On Target
Volume 19 Special Edition
Disability Rights North Carolina
Champions for Equality and Justice
Listening Sessions
In early 2015, our staff and board will be coming to your
community to hear about the issues that are impacting people with
disabilities. At these meetings, you will have an opportunity to
hear about our work, tell us what concerns you the most, and
network with other people with disabilities, their families, their
caretakers, and their providers.
We hope that you can join us when we are in your community!
Here is a partial list of the Listening Sessions that we have
scheduled so far. More dates and locations will be released by the
end of the year.
Fayetteville
January 7, 2015
5:307:30 pm
CFV Cancer Treatment &
Cyberknife Center
1638 Owen Drive
Raleigh
January 9, 2015
12:002:00 pm
Wake Med Raleigh
3000 New Bern Avenue
Jacksonville
January 30, 2015
12:303:00 pm
Onslow County Complex
4024 Richlands Highway
Weldon
February 4, 2015
12:002:00 pm
Halifax Community College
100 College Drive
(Continuing Education Building Room 401 A/B)
Charlotte
February 19, 2015
6:008:00 pm
Park Road Baptist Church
3900 Park Road
Greensboro
February 26, 2015
12:002:00 pm
Maple Street Police Station
1106 Maple Street
Winston-Salem
February 26, 2015
6:008:00 pm
Shepherd Center
1700 Ebert Street
Wilson
March 5, 2015
5:307:30 pm
Eastern NC School for the Deaf
1311 US Hwy 301 N
Manteo
March 13, 2015
12:302:30 pm
Dare County Center
950 Marshall C. Collins Drive
Asheville
April 9, 2015
5:307:30
Linwood Crump-Shiloh Center
121 Shiloh Road
Second Annual Conference
Save the date!
Tuesday, April 14, 2015
8:304:30 pm
The Friday Center
Chapel Hill, NC
Big Changes Coming: Final Rules for Home and Community-based
Services (HCBS)
Based on new guidance from the federal government, the NC
Department of Health and Human Services (DHHS) is drafting a plan
that will make big changes to how home and community-based services
are provided to people with disabilities throughout the state. In
March 2014, the Centers for Medicare and Medicaid Services (CMS)
issued final rules defining the characteristics for residential and
nonresidential settings to qualify as home and community-based
settings in order to receive HCBS Medicaid funding. The rules also
specify that service planning for individuals participating in HCBS
funded programs must be achieved through person-centered planning
that reflects the individuals preferences and goals for their
health and long-term services and support needs.
NCs Transition Plan
As a result, North Carolina is required to submit a transition
plan to CMS by March 17, 2015 detailing how the State will ensure
compliance for all settings throughout the state that receive HCBS
funding. In North Carolina, this would include programs such as the
North Carolina Innovations Waiver, the Community Alternatives
Program for Children (CAP/C), and the Community Alternatives
Program for Disabled Adults (CAP/DA) as well as any other program
that may be receiving HCBS funding.
The transition plan must detail how DHHS will provide services
to ensure that people will have greater community integration,
independence, individual rights and privacy, choices between
settings and providers, community living options, as well as how
DHHS will prevent isolation and seclusion of individuals with
disabilities from the greater community over a period of five
years. If some settings need to change, DHHS will have to explain
how they will change in a way that allows people to continue
receiving their supports.
Public Comment - Time for You to Be Heard
North Carolina needs your input to create a good plan that
provides for the most integrated settings for you and your loved
ones. If you are an individual with a disability, now is the time
to tell DHHS about where you live and work, and how it could be
better. If you are an advocate or provider agency that supports
people with disabilities, now is the time to tell DHHS why
community integration is essential and why it is or is not
happening. Not only are the final rules an opportunity to increase
community integration and prevent isolation but they also present
the opportunity to make the promise of person-centered planning
real for all individuals receiving these services. Now is the time
to let your voices be heard!
North Carolina is required to have a 30-day period of public
comment on any draft plan and again on the final transition plan
before submitting it to CMS. DHHS is anticipating making a draft
plan available for public comment by January 1, 2015. We will post
a link to the draft plan on our website when it is released.
You can submit comments or questions regarding the transition
plan directly to the State by email to [email protected];
include HCBS in the subject line. Please copy Disability Rights NC
at [email protected] so we know what your concerns
are, too! We encourage everyone to provide feedback to the State
because your experience is essential to improving the lives of
people who receive HCBS services.
