The Maine Statewide Independent Living Council

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(a)  Results of Comprehensive Statewide Assessment of the Rehabilitation Needs of Individuals with Disabilities and Need to Establish, Develop, or Improve Community Rehabilitation Programs
The Division worked actively with the CHOICES Comprehensive Employment Opportunity (CEO) grant stakeholders to complete a Comprehensive Statewide Assessment of Rehabilitation Needs of Individuals with Disabilities in FY 2006 (Attachment A). With support from the Bureau of Rehabilitation Services (BRS) and many other stakeholders, Maine’s Department of Health and Human Services has been awarded a four-year (2005 – 2009) Medicaid Infrastructure Grant (MIG) entitled, CHOICES Comprehensive Employment Opportunity (CEO). Maine Division of Vocational Rehabilitation (DVR) in conjunction with the State Rehabilitation Council (SRC) identified many constituent groups for the Muskie project staff to contact. Public forums were held as well as an Internet evaluation tool to ensure broad-based participation. Relevant information from the 2003 Maine Ability Partnership Grant assessment of the 23 CareerCenters in Maine will be included in the DVR Comprehensive Needs Assessment.

(b)  Annual Estimates of Individuals to Be Served and Costs of Services
Employment assistance to individuals with disabilities in Maine is primarily met through the Division of Vocational Rehabilitation. In 2005, DVR served 10,733 individuals with disabilities. DVR continues to have wait list for Category 1 consumers and there is currently a six-month wait list for all people with the most severe disabilities who apply and are eligible.
In FY 06 DVR embarked on an aggressive plan to reduce the wait list for category one consumers from 12 months to less than three months. This has been accomplished by reducing the present wait list by seven weeks every month. Since October 2005 the wait list was reduced from approximately 2,136 all categories to about 1,411 at the end of April 2006. The goal is to have the wait list for the most significantly disabled to three months or less at the start of FFY 07. Maine is currently serving only individuals in Category # 1, that list is a little over 1000 individuals.

The Division expects to start the FFY 2007 with approximately 5,700 cost cases (status10 - 24), close approximately 2,800 cases in statuses 26-38 and end FFY 2007 with approximately 5,000 cost cases. Around 7,800 individuals will be served in statuses 12-24 during FFY 2007. There continues to be a decrease in new applications that we expect will result in a reduction in the number of cost cases in FY 2007. Cases are taking longer to close with higher average cost per closure. The estimated service cost should be approximately $8.0 million. These estimates are contingent upon the ability to fill vacant positions without significant delay, due to the State budget crisis and executive orders that impact the hiring process.

Supported employment cases are running fairly consistently from year to year. The Division estimates that it will begin the fiscal year with approximately 250 cases, accept a little over one 100 cases, and close approximately 100 cases during the coming fiscal year. Almost $600,000 will be spent on supported employment activity. The one variable that could affect this would be the limited resources for extended supports.

(c)    (1)    State’s Goals and Priorities

A.Improve staff retention and recruitment of qualified staff.

• DVR work group will survey staff and develop strategies to reduce the 15% turnover rate of counselors.
• Develop an initiative with University of Southern Maine to expand practicum and internships with DVR for rehabilitation counselor graduate students.

B.Explore cost effective ways to meet the increasing numbers of transition students who need assistance in transitioning from school to work.

• Explore the feasibility of implementing the High School/High Tech Program in Maine.
• Consult with Transition Counselors group on creating modules of “What works and can it be made statewide?”.

C.Increase the rehabilitation rate and number of successful outcomes in order to meet the Federal standard and indicators.

• Use of video conferencing for case management practices training to facilitate the movement of clients in plan development and active plan to successful employment outcomes.
• Statewide training for staff on standards & indicators

D.Evaluate the effectiveness of post secondary training in assisting individuals to achieve an employment outcome that is consistent with the individual’s interests, abilities and capabilities.

E.Improve the clarity and consistency of the message about the purpose of the DVR program and its services.

• Developing a PowerPoint orientation presentation that will be used on a statewide basis.
• Consider statewide ‘roundtables’ for counselors on a regular basis to keep message consistent.

