[Nfbmt] MVR Responses to Last March's Public Hearing

[Dan Burke]

Here it is, found on MVR's web pages. We should consider these
responses as we prepare for the March 28 public hereaing:

*******

Responses to 2013 Public Hearing


Disability Employment and Transitions Division (DET) is one of the 12
divisions of the Montana Department of Public Health and Human
Services (DPHHS).  DET includes Vocational Rehabilitation and Blind
Services (VRB) and the Independent Living (IL) program, which were the
programs focused on in the public hearing.  Other programs within DET
include Disability Determination Services, the Montana
Telecommunications Access Program, and DPHHS Public Transportation
Coordination.  DET also provides and administers a variety of services
through contractual arrangements.  The Administrator of Disability
Employment and Transitions serves as the state director of Montana's
vocational rehabilitation and independent living programs.

The State Rehabilitation Council (SRC) and the Statewide Independent
Living Council (SILC) assisted with the hearing.  The 2013 public
hearing was held on March 22, 2013.  The public hearing was held
statewide, at SummitNet Video Network sites in Billings, Bozeman,
Butte, Great Falls, Havre, Helena, Kalispell, Miles City, and
Missoula.  About 60 individuals attended the hearing, and 9 people
responded by email or regular mail.

The comments help both programs evaluate their service delivery
systems and help develop the IL and VRB state plans.

The following paragraphs summarize the comments received from members
of the public. VRB and IL staff have studied the issues and developed
responses to those comments, and the responses are reported following
the summary of the issue.  While the reported comments are not
verbatim, we believe that they capture the essence and intent of the
persons making the comments.  VRB and IL would like to express their
appreciation to those who took the time to provide comment, either in
person or in writing.

The issues responded to in this document were received during the
comment period related to the hearing.  The comment period for this
hearing ended April 10, 2013.  Input that may come in through mail,
email, or the Division website (Montana Vocational Rehabilitation)
after this cutoff date will be responded to in the summary for the
next statewide public hearing.  There were local public hearings held
on reservations during the months preceding this year's statewide
hearing.  Summaries were posted separately on the Division website.
If there are local hearings held in the upcoming year separate
summaries will be completed and distributed to those attending and the
summaries will be posted on the Division website.

Note: The approximate count of comments made on each issue follows the
summary of the comments.  All counts noted below are approximate.
However, it is believed that the counts reflect the volume of
comments.  Making accurate counts in many cases is difficult as many
comments are imbedded within other issues and indications of support
for previous issues were sometimes too vague to specify which issues
were involved.

VRB Related Comments
DET should address the issue of paying subminimum wages to workers
with disabilities.  Montana's tax dollars should not support this
practice.  The agency should completely phase out contractual
relationships over the next three years with any and all entities
which hold certification under 14(c) of the Fair Labor Standards Act.
This comment came from 10 persons.
Response:  For many years the vocational rehabilitation program has
not recognized placement that involves less than minimum wage as a
successful closure.  Also, each eligible VR applicant is presumed to
be able to achieve employment at a competitive wage unless there is
clear and convincing evidence that the person cannot achieve that
level of employment.  In the rare cases that this occurs, the case is
closed and no VR services are provided.  The exception to the
preceding is self-employment, as there are times when a
self-employment situation may generate earnings that would equate to
below minimum wage.

In the Extended Employment program, which is administered by DET, many
of the consumers served by the program are in sheltered employment
placements.  It is likely that many of those consumers are employed at
their placement site for less than minimum wage.  About two years ago,
the Division made a commitment to work towards ending the sheltered
employment services within the Extended Employment program.  Over that
time, the expenditures related to sheltered employment have decreased
and some sheltered employment slots within the program have been
converted to competitive employment positions.  DET is considering
programmatic changes that will create more workable competitive
employment options for consumers traditionally referred to sheltered
employment.  Changes in this regard are difficult because there needs
to be an adequate infrastructure for supporting competitive community
employment in place in order to optimize the consumers' opportunity to
having a successful experience.  The Division will continue to explore
and implement procedures that assist toward that end.

