The Bureau of Rehabilitation Services is the designated agency for the Client Assistance Program (CAP) in Maine. Since 1984 the State Agency has subcontracted with outside agencies to provide CAP services. C.A.R.E.S., Inc., in existence since November 1, 1988, is a closely held, for-profit corporation making the Maine CAP an external-other organization. Since September 1992, Consulting, Advocacy, Research and Evaluation Services, Inc. (C.A.R.E.S., Inc.) has been effectively administering the CAP in Maine. CAP offers the full range of services required by Section 112 of the Rehabilitation Act. The CAP is staffed by three professionals and an administrative assistant for a total of four (4) person-years. Two of the professionals are full-time (2.0 FTE), the third is part-time (.10 FTE) and the administrative assistant is also employed part-time by the CAP (.58 FTE). C.A.R.E.S., Inc. has a retainer agreement with a qualified attorney for the purpose of providing legal representation to CAP consumers and legal consultation to CAP personnel.
The FY 2007 budget is enclosed as Attachment II. In FY 2007 the federal funds expended for the CAP were supplemented by SSA-VR funds.
During FY 2007 the CAP achieved all program goals and objectives in the following areas: Informing the general public and consumer organizations about CAP; informing consumers of their rights to services under the Act and advocating for these rights; developing a positive working relationship with appropriate agencies; advising the state agency about systemic issues and obtaining training for CAP personnel.
CAP’s Consumer Advisory Board (CAB) met to address systemic issues in delivering vocational rehabilitation and independent living services to people with disabilities and to assess consumer satisfaction concerning services received from the Client Assistance Program.
The CAP was afforded good access to the directors of the state agencies regarding policy and systemic issues. CAP’s access regarding policy matters was via quarterly meetings with the directors and through our participation in both State Rehabilitation Councils (SRCs). CAP is a mandated member of and an active participant in the SRC for both the Division for Vocational Rehabilitation (DVR) and the Division of the Blind and Visually Impaired (DBVI). (See Section VI).
During the reporting period, 168 individuals received information and referral (I&R) services from C.A.R.E.S., Inc. Of this total, 122 individuals received information and referral services regarding the Rehabilitation Act, 3 regarding Title I of the ADA and 43 individuals were provided other information. Examples of “other” information and referral services include requests regarding social security, Parent Information Center, disability/advocacy agencies and community rehabilitation providers, adult day care, Maine Care, child protective issues, general legal issues, community action agencies, Assistive Technology, housing, Special Appointment Process and the ASPIRE Program. CAP staff used VR/IL I&R requests to emphasize self-advocacy and empowerment of people with disabilities. The CAP staff also used information obtained from I&R requests to identify trends, patterns and systemic issues. This information was provided to State Agency staff during quarterly meetings and as was appropriate. Finally, requests for information and referral were used to identify potential training needs within both the CAP and the state agencies.
Along with the 168 individuals who requested and received information and referral services, 75 individuals were served as “cases” as defined by the RSA-227 reporting instructions. Of the 75 individuals served as open/active cases, 32 were pending as of October 1, 2006. Another 43 individuals had cases opened with CAP during the fiscal year. Eight (8) individuals were applicants of Title I, Vocational Rehabilitation (VR) Program and 67 individuals were Title I consumers. Of the open 75 cases, individuals with mental illness comprised the largest group of individuals served (25 cases). They were followed by individuals with orthopedic impairments (14), learning disabilities (11), mental retardation (7) and traumatic brain injury (4).
During the past fiscal year, 39 cases were closed. Of this figure, 20 were closed with all issues resolved in the individual’s favor, while another 9 cases were closed with some issues resolved in the individual’s favor. In 4 cases CAP determined that the VR agency had taken appropriate action, while in 2 cases CAP determined the case lacked legal merit.
CAP staff responded to the following problem areas for the 75 individuals we represented: Information requested (75), communication problems between individual and counselor (56), conflict regarding services to be provided (41), problems related to IPE development/implementation (41) and problems related to the application/eligibility process (19). Obviously, multiple responses are permitted for open cases.
During the past fiscal year Maine’s CAP represented individuals in all five VR regions; 17 in Region 1, 27 in Region 2, 22 in Region 3, 7 in Region 4 and 2 in Region 5.
We estimate that CAP resolved 20 potential due process cases using negotiation and other alternative dispute resolution activities. The primary issues in these cases included case closure, self-employment, eligibility (advance in employment), long term support/supported employment, post-secondary education and the broad area of IPE goal and/or services to reach the goal.
(Please see Attachment I for examples of cases handled during FY 2007)
A. Training Received. During FY 2007 CAP staff attended the National CAP
Conference, a two day conference in St. Louis, MO for CAP staff nationwide. The conference covered a wide range of topics such as transition services, legal strategies in due process hearings and post secondary education issues in VR. Other trainings received by CAP staff during the reporting period include:
B. Training Provided. During FY 2007, CAP staff provided the following training:
C. Linkages/outreach withconsumer, family, advocacy and community providers occurred on a regular and as-needed basis during the past year. A partial list includes the following groups/organizations.