F.Increase the number of individuals receiving SSDI or SSI who are able to enter full time competitive employment.

• When the new Ticket to Work Regulations are finalized, promote the development of new employment networks with CareerCenters, DHHS, employers, and other providers and build new partnerships that support full time competitive employment.

(c)    (2)    (A)    Order of Selection
The Division continues to strive for is statewide consistency in identifying individuals with the most significant disabilities at this time. The Order of Selection criteria defined in the DVR policy manual 2004 are the current State rules.

(c)    (3)    Goals and Plans for Distribution of Title VI, Part B Funds
Based on level funding, the Division’s goal will be to continue to use the VI-B, Supported Employment Program, funding on a fee for service arrangement, providing services to a minimum of 38 consumers with the most significant disabilities for whom supported employment is an appropriate vocational alternative. Priorities for supported employment are services to individuals with most significant disabilities in rural areas, individuals with long-term mental illness, individuals with traumatic brain injury, and individuals with severe physical disabilities.

The State’s budgetary restraints continue to have had a negative impact on the extended support funds available. These diminishing funds have significantly impacted the numbers of individuals with mental retardation (MR) to be served, based on limited sources of extended funds available. The general grant monies that covered all consumers with MR not covered under the Medicaid Waiver program no longer exist and the Waiver is the only option. This limits the number of plans that will be written.

A second goal remains continuous improvement of supported employment services through training. The Division has developed, and made available in each region of the state, a comprehensive training package on supported employment. This training is offered to all new staff, and, as a refresher, to existing staff. The training covers definition, eligibility, assessments, plan development, initiating and monitoring plans, and termination from time-limited services. This training, and ongoing monitoring of casework, provides for greater consistency in the delivery of supported employment services. Having the tools and knowledge generated in the training also makes services more cost effective.

There is also a collaborative training effort that is called the Maine Employment Curriculum, which is designed for providing training in Supported Employment for Employment Specialists and job coaches. This is a collaborative effort with the Maine Department of Health and Human Services through the University of Maine’s Center for Community Inclusion. We have identified minimum training requirements for new Community Rehabilitation Providers to become an approved provider. It is our expectation that this requirement, as well as the requirements around standards for services provided through Certification Accreditation of Rehabilitation Facilities and our in-state accreditation process, will improve services to all our consumers.

The plan is to continue to purchase services for designated VI-B clients. Service types will continue to be primarily job coaching, transitional employment services for individuals with long-term mental illness, and job development. We will also continue to work with the Association of Persons in Supported Employment and other stakeholders to expand the availability of supported employment services.

(d)    (1)    State’s Strategies and Use of Title I Funds for Innovation and Expansion Activities To Address Needs Identified in the Comprehensive Assessment and to Achieve Identified Goals and Priorities

Improving Self-Employment Outcomes
The Division (DVR) continued its partnership with the Division for the Blind and Visually Impaired (DBVI), the University of Southern Maine/Maine Small Business Development Centers (Maine SBDC) and Coastal Enterprises, Inc., (CEI), a micro-enterprise development organization, to develop and implement a coordinated self-employment initiative designed to assist potential entrepreneurs with disabilities in Maine. During the first year of this effort, DVR referred 114 individuals to the project for assistance with a wide range of small business ideas, including a shuttle van service, candy making, landscaping, financial advising, auto mechanics, massage therapy and furniture restoration. The model being tested includes a multi-step pathway designed to move individuals successfully towards sustained business ventures with clearly defined procedures, resources and tools across the state. Given the general course of business start-ups, it is early yet for outcome data that can be considered in the program evaluation, but as anticipated, there was an initial reduction in the number of closures in self-employment during the first year of activity to 40 cases from 60 the previous year. (Note: This was 5.8% of all successful closures in SFY 2005.) This makes sense, given clearer definitions of self-employment in policy and the emphasis on sustainable businesses. Qualitative measures found general satisfaction with the initiative and the relationships being established between business and rehabilitation counselors across the state. The level of participation was higher than projected and the availability of business counselors in some areas of the state with high service demand (Augusta) and SBDC turnover issues (Bangor) were concerns addressed during the year.

