help her secure VR services in order to obtain a canine trainer certification, which she was seeking as part of her self-employment plan to work as a service dog trainer. Her VR case had come to a halt. During the investigation of the case, CAP learned that the VRC had unsuccessfully attempted to link three training entities as a TWS-VRS payee/vendor.

CAP successfully negotiated to have VR issue funds for tuition to the client via maintenance check so that the client could pay directly to the training entity. The request was approved at field office and regional levels, but later rescinded and the client was notified that she must complete a functional capacity evaluation (FCE) and business plan first. CAP conducted calls and meetings with TWS-VRS supervisory staff and received reconsideration, which stated that, in lieu of the FCE, the client could submit a work restriction checklist from her physician and, if approved for training, she would not be required to complete the business plan before pursuing training. CAP successfully facilitated the submission of the work restriction checklist and monitored the case until an approval for tuition maintenance was received at the field and regional levels again. CAP corresponded with regional level staff to monitor the approval process to state level and, when the process stalled, CAP contacted the VR Director which resulted in an approval. CAP participated in the IPE amendment meeting to reflect the agreement and monitored the case to ensure the client was established as a payee, so she could receive the check directly. ,

BARIATRIC SURGERY:

AP is a 47-year-old Female with Diabetes, Heart/Circulatory Conditions, and Orthopedic/Physical Impairments. The client reached out to DRTx and CAP with concerns over delays with scheduling a bariatric surgery that TWS-VRS had agreed to support, as a part of her IPE. Even with CAP’s intervention and negotiation, this case took an extended time due to a number of factors that included a change in VRC, a change in surgeon, and expired assessments and tests needed by the client’s doctors that had to be redone. CAP attended meetings with the client and her VRC, requested frequent updates from TWS-VRS, and kept the process moving, providing guidance to the client throughout the process. The client’s surgery was completed successfully.


VEHICLE MODIFICATION/DELAYS IN SERVICE/INCONSISTENT COMMUNICATION:

KU is a 20-year-old female. She had a stroke/brain aneurysm when she was 18 years old. She was in college at the time, and working two part-time jobs. KU reached out to DRTx/CAP with a request to change counselors, due to conflicting communication from VRC regarding vehicle modification services. KU had started the vehicle modification process a year prior. KU and her family had the belief that TWS-VRS would be able to help her with a down payment and six months of payments for a vehicle. CAP Advocate investigated KU’s concerns, which included talking with TWS-VRS and reviewing TWS-VRS records. During the investigation, the TWS-VRS Counselor (VRC) agreed that she wanted to help KU. During the year, there were some missteps, as the family did not have information from TWS-VRS about approved vehicles. The family exchanged vehicles, which added an additional expense/hardship to the family. During the CAP investigation, KU and her family wrote a letter of hardship, and presented the information to TWS-VRS. The request was approved, and KU received the much-needed financial assistance, vehicle modification, and follow-up drivers’ training.

CAP agreed to facilitate communication with TWS-VRS, and transfer of counselor to someone who had more experience, as the assigned VRC did not know KU very well, and was primarily focused on job placement assistance. Advocate provided the VRC information about KU’s long-term goals, which included returning to college. This information helped the VRC prepare for meetings with KU. With CAP’s help, KU’s Individualized Plan for Employment (IPE) was amended to include additional substantial services, including: tuition, fees, books, supplies, Assistive Technology assessment, vocational assessment, a computer, and benefits counseling. Because the VRC was amenable to KU’s unique goals, interests, and capabilities, KU decided to continue working with the assigned VRC.
Vehicle modification is a complex service that occurs in several phases and requires input from other VR staff, including the Assistive Technology Specialist (ATS) and the Program Specialist for Assistive and Rehab Technology (PSART). The ATS in this case was very resourceful, and provided in-depth information during the steps.

DEAFNESS, COMMUNICATION ISSUE W/VRC REQUIRING COUNSELOR CHANGE AND POLICY TRAINING FOR VRC:

CC is a 29-year-old female who is Deaf. She uses ASL to communicate. CC experienced communication barriers with her TWS-VRS Counselor (VRC), who works with a specialized Deaf and Hard of Hearing case load, but he does not use ASL. CAP investigated CC’s concerns, which included talking with the assigned VRC and reviewing TWS-VRS records. The VRC characterized CC as having high expectations and requiring a significant level of support. The VRC also emphasized his own capacity to deliver exemplary vocational rehabilitation services tailored to meet customer’s demands. CAP determined that, while the VRC determined eligibility for services prior to the 60-day requirement and prepared a plan of services to help CC find employment, documentation regarding communication seemed to trail off after that. Of note, the VRC determined presumptive eligibility based on CC’s receipt of Social Security benefits, however, CC had not received disability benefits for several years.

Unfortunately, the VRC did not keep records of text messages with CC to verify the scope and quality of services/communication. There was also miscommunication that CC did not pass a background check at work, as the job loss seemed to relate to issues regarding interpreter services purchased by TWS-VRS. VRC also noted that employment with a former job placement provider affected CC’s employment, but there was no documentation.

At the client’s request, CAP agreed to facilitate a change of counselor to a VRC who uses ASL as their primary means of communication. This was accomplished expeditiously. CC met with her new VRC, and chose to work with a job placement provider who also uses ASL. CAP shared with CC and TWS-VRS how she could convey communication about her experience with the interpreter services (internal TWC form). CAP provided the transferring VRC and his supervisor with the policy regarding maintaining documentation and encouraged VRC to keep accurate records in the case file. CAP received assurance from the supervisor that TWS-VRS will receive training.

TRAINING/DENIAL OF RENT PAYMENT:

KP is a 24-year-old female, with the reported history of Bilateral Madelung’s deformity which cause deformities in the hands, wrist, and arms. Client reported issues with TWS-VRS not paying her rent and she was being evicted because of it. She was being financially sponsored by VR in a teacher certification program and was needing to complete her field observation to finish the program. The fear, and real possibility, of eviction was going to significantly impact her success. She stated she had attempted to call the VR Counselor, VR Supervisor, and VR Manager, without response.

CAP agreed to schedule and attend meetings with client and the assigned TWS-VRS counselor to advocate for the training and support, previously requested to maintain her current employment with Crowley Independent School District CAP helped find and negotiate an additional three months of temporary housing while she completed her semester. With CAP’s help, the client and the TWS-VRS counselor amended the Individualized Plan for Employment (IPE), to include all requested services, including approval of the additional three months of temporary housing.