25. Catholic Charities
Numerous CAP brochures were either mailed out or made available at various trainings and conferences in the state. CAP brochures are also available at the Career Centers across the State.
The Consumer Advisory Board to the Client Assistance Program is a group of current and former recipients of VR and Independent Living (IL) services. Their mission is to provide CAP with a consumer perspective regarding important issues encountered by Maine citizens with disabilities. They review and comment on significant policy issues and internal guidance memos. They help us to identify strengths and weaknesses in the VR/IL service system. The CAB met and was provided information on the state VR program, the status on the revisions to the DVR Policy manual and updates on national initiatives such as Reauthorization of the Rehabilitation Act and Ticket to Work implementation. The board also assessed consumer satisfaction with services received from the Client Assistance Program. Upon case closure with CAP, a survey is sent to each individual. All returned surveys are forwarded to the board. At the end of the year, the board collates the data and produces a report of their findings, conclusions and recommendations.
The Client Assistance Program in Maine continues to place considerable emphasis and program resources on systemic advocacy. During the past year our involvement in the two State Rehabilitation Councils (SRC's) presented us with many opportunities to provide input on issues that have systemic implications for individuals with disabilities. During the past year CAP was an active participant of the DVR/SRC Policy Group. This group reviewed and commented on the DVR Orientation Procedure and Application Form as well as reviewed proposed changes to the State Rules. CAP has also been part of the SRC committee whose charge is to draft changes to the DBVI Policy Manual. Other SRC related activities that CAP was engaged in include membership, informed consumer choice, by-laws and retreat planning. CAP staff was the catalyst for comments submitted to both DVR and DBVI regarding their draft FY 2008 State Plans. We did this in conjunction with the respective State Rehabilitation Councils.
CAP staff was invited to participate in internal DVR committees for Self-Employment Post-Secondary Education and Comprehensive System of Personnel Development. CAP’s role on these committees is to present individual and systemic issues and to help develop a better product.
CAP staff met with the Director of the Independent Living Center during the past fiscal year. We discussed IL issues such as assistive technology and case management as well as notification of CAP services for consumers of IL services.
Staff from Maine’s CAP continued to be a member of the Region I RCEP Advisory Committee. This committee is responsible for designing and implementing training for all VR staff in New England. We feel our participation on the RCEP Advisory Committee presents an excellent opportunity to provide input on staff training needs and priorities such as assistive technology, substance abuse, VR and informed consumer choice. As a member of this committee, the staff person plans and organizes staff training for all New England CAP’s.
During the past year CAP participated in activities and meetings that do not fit the previous categories. Examples of these activities include:
A. Meeting with the Directors of DBVI and DVR, the Independent Living Coordinator and central office staff on a quarterly basis to discuss trends in CAP cases as well as systemic concerns;
B. Completing and disseminating the FY 2006 CAP Annual Report and Narrative;
C. Following up on a meeting with staff from the Office on Program Efficiency and Government Accountability (OPEGA) regarding systemic and programmatic issues within BRS; and
D. Discussing strengths and weaknesses in DVR and DBVI policies and procedures with Maine’s lead person at Rehabilitation Services Administration.
What follows are the trends we observed in FY 2007 in the operation of the CAP in Maine:
A. There is an increased scrutiny within DVR regarding cases that have been open for several years. We continue to observe VR asking the question how much, how long and how far should VR stay involved in certain cases. There are numerous variables to consider in cases such as this. The point we are making is that CAP is involved in many of these cases and understands the challenges that VR faces.
B. As of this writing, the OPEGA Report is nearing completion. Preliminary findings seem to indicate there will be a greater emphasis on the manner in which counselors procure services for their clients. It’s CAP’s hope that any procedures developed will allow for services to be provided in a timely manner. The agencies have made significant improvement in this area. We’d like to see timeliness of provision of service continue to be a priority for BRS.
C. For most of this fiscal year, case closure was the most popular reason for contacting CAP.
D. The reduced opportunity in the Maine labor market was evident in the cases we handled. Job Development required more time to locate a job and people were engaged with VR for a longer period of time. This had a ripple effect to areas such as the Wait List and agency resources, both human and fiscal.
E. More consumers are reporting they access our website and there is also an increased use in email to access our information and referral services.
F. The relationship between the consumer and the VR counselor is paramount. We were involved in several situations where the cases were bogged down because the relationship had deteriorated. In most situations, a change of VR counselor was all that was needed to get things moving again. We appreciate the agencies’ cooperation in reassigning new counselors to clients.