A steering group that consists of statewide representation from DVR, DBVI, SBDC and CARES continues to meet on at least a quarterly basis to address issues that arise and to support the continuing development of this service. As the second year comes to a close, further evaluation, staff training, and moving beyond start-up to business support and growth are areas of focus. Additionally, the use of community rehabilitation providers for disability-related supports and assistance from the Iowa Abilities Fund to increase the utilization of specialized lending programs for micro-enterprises and the PASS for Social Security beneficiaries have been identified as opportunities in the effort to maximize the limited DVR resources.

Statewide Rehabilitation Council
The Statewide Rehabilitation Council (SRC) for the Division meets monthly as a full council. Several members meet with DVR staff regularly regarding specific topics that interest DVR and the SRC. The input of the SRC is vital to the ongoing success of the Division’s services to Maine’s citizens. Three areas in which the SRC and DVR worked closely in FFY 06 are:

1.The Comprehensive Statewide Needs Assessment:
The SRC were instrumental in working with DVR staff to formulate conclusions, recommendations, and goals for the next three years based on information obtained from the needs assessment. The Maine SILC is also partially supported by Title I I&E funds. SILC members were additional stakeholders included in the comprehensive statewide needs assessment and its discussion.

2.Order of Selection Tool/Client Means Test:
A sub-committee met every two months to discuss these issues and their appropriateness for DVR consumers. The Order of Selection Tool is on hold at this time and will be revisited in FY 2007. A Client Means Test pilot project will be conducted in one region in the summer of 2006 to explore the benefit to the agency.

3.Satisfaction survey:
In March 2006, Maine participated in its second multi-state Client Satisfaction Survey with the general VR agencies of Vermont and Connecticut. Information from both these surveys is incorporated in the Comprehensive Statewide Needs Assessment and will help drive the goals and recommendations for the next three years.

Improvement in Data Collection
Maine BRS meets monthly with programmers from the Department’s Office of Information Processing (OIP) to correct and improve data available to DVR leaders and staff. Collection and retrieval of data for the Federal Reports, such as the 911, have always been a top priority. Other improvements include:

Standard and Indicator 1 (1.1-1.6) reports,

• New Occupation Selection Screen has been developed that will display Standard Occupational Classification (SOC) codes alongside their corresponding DOT codes to comply with the required change starting October 1, 2006.
• Development of a new closure screen to comply with federal closure regulations. Maine DVR had some deficits in this area after the last 107 review August 2005.

(d)    (2)     State’s Strategies and Use of Title I Funds for Innovation and Expansion Activities To Carry Out Outreach Activities to Identify and Serve Individuals with the Most Significant Disabilities Who are Minorities.

Maine DVR continues to struggle in increasing services to individuals with most significant disabilities who are minorities. Maine is one of the least diverse states in the nation, however we are pleased that the percentage of individuals of minority populations has been increasing over the past five years. In FFY 2005, Maine DVR surpassed the Standard Indicator 2.1 with a service rate of .866. Maine’s minority population is growing according to the U.S. Census Bureau; Both the Black or African-American and Hispanic populations have increased between 2000 and 2004. As stated in last year’s report, many of theses individuals live in the Southern part of Maine with a large Somali presence in the Lewiston area and many diverse cultures being served in Portland area. DVR continues its work with Maine Indian Tribes, including the Passamaquoddy Tribe, the Penobscot Indian Nation, the Houlton Band of Maliseets, and the Aroostook Band of Micmac Indians. Unfortunately, the Section 121 grant was not realized, however DVR remains in contact the Tribal leaders.

(d)    (3)    State’s Strategies and Use of Title I Funds for Innovation and Expansion Activities To Overcome Identified Barriers Relating to Equitable Access to and Participation of Individuals with Disabilities in the State Vocational Rehabilitation Services Program and the State Supported Employment Services Program.