State Appoints New Director of Office on ADA
Effective May 1, 2014, Nancy Lipscomb, the Employer Relations
and Local Government Division Director at the Office of State Human
Resources was appointed to serve as the Director of the NC Office
on the Americans with Disabilities Act (NCOADA). Under Title II of
the Americans with Disabilities Act (ADA), public entities, like
states, state agencies, counties, and towns, are required to
designate an ADA coordinator, make his or her contact information
known to interested individuals, and adopt a grievance
procedure.
In 2002, North Carolina created the NCOADA which adopted a
mechanism for public agencies and contractors to accommodate
accessibility requests, in addition to a requirement to adopt a
dispute resolution procedure to govern the responses to those
requests. The NCOADA requires public agencies and contractors to
designate a Public Service Accessibility Coordinator (PSAC) to
evaluate accommodation requests and make determinations within
specified timeframes. If a public entity refuses to provide the
requested accommodation, the PSAC works with the agency, in
consultation with NCOADA, to provide an individual a written
rationale for the denial.
In addition, the PSAC has the responsibility to inform an
individual of the right to file a formal complaint with the US
Department of Justice and the availability of an alternative
dispute resolution process. If an individual chooses informal
dispute resolution, the PSAC refers the individual to the NCOADA,
which uses facilitation and mediation efforts to resolve the
dispute. If the NCOADA cannot achieve resolution through informal
efforts, NCOADA refers the individual to local mediation sources
and, upon request, assists the individual in contacting the US
Department of Justice to investigate the denial of the
accommodation request.
Nancy Lipscomb with the NC Office on the Americans with
Disabilities Act can be contacted at (919) 807-4800. To learn more
about alternative dispute resolution, contact Disability Rights to
get our self-advocacy packet entitled Advocating for Access: Using
Coordinators and Grievance Procedures to Resolve Disputes.
Special Report: 2015 Targets
From the Director
Each year, we refine and adjust the scope of our work with what
we call Targets. Our Targets are developed based on:
-public input received through the annual Target Survey and
periodic Listening Sessions;
-information provided by individuals who call our office for
help; and
-issues that our staff see throughout the year.
-The Targets guide the work of our staff for the year.
Public input is a crucial part of the information base that we
use to determine where we need to focus our work. In 2010, we
gathered public input through a series of Listening Sessions. Its
time for us to host the Listening Sessions again so, in early 2015,
we will visit about 15 communities across the state.
I hope that you will take the opportunity to join us when we are
in your area. Your input is invaluable to us. Weve included a
partial list of the Listening Sessions in this newsletter so you
can go ahead and mark your calendar. The complete list will be
available soon.
Vicki Smith, Executive Director
What Is a Target?
The Targets adopted by Disability Rights NC are true to the
definition -- a goal to be reached. To achieve full equality and
justice for people with disabilities living in North Carolina, we
need to accomplish many different goals. But we do not have
resources necessary to tackle all of the issues facing people with
disabilities at one time.
Through public input and information received from people who
call our office for help, we look for problems that are widespread
or that pose the largest threats to the independence of people with
disabilities. Once we identify the problems, we develop an outcome
that represents the resolution or elimination of the problem. That
outcome becomes a Target of our work.
Why Does Disability Rights NC Need Targets?
As the federally-mandated protection and advocacy (P&A)
system in North Carolina, we are required to protect the rights of
all people with disabilities residing in North Carolina. Statistics
released by the U.S. government estimate that one in five people
live with some type of disability. Based on North Carolinas current
population, thats 1.9 million children and adults living with a
disability in our state.
Disability Rights NC receives most of the funding for its work
from the federal government. With these resources, Disability
Rights NC is expected first to ensure that people with disabilities
live in safe and humane conditions. We must also work to inform
individuals about their legal rights and how to enforce them;
ensure that people with disabilities are not unnecessarily
institutionalized; and enforce the rights of all North Carolinians
with disabilities under federal and state law.
Targets give us the structure within which we can spend our
limited resources. Each year, we carefully plan the expenditure of
the grant funds across the Targets and activities conducted under
the three core P&A functions not included in the Targets.
In addition, the Targets give our funders a measurable objective
with which to gauge our success in achieving the Target. As with
all grant funds, the grant recipient must account for how it spent
the money.
Does Disability Rights NC Do Any Work Not Covered by the
Targets?
Yes!