It must be noted that employing persons with disabilities at below
minimum wage is legal under the guidelines of 14(c) of the Fair Labor
Standards Act.  Therefore, the DET's efforts are focused on developing
and encouraging reasonable alternatives to this practice rather than a
total ban or punitive actions.

Also, in developing the State Plan for Independent Living there is an
activity indicating the IL Centers will host meetings to facilitate
discussions related to exploring and implementing alternative services
for consumers who have been traditionally served in sheltered
workshops.  This follows the model of Vermont IL Centers that
conducted similar activities when Vermont transitioned from sheltered
employment services to competitive employment in the community.

VRB should address issues related to the waiting lists for accessing
supported employment services.  This comment focused on the issues
impacting youth transitioning from high school and their families.
This comment came from 4 persons.
Response:  The supported employment waiting lists occur primarily
because of inadequate funding to support all persons who need ongoing
long term supports.  VRB cannot fund long term supports because of
federal rule for vocational rehabilitation services.  In general, VRB
services end after a person has been employed for 90 days.  It is
possible for VR to provide post employment services after the 90 days
of employment, however post employment services are only provided for
very specific short term services needed to maintain employment.

However, the supported employment waiting lists do impact VRB
services.  VRB cannot provide ongoing supports and therefore must
identify and obtain a commitment from the provider and funder of the
ongoing supports prior to initiating services necessary to obtain the
employment goal.  The reason is that if a person needs ongoing
supports and receives VRB services and is closed after 90 days of
employment without the supports being available, it is likely that the
consumer will have a negative employment experience and possibly lose
employment.  Therefore, knowing that the long-term support services
are in place prior to initiation of VRB services is necessary in
planning for a successful closure.

There are a variety of long-term support services that VRB utilizes.
The most used resources are the Developmental Disabilities Program,
The Addictive and Mental Disorders Division and the Extended
Employment Program.  Each has different guidelines for the long-term
support services.  The Developmental Disabilities Program and Extended
Employment Program have significant waiting lists due to a lack of
funding to serve all that are eligible for those services.

VRB is working with many stakeholders in the State Employment
Leadership Network in order to develop strategies to increase the
number of persons with intellectual disabilities who obtain
competitive community placement.  Through these efforts it is hoped
that Medicaid Waiver resources may be able to support more long term
employment supports for individuals eligible for Waiver services, and
this could reduce the number of persons on waiting lists.

With regard to the Extended Employment Program, when possible the
Division seeks to gain funds to expand the number of persons who can
be served by the program.  These efforts must go through the
administrative approval and legislative process.  During the last
legislative session there were no funds approved to expand services in
the Extended Employment program.  Funds were provided to increase the
rates paid for the program services.  On an ongoing basis the Division
seeks to move persons through the waiting lists as efficiently as
possible.  At times, there are notable successes in reducing the
waiting list due to increases in funding or increased efficiency.
However, successes are usually short term as persons continue to move
on to the waiting list and soon the waiting lists are as long as they
were before the various initiatives.  Efforts will continue to
identify ways to reduce the Extended Employment waiting list.

With regard to transition age youth and the Extended Employment
Program waiting list, for state FY 2011 the wait time for persons
coming off waiting list was a month shorter for transition age (14-24)
consumers compared to all consumers.  There have been some specific
strategies that have been identified to place students on the waiting
list while in school to expedite the consumer coming off the waiting
list as close to leaving high school as possible.