Communication Access has being been a barrier for Deaf individuals who rely on manual communication and DVR has hired counselors conversant in American Sign Language (ASL) for many years. This year three of the four staff providing direct service to the Deaf are deaf themselves. The supervisor of two of the deaf staff members is also fluent in ASL. Two deaf staff members have videophones (VOIP), which allow them to communicate directly with consumers in their native language.

Another new communication access feature is Web cameras to connect with Video Relay Services (VRS) or Video Remote Interpreting (VRI) over the Internet. This allows signers and non-signers to communicate using qualified interpreters who are in a remote location. These systems will be in VR locations and CareerCenter information centers to allow 1:1 communication or distance learning for both consumers and staff.

The wait list continues to be a major barrier for individuals with significant disabilities to access both the VR system and supported employment. As stated earlier, Maine DVR continues to serve only individuals in Category #1 and DVR’s efforts in reducing the wait list does not include individuals in Categories # 2 and # 3. The proposed Order of Selection tool is still a work in progress. Informational forums with stakeholders are planned in the near future. The goal is still to better identify individuals in Category 1 and Category 2 (individuals with a significant disability), to serve all in Category # 1 and finally serve those in Category 2.

Maine DVR participated with other New England states in consumer satisfaction phone survey in the spring of 2006 and preliminary results of the survey will be included in this report.

Maine’s Bureau of Rehabilitation Services maintains a web-site www.maine.gov/rehab that is for the use of the public. Links to DVR give specific information and additional resources to individuals seeking information. Ensuring this site is accessible to all visitors is a primary concern.

(e)      Evaluation and Report of Progress in Achieving Identified Goals and Priorities and Use Of Title I Funds for Innovation and Expansion Activities

A.     Develop Program Improvement Strategies (reduce costs and wait list while improving employment outcomes as result March 10, 11th DVR staff meetings) by reviewing:

Job development services and different approaches to meet job development needs.
Job Development & Placement services are the largest single service group of total DVR case costs each year however, there has been a 7% reduction in spending from FFY 2003 to 2005. This may be due to the adoption of a Job Readiness Tool that assesses the individual’s job readiness in 53 areas across 14 domains. It is a tool that both counselor and individual work on together and can track improvement.

A Job-Readiness Coordinator has been approved and will be on board by FFY 07. The coordinator will serve as a resource to VR counselors identifying strategies, services or interventions that can address the job readiness needs identified in the job readiness assessment. The coordinator will also facilitate small-group training, and education of consumers in targeted areas such as hygiene, budgeting, job keeping and job development.

Post secondary training to reduce costs and improve consistency in providing post secondary training.
This year a Post-Secondary Work Group was assembled with representation from across the state, the Client Assistance Program and a Financial Aid Officer to identify and address inconsistencies in the provision of post-secondary training services by DVR. Much effort was spent creating a post-secondary guidance package for counselors to use with individuals who are in need of a post-secondary education to achieve an employment outcome consistent with their comprehensive assessment of rehabilitation needs. This package is nearing completion and includes the following: A procedural directive highlighting current policy, a timeline to guide counselors and students though the application for Federal Financial Aid and exchange of information with the attending school, Financial Aid Exchange forms and instructions for completion, a Frequently Asked Questions section, and case examples. The package will be posted on DVR's intranet and will be included as a module in New Counselor Training. It is anticipated that the work of this group will conclude by Fall 2006.

Support services to reduce transportation costs including vehicle repairs.
DVR has seen a 19% reduction in transportation cost since 2003. This was achieved by changing the DVR Policy Manual to identify transportation as a support service that can only be addressed in an IPE or Post employment plan in association with VR Core Services. A Procedural Directive was written, adopted and made available to DVR staff on DVR’s intranet site. It has also been incorporated into the New Counselor Training.