The Targets guide the work conducted by our legal teams. But
legally-based advocacy is only one of four core functions of a
P&A system. We do not develop Targets for three of the four
P&A core functions because the work in those areas is narrow in
scope.
Four Core Functions of Disability Rights NC
Information, Referral and Training
Information is a powerful advocacy tool. Knowing your rights and
how the system works can empower people with disabilities to get
the help they need. For this reason and because we do not have
enough resources to represent everyone who contacts us, we provide
information, advice and/or written materials to every eligible
caller. As part of our established protocols, our goal is to
provide all P&A-eligible callers some level of information and
referral (I&R) when their issue falls outside our annual
Targets.
Disability Rights NC provides training on disability rights
including special education, guardianship and rights restoration,
resident/patient rights in facility settings, anti-discrimination
laws in housing and employment, mental health laws, voting rights,
and self-advocacy. We offer training to groups across the state
that builds advocacy skills and knowledge of specific areas of
law.
Monitoring
Disability Rights NC monitors facilities where people with
disabilities live or receive services to prevent, detect, and
address instances of abuse, neglect or exploitation. Our monitoring
activities may include (1) face-to-face interviews with individuals
with disabilities living in the facility, (2) face-to-face
interviews with at least one staff member working in the facility,
(3) observation and evaluation of the physical conditions of the
facility, and (4) a review of records, when appropriate, in
accordance with applicable federal and state law. Our primary goal
is to ensure the residents rights are protected and that they are
living in a safe environment with opportunities to participate in
activities important to them, such as recreational activities and
work. Also during our monitoring visits, we identify individuals
who could live in the community if they had the proper supports and
services.
Investigations
In situations where we believe serious abuse or neglect may have
occurred, we conduct an investigation. The investigation is a
systematic and thorough examination of information, records,
evidence and circumstances surrounding the allegation of abuse and
neglect. Investigations are distinct from advocacy and require a
significant allocation of time and resources for activities such as
interviewing witnesses, gathering evidence, and generating a
written report which may or may not be released publicly. Because
of our limited resources, we focus on
investigations where the outcome is systemic change resulting in
better care for large groups of people with disabilities.
Legally-based Advocacy Including Individual and Systems
Advocacy
We represent the interests of individuals both individually and
systemically in the courts and other legal tribunals. This is the
work tied to our Targets, and includes the cases we take to
represent one person as well as class action lawsuits we file to
address widespread legal violations.
Disability Rights NC develops Targets for only one of the four
core areas of its work.
What Is a P&A?
The first protection and advocacy (P&A) program was created
in 1975 after a series of television reports exposed the deplorable
conditions at Willowbrook, a large New York state institution for
people with mental retardation. Similar concerns about the abuse
and neglect in mental health facilities led to the expansion of the
P&A system to include people with mental illness.
Safeguarding the well-being of individuals living in
institutions remains a major focus of the work of Disability Rights
NC. Over the years, the scope of P&A work has expanded to
include protecting the rights of people with all types
disabilities, whether they live in their own home, in a group home
or in an institutional setting. The P&A laws evolved to give us
the authority to devote resources to ensure full access to
inclusive educational programs, healthcare, accessible housing,
transportation, and productive employment opportunities.
Public Policy and Legislative Advocacy
In addition to the four core functions of a P&A, Disability
Rights NC engages in policy advocacy, including lobbying, to create
systemic change. We cannot use our federal funds to conduct
lobbying activities. Instead, lobbying activities are funded by
donations we receive from individuals and corporations. As an
independent 501(c)(3) non-profit organization, all donations given
to Disability Rights NC are tax-deductible.
Legislative and regulatory advocacy is a critical piece of our
work because laws and regulations can be the ultimate cause of the
problems people with disabilities face. A statute or regulation may
not be protective enough or may be interpreted incorrectly. We
focus on public benefit programs because, frequently, those are the
only places people with disabilities can get the services they
need.
We use systems advocacy to change policies at every level, but
pay special attention to agencies with enforcement
responsibilities. We also monitor non-governmental agencies that
are paid with federal or state money. Our advocacy efforts might be
directed at the local, state, or federal level. Where we work and
what we do will depend on the nature of the problem and who has the
ultimate authority over it.