VRB should start working with youth with disabilities at a younger
age.  There is a need for teaching job skills in junior high.  Also,
youth with disabilities at this age need mentoring.
This comment came from 1 person.
Response:  Through the VRB transition initiative print materials and
in-person presentations, the focus has been to educate teachers and
parents that VRB can and will be available for consultation whenever
asked.  A VRB counselor, for example, can attend an IEP meeting of a
student in junior high to educate the team about what VRB can do when
the person is eligible to apply (currently spring preceding exit year
or sooner if the person is no longer in school.)  The Transition
Specialist advocates that VRB counselors begin taking applications
before the spring preceding the exit year.  The practice of taking an
application before the spring preceding the exit year is a guideline
and not a mandate.  The Rehabilitation Act expects Individual Plans
for Employment (IEP) to be in place prior to high school
graduation/exit. VRB has included completing IEPs prior to graduation
as a measure of progress in the area of transition in the new
strategic plan.  VRB will be taking steps to increase the number of
IEPs completed with students before graduation/exit from high school.
With regard to mentoring, VRB will explore additional outreach
activities related to Montana Youth Transitions' Disability Mentoring
Day, including the possibility of transitions counselors promoting
Disability Mentoring Day at their respective schools and assisting
students in completing applications.

There needs to be a task force of Mental Health administrators, VRB
staff, community rehabilitation providers, and other stakeholders
involved with long term supports for persons with severe mental health
disabilities.  The primary issue that needs to be addressed is getting
the long-term employment supports they need.
This comment came from 1 person.
Response:  VRB has been serving more persons served by mental health
system in recent years and recognizes that collaborating with the
mental health providers is an important activity.  As mentioned in a
previous response, obtaining adequate long term supports in general is
also recognized by VRB as an important issue.  At the present time,
the focus of collaboration related to mental health long term supports
is primarily at the local level.  These efforts have generated a
variety of successful local initiatives.  Those efforts will continue
to be encouraged.

With regard to statewide efforts, a few years ago there was an effort
to gather stakeholders involved with the employment and consumers with
psychological disabilities.  The attendance and results of the meeting
were less than anticipated and discouraging.  The results from this
initiative seem to indicate that a significant amount of time and
effort may be necessary to achieve statewide collaboration that has an
impact.  VRB does not have the administrative staff time available to
lead such an effort.  The SELN initiative mentioned in a previous
response may serve as an appropriate model.  SELN was an initiative
lead and staffed by the Developmental Disabilities Program.  With the
strong leadership of Developmental Disabilities, VRB has been an
active participant and collaborator on several issues.  If another
agency or entity were to take the lead and provide leadership, VRB
would participate actively.

We request that VRB explore additional fee for service opportunities
with the IL centers.  Specifically, the following were mentioned:  VRB
should utilize Living Well with a Disability and Working Well with a
Disability programs more often.
This comment came from 10 persons.
Response:  It is VRB's understanding that Living Well/Working Well
with a Disability is offered free by most of the ILCs.  It does appear
that all VRB regions are utilizing Living Well with a Disability
and/or Working Well with a disability.  However, the degree of use of
the programs seems to vary between regions.

In addition to the Living Well With a Disability and Working Well With
a Disability programs, VRB and the IL Centers have developed a
significant amount of collaboration related to Social Security
benefits planning services.  When the Social Security funding for this
service ended VRB worked with the Centers and other providers of the
service to develop a workable fee schedule for the service.  The fee
schedule and fee for service process allowed most of the IL Centers to
maintain the service for VRB consumers who required the service as
part of their plan for employment.

VRB is open to exploring additional fee-for-service opportunities with
the ILCs, and we encourage the local ILCs to contact the local VRB
offices to set up a meeting to discuss the types of services they can
provide, and the proposed fee, if any.

BLVS Specific Comments
BLVS should assess the effectiveness of the current Assistive
Technology (AT) delivery strategy, including the appropriateness of
the position description for the AT Specialist, for the next 3 to 5
years.  We suggest the agency work with consumers to find ways to
improve access to high-quality AT training and support for BLVS
consumers.  It may be helpful if BLVS staff went to conferences such
as CSUN.  It may also be helpful if BLVS staff interacted with
companies that sell AT and arrange for these companies to do training
remotely or locally.
This comment came from 11 persons.
Response:  BLVS recognizes the important role of AT for persons who
are blind or visually impaired achieving successful independence and
employment.  BLVS also recognizes that staying current and competent
as consultants in the field of AT is a daunting task. Given this
important challenge BLVS conducts a variety of activities, including
the following, to address the issue:
1)	Maintaining awareness of the overall AT services and resources.