Rehabilitation rate with the intent to increase the number of successful employment outcomes
The Division has been working very hard towards this goal. Two initiatives are under way, including special attention being paid to bringing long-term high-cost cases to successful conclusion. Supervisors and counselors review these cases by regularly and a “High-Cost Long Term List” report sent to each supervisor to enable to review the individual cases. The second initiative is the result of the Counselor Advisory Committee meetings where they requested the institution of a monthly statewide paperwork day. The fourth Thursday of each month is set-aside for counselors to focus on the all the aspects of documentation in the case records. This includes closures with an emphasis on successful outcomes. Division Leaders plan meetings involving counselors on these days and counselors plan their appointments with clients around these days. The prorated statistics for 2006 indicate a positive movement towards bettering 2005 in successful employment outcomes.

Social Security Administration (SSA) reimbursement to increase funds available for case services.
Since the implementation of our SSA/VR Reimbursement tracking system a little more than a year ago, we are able to identify and submit claims for clients whose cases are in an active status. Prior to the utilization of this program, by the time these cases would have been identified as appropriate claims for submission, they would have missed the timeliness guidelines and been denied. In FFY 2004, 7 claims were identified, bringing in and additional $14,055. In FFY 2005 the number grew to 11 claims and $120,058. We expect this increased revenue to continue.

In addition to submitting claims on active clients, we are also able to identify appropriate claims for clients who unsuccessfully exited their VR program but who are working. We have been bringing in about an additional $100,000 per year since implementing this change three years ago, and the new Tracker software program greatly facilitates the identification of these claims.

Although the number of successful closures continued to decline in FFY 2005, income from reimbursement claims has actually increased for claims submitted in FY 2005 from $872,530 to $1,100,224. ($549,059 was received in 11/05).

B.     Establish a Case Management System that addresses all disability related barriers for achieving the employment goal by ensuring:

• The vocational goal shall be mutually agreed upon in the IPE and must be provided as cost effectively as possible.
  Effective case management practices are discussed on a monthly basis with the DVR Leaders’ group and every two months the Leaders’ group meets jointly with the Counselor Advisory Committee to support the development and implementation of case management practices that support the movement of clients to successful outcomes and reduce the time clients are in the VR process. By assisting individuals to achieve their goals and move towards successful outcomes in a timelier manner, DVR will be able to reduce the wait list and meet individual vocational needs.
• Statewide trainings on case management practices to all staff creating consistency and efficacy of services to clients.
  The greatest increase in case service expenditures during the past 3 years has been in post-secondary training services. A work group with representation from each Region along with representation from student financial aid and the Client Assistance Program are developing a procedural directive that will improve consistency and maximize the use of comparable benefits. In addition a question and answer document will accompany the procedural directive and regional training is planned.

C.     Re-establish formal collaboration with newly created Department of Health and Human Services (DHHS) (formally Mental Health and Mental Retardation Services)

DVR program staff meets every 2 months with DHHS staff from Mental Health Services and Mental Retardation Services to increase collaboration to improve vocational services to these populations. The State Rehabilitation Council has a committee that focuses on improving vocational outcomes for individuals with mental illness and has a representative active in these meetings. DHHS is working on developing a Request For Proposals (RFP) to address to expanding vocational services for individuals with mental illness and DVR and SRC are involved in the development of criteria for the RFP.

The Division is concerned with the limited extended support funding available for individuals with mental retardation and is tracking the development of a Medicaid waiver that could expand the number of individuals eligible for extended support.

D.     Maximize the resources available through the Centers for Medicare and Medicaid Services Comprehensive Employment Opportunity (CEO) grant to conduct a comprehensive statewide needs assessment in collaboration with the State Independent Living Council (SILC), Developmental Disability (DD) Council, and DHHS.

See Attachment A, Maine DVR's Comprehensive Statewide Needs Assessment.

E.     Re-establish the consumer satisfaction phone survey of open and closed cases in partnership with other interested New England State Agencies and use results to target areas for improvement.

Market Decisions from Portland conducted a consumer satisfaction survey in March 2006. We used the same survey instrument that was used previously in 2003. The survey involved contacting a random sample of active and closed cases that were active at any time during the period April 2005 to March 2006 by phone. In order for us to do a trend analysis with the previous survey, we needed to keep the survey questions and process similar to the previous survey, but we did have the opportunity to add to up five additional questions. The SRC/DVR Consumer Satisfaction Committee finalized the survey process this year. Individuals also had the option of having a survey mailed to them or completing the survey by TTY if needed. A brief comparison of results is included in the Comprehensive Statewide Needs Assessment. The satisfaction survey and the needs assessment results will be analyzed together to create future planning of DVR.