In concluding the Narrative Report for the 2007 CAP Annual Report, we would like to offer the following recommendations.
A. Trial Work Experience and Comprehensive Assessment. In our experience over the past year, CAP has had cases where VR clients have been involved in “comprehensive assessments” that varied greatly depending on the region of the State in which they were receiving VR services. These differences stemmed from the VR Counselors’ interpretations of what the assessment consists of and how to document this step of the VR process. In some regions, VR Counselors do not write a Plan (IPE or Trial Work Experience) until the Comprehensive Assessment is complete. In other regions, we discovered VR did have an IPE or Trial Work Experience Agreement which identified the specific assessment tests, methods, timelines, etc. CAP brought these discrepancies to the attention of VR casework supervisors in 3 different regions and was told they were addressing this in their VR leaders’ meetings. CAP strongly recommends that procedural guidelines be developed to assure that clients receive services that are more consistent across the State. In addition to consistency, CAP believes it is important to have all cost services, for example, neuropsychological evaluation, occupational therapy evaluation, transportation to and from trial work experiences, etc. documented in a plan. This would most likely clarify services to be provided by the VR agency and involve the client in the process of plan development and choice of vocational goal.
B. Post Secondary Education Services. The Division of Vocational Rehabilitation revised its State Rules in July 2007. In the area of Post Secondary Education, some changes include the level of tuition assistance VR agrees to give an eligible client/student. They will base the first two years of assistance on Community College rates, even if a client’s career goal requires a 4 year Bachelor’s degree. The Client Assistance Program is part of the Post Secondary Committee and we have shared concerns regarding the lower level of tuition assistance if, in fact, a program is not offered at the Community College. In our discussions, VR has stated that if the courses needed to complete a program for a client/student’s career and IPE goal are not available and/or transferable to a four year degree program, then VR will pay the rate at the four year institution. CAP has been assured that exceptions to the new policy/rules can and will be made on a case by case basis. CAP will monitor this and make a note of the cases we have in this area.
C. Transportation Services. Recently, it was reported that BRS spends more than a million dollars each year for client transportation-related services. The bulk of this amount is spent repairing and maintaining clients’ vehicles. Many of the vehicles repaired might be considered marginal. Counselors have been made aware of the possibility of vehicle purchase via the M-power Loan Program. In addition to this, there are other programs in Maine that refurbish used vehicles and provide quality reliable transportation to clients in the ASPIRE Program. We recommend that the agency seriously explore the feasibility of becoming part of and contributing to these programs.
D. Caseload Supervision. In recent annual reports, CAP has cited the lack of a proactive case review process as one of the glaring weaknesses in the VR system. We understand that BRS is in the process of redesigning and strengthening their case review system. We applaud this initiative. However, we have some concerns about the time constraints on supervisors and their ability to perform the duties outlined in the case review redesign. Staff turn over, especially in DVR, remains a constant issue. When there is a vacancy in an office, the supervisor manages the caseload until the vacancy is filled. Managing a one hundred plus caseload is a full time job. Given this, is it reasonable to expect that proactive case supervision can be conducted? We recommend that BRS explore other options that may be available to manage the inevitable vacant caseloads.
E. Informed Consumer Choice. Both agencies need to view informed consumer choice as a work in progress. It needs to be constantly assessed, revised and evaluated so that consumers are provided a choice in the VR and IL process. We feel the agencies have made a good faith effort to institutionalize informed consumer choice. A request for a change of VR counselor is almost always granted. Many offices are encouraging consumers to interview several community rehabilitation providers before making their choice. Some of our areas of concern include assistance for individuals with cognitive impairments. We are concerned that the agency is not providing information about the availability of support services for consumers who require assistance in exercising informed choice throughout the VR process. The agencies should review the appropriate section of the Federal Regulations to truly understand what information and supports should be provided to individuals with cognitive impairments. Finally, CAP recommends that this topic be considered by the SRC/DVR Policy Group in the upcoming fiscal year.
F. Assistive Technology (AT). Conversations with counselors, reviews of employment plans and our representation of consumers indicates the need for a more institutionalized approach to assistive technology within DVR. Technology opens up infinite opportunities for people with disabilities, and new developments occur almost daily. It is not realistic to expect VR Counselors to stay current with emerging technology. Counselors can spend countless hours researching AT resources for their clients. It would be much more efficient to have an AT Lead Person in Central Office to assist field staff with AT related issues and concerns. The Division should adopt this and other recommendations that were part of the AT Report that C.A.R.E.S., Inc. issued in June of 2005.
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(Client’s names have been changed to protect confidentiality)
Problem #1: Judy is a young woman with a significant learning disability. She contacted CAP when her request for assistance to attend post secondary education was denied by VR.