2)	Exploring and implementing additional ways to better address changes in AT.

3)	Attending conferences like CSUN and Closing the Gap.

4) Maintaining contacts with AT companies, including inviting vendors
to show products at bi-annual staff meetings.

5) Continuous research and exploration of resources and resource
reference materials for consumers.

6) When appropriate, sending people out of state for intensive training.

7) Collaboration with MonTECH on equipment and training.

8) Conducting training programs around state on different AT devices
and techniques.

VRB should fund access to the National Federation of the Blind (NFB)
Newsline under the service to groups category.  NFB Newsline is a
newspaper/magazine delivery system that gives daily accessible formats
of five Montana dailies, as well as important national papers and
magazines.  Blind and other users with print-disabilities use this
service daily.  NFB Newsline also has the option of providing job
listings.  In short, it is a vital means of access to our state's
newspapers and much more.
This comment came from 13 persons.
Response:  VRB recognizes the value the Newsline has for a wide
variety of consumers and is in the process of exploring the following
information to make a decision on how to proceed.
1)	Analyze the potential outcomes of obtaining the service and
determine priority related to other issues.

2)	Analyze potential funding sources within DET.

3)	Look at collaborating with other agencies, i.e. Talking Book
Library and Montana Association of the Blind, NFB of Montana, Talking
Books Library and other possible partners in funding

4)	 Evaluate issues related to maintaining funding on a long term basis.

BLVS needs to further expand the blind vendor's program.  Some
part-time routes should be increased to full-time and another route
should be added in the state.
This comment came from 1 person.
Response:  BLVS recognizes the importance of the blind vendor's
program and has taken a variety of actions to increase support of the
program.  For the contract covering October 1, 2012 through September
30, 2013 BLVS increased the amount for the management services through
Montana Business Enterprise Inc. (MBEI) by $40,000.  This doubled the
amount MBEI had been receiving.  In addition to these funds, MBEI has
income from unassigned vending to use towards the vending program.
The increased funding included funding to purchase additional machines
so existing routes could be expanded to full time and to create new
routes.  To date, these funds have been used to purchase vending
machines for routes, and for replacing old equipment that is now
obsolete.  The plan is to continue funding the BEP at the level of
$80,000 per year.

In addition, BLVS is considering the following factors for possible
action in the future:
1) Find ways to increase unassigned vending income.

2) Look at feasibility of starting new route in a major Montana city,
based on the following factors: existing contracts with vendors,
interest of individuals becoming involved with BEP, and availability
of funds.

Persons interested in participating in the Business Enterprise Program
are encouraged to talk with their local BLVS counselor.