F.     Pilot test new fee structure and contracting protocol with Community Rehabilitation Providers (CRP).

Preliminary research conducted by the Division suggested that a results-based outcome payment system might have merit in addressing perceived inefficiencies and disincentives in the current Community Rehabilitation Provider (CRP) payment system, and hence, might offer a way to maximize the state agency’s resources while increasing the successful employment outcomes of individuals served. The availability and quality of employment services in communities throughout the state have a direct impact on what is offered to individuals with disabilities as they pursue their vocational goals. In FFY 2006 the Division focused on investigating this payment system model with the goal of determining whether changes in the payment of CRP’s would result in a system improvement. Engagement of national technical assistance resources and Maine stakeholders were identified as critical to the initiative’s success to ensure that any changes in the payment system aligned with best practices and the mandates of the public vocational rehabilitation program. Specific objectives identified for the year included:

• A one-day forum planned and convened in July 2006 that provides up-to-date (Next Generation) information on results-based outcome payment systems.
• Focus groups gathered to identify issues related to DVR moving to some type of outcomes-based payment system.
• A written report compiled to summarize data, issues and recommendations for consideration and communication in making changes from the current CRP payment process to a results-based model.
• By Fall 2006, a conclusion about results-based payments will be reached and an implementation plan initiated to ensure that the CRP payment system administered by DVR is effective, efficient and successful in increasing in the number of employment outcomes.

G.     Initiate a comprehensive Financial System that will;

• Use best business practices
• Be compliant with Federal, State and Departmental regulations
• Establish and Improve accountability and internal controls where necessary.
• The Division has been part of a comprehensive Bureau enterprise to standardize Division and program budgeting practices. This falls in line with a Departmental and statewide shift to maximize state and federal resources. To this end all contract managers have been offered training in the state procurement process with the goal of standard contracting procedures in all Divisions. Division directors have worked closely with the fiscal unit to develop budgets for which they are accountable.

H.     DVR will collaborate with the Department of Education through the Committees on Transition, and the Maine Advisory Council for the Education of Children with Disabilities to implement the principles as authorized in the 2005 IDEA and Rehabilitation Act as reauthorized in 2005 to improve employment outcomes for youth.

According to our most recent comprehensive statewide needs assessment, transition-age individuals made up about 31% of VR closures were under the age of 23 at the time they applied for DVR services.

The Committees on Transition are working on assisting parents and students to adjust to the demands of Maine's Learning Results and the requirements of No Child Left Behind. There are seven area Committees on Transition that are comprised of a coordinator and representatives from parents, schools, VR, DHHS, provider agencies and other local people interested in transition. This is a strong forum to collaborate with all the partners working with youth in transition from high school to post-high school.

This year Maine Advisory Committee on the Education of Children with Disabilities (MACECD) has been integral in providing advice to the Commissioner of Education about the State Performance Plan. They have made recommendations this year to include documented feedback for each student with a disability to be included in the Individual Education Plan. There is also a recommendation to promote a consistent method of documenting credits for students experiencing outside placements i.e. Corrections' academic programs, tutoring in hospitals, etc. This information will help the DVR counselor determine a student applicant’s eligibility and develop an accurate comprehensive assessment of rehabilitation needs.

The Division serves underserved populations throughout the state, including American Indians and other minority groups, and does effective and continuing outreach to share information with these groups. Materials used in connection with this program are in accessible formats. We provide interpreters and other service personnel to guarantee accessibility to persons with diverse disabilities. The program has been developed with consumer input; consumer satisfaction continues to be monitored; and, consumer choice remains a priority. The staff is qualified and receives continuing education to keep their skills at a high level. The agency engages in systematic assessment of its operations, and eliminates barriers to positive service outcomes.