Intervention Summary: A review of the case record revealed that Judy’s parents were unable to provide a W-2 to document income during 2006. This pertained to a dispute with an out of state employer that was in litigation. The lack of a W-2 prevented the college from completing the FASFA. Further investigation from CAP revealed that the VRC was aware of this situation prior to Judy’s application to attend the college. Also, there was a documented promise by the VRC to provide support in the event the FASFA could not be completed.
Outcome: CAP persuaded VR to honor the commitment made by the VRC for both semesters of the 2007 school year. Efforts are now being made to assist Judy to be considered an Independent Student in the FASFA process.
Problem #2: Michael, an individual with mental illness, contacted CAP when he was barred from using the Career Center, the location of the VR office.
Intervention Summary: CAP’s investigation revealed that while Michael had made some statements that were clearly inappropriate, he had not made a direct threat to the VRC. CAP staff facilitated a meeting between Michael, his psychologist and the VR Regional Manager. There was a letter written from the psychologist that said Michael was not a danger to himself and/or others. Michael continued to receive VR services, but meetings were held outside of the Career Center. Through subsequent meetings with the VR Regional Manager, Advocate and community rehabilitation provider, Michael demonstrated appropriate behavior.
Outcome: After 6 months of appropriate behavior, Michael’s ban was lifted and he was able to access the Career Center. Michael continues to work with VR to find employment.
Problem #3: Doris is a woman with an orthopedic impairment. She contacted CAP when she received a letter from her VR counselor that unilaterally reduced the services in her employment plan.
Intervention Summary: CAP staff obtained a copy of the letter, which was an open letter to all clients in that counselor’s caseload. The letter contained statements that were contrary to existing state rules. CAP contacted the Regional Manager and discovered that the counselor issued the letter without the approval of her supervisor.
Outcome: A letter of rebuttal from the Regional Manager was sent to all clients who received the original letter. With CAP’s assistance, Doris was assigned a new VR counselor.
Problem #4: Don was a VR client with an orthopedic impairment. Don asked VR to help him become self employed as a bait fisherman. After a few months of poor fishing, Don requested additional equipment that he believed would be necessary in order for his business to succeed. VR denied Don’s request and closed his case stating he had met his goal and was actively self-employed.
Intervention Summary: CAP reviewed the case and met with the VR Counselor and Don. We discussed the VR Self Employment policy, closure guidelines and revisited Don’s specific requests for additional equipment.
Outcome: CAP successfully negotiated re-opening Don’s case. VR purchased the equipment requested and Don was very satisfied. The following fishing season was much more successful for Don and his business is growing.
Problem #5: Betty is a long term VR client with a neurological impairment. VR has supported Betty through a Master’s Degree and has paid for some job development. VR was pressuring Betty to look for employment outside of the field she received her degree in because there appeared to be very few jobs available for Betty. After Betty refused to go along with this, VR threatened to close her case. Betty asked CAP to assist her with obtaining VR support for her vocational goal and to keep her case open with VR.
Intervention Summary: CAP reviewed Betty’s case and had several meetings with the VR Counselor, the VR supervisor and eventually the VR Regional Manager. We discussed changing methods of job development and different ways of marketing Betty’s skills and training. Due to strong personality differences between Betty and her VR counselor, CAP recommended Betty work with a new VR counselor.
Outcome: Betty’s case was transferred to different region and the Regional Manager agreed to take her case. The Individualized Plan for Employment (IPE) is presently being amended. VR has agreed to continue the search for employment in the field Betty has chosen for a specified and agreed upon period of time.
Problem #6: Sandra, who has significant anxiety and depression, was a VR client who was seeking new employment and needed job development and transportation assistance. Sandra felt that VR was not supporting her and they were putting road blocks in her way in an attempt to discourage and defeat her.
Intervention Summary: After reviewing Sandra’s case and speaking with her and the VR Counselor, CAP attended meetings to negotiate VR services and support. Sandra received a job offer and it was determined that a more reliable means of transportation would be necessary.
Outcome: VR assisted Sandra with a down payment for a used vehicle and agreed to provide time limited financial assistance with insurance and gas mileage to and from her new job.
Problem #7: Robert is a person with a learning disability who has been involved with Vocational Rehabilitation for approximately six years (the first time for three 3 ½ years before being closed and this present time approximately 2 ½ years). Robert has held jobs in the cleaning and construction related fields and his present career goal is driving delivery trucks. He contacted CAP when VR was pressuring him to accept a part time job as his VR career goal.
Intervention Summary: CAP reviewed Robert’s case and met with him and the VR Counselor. After reviewing the Federal Regulations and State Rules, the VR Counselor consulted with her supervisor and agreed to keep Robert’s case open and to assist Robert with training to become a Class B licensed truck driver. Once this took place VR paid for job development.
Outcome: Robert is working with a new VR Counselor after moving to a different part of the State. VR is assisting him with obtaining a job that he considers acceptable.