Special Authority of P&As
Since P&As were created to prevent the abuse and neglect of
individuals with disabilities, Congress gave them extraordinary
investigative authority. For example, we have routine access to all
individuals with disabilities in facilities providing services. The
facility must give us access to all records of individuals with
disabilities and other records that are relevant to the
investigation we are conducting. We also must have immediate access
(within 24 hours of request) to all records related to the death of
an individual living in a facility, or in cases where we believe
there is probable cause to believe that the health or safety of an
individual is in serious and immediate jeopardy.
We can take a variety of actions in response to findings of
abuse and neglect, including litigation to enforce constitutional
and statutory rights of facility residents and the issuance of
public reports describing our findings and recommendations for
corrective action.
Who Responded to
the Survey?
How Many?
712 individuals residing in 99 of North Carolinas 100
counties
What was their relationship to disability?
I am a person with a disability -- 155
I have a family member with a disability - 363
I work in the disability field - 318
I am a person who cares about disability issues - 345
What disability did they identify with?
Developmental disability (including autism) 396
Intellectual disability or learning disability 331
Mental illness 324
Physical disability 367
Deaf or hard of hearing/hearing impaired 172
Blind or visually impaired 181
Traumatic brain injury - 198
What is their relationship to veterans?
I am a veteran 37
I am a current member of the U.S. armed forces 1
I have a close family member who is a veteran 360
I have a close family member who is a member of the U.S. armed
forces 104
None of these choices apply to me - 286
2015 Targets
Target 1. Advance community-based services and supports allowing
people with disabilities to remain in their homes and integrated
community settings.
Why is this important?
The integration mandate established by the US Supreme Court in
the Olmstead decision that people with disabilities have a right to
receive services in the most integrated setting appropriate to
their needs has been imperilled in North Carolina by the steady
erosion of funding for community-based Medicaid services for people
with developmental disabilities. Currently, there are nine Medicaid
MCOs across the state, each with its own staff, culture and
provider network. Although all of the MCOs operate under identical
contracts with the NC Department of Health and Human Services
(DHHS), employ the same service definitions from the State Medicaid
Plan, and administer the same waiver program, there is little
uniformity among the MCOs in their administration of the rules
governing eligibility, the number of authorized hours, and the
processing of grievances/appeals. This compounds the difficulty for
those seeking community services.
This year we will:
Continue litigating our federal lawsuit (Pashby v. Wos) to
restore and preserve personal care services to people living at
home and ensure due process protections.
Educate families/guardians and people with disabilities about
their rights and how to effectively advocate in the new managed
care environment.
Continue to work on a settlement agreement in K.C. v. Shipman, a
federal lawsuit we filed in 2011.
Counsel DHHS on any proposed state policies and regulations
related to the States compliance with the new federal HCBS
regulations.
Collaborate with and train advocacy organizations on issues
related to the administration of the States Medicaid program.
Educate policy makers concerning the competing proposals to
further reform the Medicaid system in North Carolina.
Provide direct legal services and representation to individuals
who meet case selection criteria.
What is the case selection criteria?
Individuals eligible for an Innovations Waiver who experienced
an adverse action by an MCO but who were not afforded appeal
rights.
Individuals eligible for an Innovations Waiver who had services
reduced or denied solely because of their budget.
Individuals eligible for an Innovations Waiver who were
discouraged/threatened by the MCO for seeking additional services
or exercising appeal rights.
Who benefits?
People with disabilities needing home and community-based
services and supports.
Funding: PAIDD, PAIR
Target 2. Advocate for the employment of people with
disabilities in competitive and integrated jobs.
Why is this important?
There are many new policies at the state and federal level that
impact employment. Congress recently enacted the Workforce
Innovation and Opportunity Act (WIOA), which, among other things,
directs states to focus resources on competitive, integrated
employment opportunities for young adults with disabilities. There
also are new Centers for Medicare and Medicaid Services (CMS)
regulations which prohibit states from using Medicaid funding to
support sheltered work settings. Finally, North Carolina recently
declared itself an Employment First state, a philosophy that
employment in the general workforce is the primary, preferred
outcome in publicly funded services for all citizens with
disabilities. All of these policies are based on the knowledge that
people with disabilities can be successful in competitive,
integrated employment when provided appropriate training and
supports. But even the best policies do not guarantee good
practice.
North Carolina does not appropriately prepare people with
disabilities for work, resulting in their low work force
participation. Our educational and behavioral healthcare systems
transition young adults with significant disabilities from
childrens services to adult services with little attention to
integrated employment, defaulting instead to placement in a
sheltered setting.