BLVS needs more services in Gallatin and Lewis and Clark counties.
This comment came from 1 person.
Response:  Office placement is a difficult and complex issue.
Staffing needs and office placement are reviewed on a periodic basis.
Decisions are not based solely on population or voter distribution.
Factors considered are:
1) the number of consumers in various areas and service waiting lists
2) efficiency of staff travel, to reach consumers
3) ability to recruit and maintain qualified staff at various locations
4) ability to obtain new FTE for new positions
5) existing office leases
6) costs related to starting a new office
The primary emphasis of major decisions such as office placement or
increasing staff resources is the impact that can be expected by such
a change.  What will be the positive increase in desirable outcomes
for the expense and effort invested in such changes?
There are a number of consumers of BLVS that have multiple
disabilities, and there are national programs that address some of the
issues of multiple disabilities.  The Perkins Institute is one
example.  VRB should explore more of these resources.
This comment came from 1 person.
Response: BLVS works with national programs that address the needs of
individuals with multiple disabilities like Perkins Institute, Helen
Keller and others.  Consumers are referred to these programs based on
their needs and goals.  BLVS also works with several rehabilitation
centers outside of Montana when appropriate for an individual to
receive intensive training.  These centers also work with individuals
with multiple disabilities.
VRB should consider persons who are experiencing depression in
addition to being blind or experiencing low vision as an
unserved/underserved population.  More needs to be done in the
identification of this population.
This comment came from 1 person.
Response: BLVS will consider this issue in the process of developing
ongoing staff training.  The need for such training will be weighed
against the needs in other areas to determine if this is a priority
for limited staff development resources.
While the co-occurrence of blindness and low vision with a wide
variety of other disabilities is not unusual, it is felt that the
assumption that particular psychological conditions coexist with
blindness and low vision or other disabilities needs to be considered
carefully.  Historically, disabilities such as blindness and low
vision were often associated with depression based on the negative
perceptions of disability that existed in the past.  However, the
present view of disability focuses on empowerment.  The past views of
relating depression with disability are now seen as a reflection of
obstacles created by the environment that need to be dealt with rather
than a natural reaction to disability.
BLVS should establish an advisory council to address the unique
elements of the program.
This comment came from 6 persons.
Response: BLVS and DET also see a need for an advisory group
specifically for BLVS to address issues such as the Older Blind
Program, Business Enterprise Program, Visual Medical and other issues
specific to blindness rehabilitation and independent living.  The
request for an advisory council is not new.  Previously lack of
funding for another advisory group or the political atmosphere
hindered the development of a council.  BLVS and DET commit to
renewing efforts to establish a BLVS advisory council and to develop a
workable solution on this issue.
IL Comments
The Missoula independent living center only knows how to serve people
with physical disabilities and personal care needs.  Their classes are
inadequate.  They may need training from other centers around the
country to get new ideas.
This comment came from 1 person.
Response:  While Summit Independent Living Center does contract with
DET/DPHHS to support a portion of the services Summit provides, they
are an independent organization.  In order to respect their
independence, DET asked Summit to respond to the issue.  The following
is the response provided by Mike Mayer the Director of Summit:
Summit respectfully disagrees with this comment. Throughout our
organization we have staff and peer advocates who have physical
disabilities of varying types, mental illness, intellectual &
developmental disabilities, hearing loss, deafness, visual impairment,
brain injury, and other disabilities. Summit serves people across the
disability spectrum as evidenced in our annual 704 performance report.
In 2012, the report reveals that of the total 818 individuals with
disabilities served, 286 people described their disabilities as
physical, 115 mental/emotional, 93 cognitive, 8 hearing, 23 vision,
245 multiple disabilities, and 48 other. Summit offers Living Well and
Working Well with a Disability workshops, classes on self-advocacy,
assertiveness, self-esteem, and other topics. We also teach Building
Advocacy & Learning Leadership Skills courses for high school students
with disabilities in western Montana, provide peer mentoring services,
advocacy assistance, social activities, senior companion services,
self-directed personal assistance, and information and referral
services. Staff and peer advocates regularly participate in national
training in the core services of independent living through the IL Net
and other appropriate training resources.
DET should provide support for IL Centers and the SILC in the future.
This comment came from 9 persons.
Response:  DET has provided support for the IL Centers and SILC for
many years.  In general, the support for the IL Centers comes from
General Funds and a portion of the IL Part B funding.  The SILC has
received funds to support administrative costs from the IL Part B
funding.  Also, vocational rehabilitation (110 funds) has provided for
the meeting and travel expenses of the SILC.  Recently, the federal
sequestration has negatively impacted a variety of federal funding
sources for the IL Centers and to a lesser degree the SILC.  DET has
committed additional funding this year to offset some of this lost
funding.  DET intends to review the needs of the IL Centers and SILC
on an ongoing basis and continue support in the future.  However, the
exact amount and source of funding will be dependent on a variety of
factors.

There needs to be services to assist people with disabilities to
access Money Follows the Person and Community First initiatives.
This comment came from 1 person.
Response:  The IL Program Manager has been assigned as the DET point
person for the Money Follows the Person and Community First
initiatives.  She will follow developments in these initiatives and
provide appropriate information to the IL Centers and VRB staff that
will assist them in making sure they have information to provide to
the consumers of the programs.  It is also anticipated that the IL
Centers may be involved with outreach efforts to inform the disability
community of the options and services available under these
initiatives.  It should be noted that the IL Centers have been major
contributors to the success of the Medicaid for Workers with
Disabilities initiative.  It is anticipated that their efforts will
also have a positive impact on the success of Money Follows the Person
and Community First initiatives.
In addition, DET has a specific role in the Money Follows the Person
initiative.  The Division will develop public awareness videos
describing the issues and solutions for persons who have visual
impairments and persons who have hearing impairments to maintain
independence in their community.
All of the programs in DET will be kept informed of these activities
and have access to appropriately develop the materials developed.
The State Plan for Independent Living needs to provide specific
direction in how to address the problems of persons with disabilities.
This comment came from 1 person.
Response:  The SILC is working to develop a plan for the next three
years that addresses specific independent living issues.  One of the
specific initiatives was previously discussed in the discussion of
minimum wage.  The IL Centers will coordinate stakeholder discussions
on how to transition sheltered employment to competitive community
employment.

Joint IL and VRB Comments
VRB and IL should explore collaboration in the area of youth in transition.
This comment came from 2 persons.
Response:  Part of the activities of the Transitions Coordinator when
she was developing the Adopt a School program that is now a statewide
initiative of VRB was to frequently refer youth to IL for peer
advocacy and IL skills training.  IL services were seen as a rich
source of instruction for a variety of skills necessary to transition
into the adult world.  IL is one of the major resources noted in the
transitions GPS which is a key component of the Adopt a School model.
The Transitions Coordinator is considering surveying the transition
counselors to determine the amount of interaction with IL centers and
the use of the GPS system as a referral mechanism to IL services.
After conducting the survey, strategies to increase coordination could
be developed if necessary.

The IL Program Manager conducted an email survey of IL Centers on the
issue and found that the Center's involvement with VRB related to
transition and the Adopt a School model varied between the Centers.
Some Centers were not familiar with the model and had little
coordination on transition issues and others were aware of the model
and had some specific coordination activities initiated.

In addition, both the VRB Transitions Coordinator and various IL
representatives actively work together in the collaborative efforts of
the Montana Youth Transitions Program and the Montana Youth Leadership
Forum Program.

VRB should collaborate with IL to develop strategies to address
potential gaps in services created by changes in Medicaid and Medicaid
waiver services.
This comment came from 2 persons.
Response:  Medicaid and Medicaid waiver services are large service
programs and completely filling gaps that may develop as a result of
cut backs in these programs will be difficult.  As mentioned
previously the IL Program Manager has the responsibility of keeping
DET programs informed on these issues and distributing information as
appropriate.  Any negative impact on Medicaid or Medicaid waiver
services has a significant impact on the persons served by VRB and IL
and whenever such impacts are identified, the programs will work to
assist their consumers who are affected.

Comments of Appreciation
Thank you for the increased support for the blind vendors program in
Montana.  This support has been increased to a more realistic and
sustainable level, and will be instrumental in developing the program
further.

Thank you to BLVS for adding services to the Kalispell area.

Thank you to Jim Marks for what he has done at VR.

Thank you for the financial support of IL Centers this year.

Thank you for the fee for service opportunities with the IL centers,
such as the accessibility studies.

Thank you for the IL/VRB partnership in the area of benefits planning.

Thank you to VRB for providing leadership in supporting Montana in
applying for Money Follows the Person program.

Thank you for the collaboration with the SILC.

Thank you to Peggy Williams for revitalizing the SILC.

Thank you for the collaborating with Montana Youth Transitions to
build a sustainable service for youth with disabilities and their
families.

It was noted that consumers are speaking more positively about VR
services than in the past.

Thanks to the IL Centers in counseling with persons with disabilities
to alleviate their fears and helping them to achieve independence.

There were comments that in an individual case in Bozeman VRB and IL
worked well together and it was beneficial to the consumer.

Thank you to Tammy Hogan in the VRB Great Falls office for leadership
and support in the regional youth transition group.


-- 
Dan Burke
My Cell:  406.546.8546
Twitter:  @DallDonal