This year we will:
Ensure that transition-age youth (starting at age 14) and adults
will receive appropriate training and supports to achieve and
maintain competitive, integrated employment.
Provide training and outreach to the disability and legal
communities about the employment rights of people with
disabilities.
Educate policy makers on the benefits of training and supports
that help people with disabilities find work, thereby ending North
Carolinas reliance on sheltered employment.
What is the case selection criteria?
Individuals who were not hired or have been terminated by a
large and/or public employer for reasons related to their
disability.
High school students with disabilities who have an IEP and want
to work.
Who benefits?
More than 22,000 North Carolina students are entitled to
transition services beginning at age 14. Many of these young adults
live in rural areas of the State where high unemployment rates and
sheltered work settings are prevalent. Our work under this target
will increase employment opportunities for individuals living in
rural areas. When people with disabilities are in the workplace,
stereotypes are weakened.
Funding: PABSS, PAAT, PAIDD, PAIR
Target 3. Children and adolescents with complex mental health
needs receive medically necessary community-based services and
supports.
Why is this important?
Parents of children and teens with mental illnesses who also
have secondary disabilities struggle to find the appropriate mix of
services to care for their children in North Carolina. For these
children, mental health services and supports and other services
and supports are often mutually exclusive. The few available mental
health services are time limited and other necessary services
wait-listed. There is a shortage of providers willing to apply a
holistic approach to their treatment. If an appropriate mix of
services is deemed medically necessary, the Managed Care
Organizations (MCOs) often deny the authorization requests. Because
of these barriers, most of this population cycle in and out of
in-state facility based treatment, acute care units at hospitals or
are sent to institutions out of state far away from their homes.
These young North Carolinians need services and supports that meet
their individualized needs allowing them to stay at home and thus
out of institutions. The plight of these children and teens is a
growing problem one that is unlikely to abate in the near future
without legal intervention.
This year we will:
Continue negotiations with DHHS to create more services on the
continuum and increase the availability of trained providers.
File a federal class action lawsuit if negotiations with DHHS
fail.
What is the case selection criteria?
Children and teens who have complex mental health needs with a
significant mental health diagnosis and a co-occurring intellectual
or developmental disability diagnosis and a CALOCUS of IV or
higher. A CALOCUS is a child and adolescent assessment used to
assess level of care needs (levels range from I-VI) for mental
health clients and are required for all Service Authorization
Requests (SARs). In the contracts between NCDHHS/DMA and LMEs/MCOs,
these children are identified as the Special Healthcare Needs
population.
Who benefits?
Approximately 550 children in North Carolina have a significant
mental health diagnosis and a co-occurring intellectual or
developmental disability diagnosis. All of these children will
directly benefit from this litigation. Indirectly, all children
with disabilities will benefit from the creation of more services
on the continuum and an increased availability of qualified,
trained providers.
Funding: PAIMI
Target 4. Students with disabilities will stay in school and
have transition plans for meaningful post-secondary outcomes.
Why is this important?
The Individuals with Disabilities Education Act (IDEA) requires
state and local education agencies to provide a free and
appropriate public education for all children with disabilities.
IDEA prohibits school systems from excluding students from school
or reducing their educational services because they are difficult
to serve. Yet, students with IEPs continue to be excluded illegally
from school based on behavior that is a manifestation of their
disabilities.
Statistics that individuals with disabilities have the highest
rate of unemployment of any group underscore the importance of the
transition requirements of IDEA and WIOA. Post-secondary outcomes
for students with disabilities improve when meaningful transition
planning, evaluations, and services are available for high school
students. Delays in services from the Division of Vocational
Rehabilitation compromise a students chances for independent living
after high school. For many of students with disabilities, special
education with transition services is their best chance for
acquiring educational and life skills to overcome poverty,
illiteracy, and unemployment. When they learn how to read, write,
count, and work, everyone benefits. When these students graduate
from high school with skills, the likelihood of further education
and/or employment minimizes dependency on inadequate service
systems, including the correctional system.
This year we will:
Obtain compensatory services for clients denied FAPE related to
illegal suspensions.
Obtain compensatory services for clients who are reading and
writing well below grade level because school systems have failed
to identify and address reading deficits.
Obtain comprehensive psycho-educational evaluations, including
independent educational evaluations, to determine the specialized
instruction needed to address learning deficits.
Obtain functional behavioral assessments and behavior
intervention plans that include positive behavioral supports
preventing school suspensions.
Obtain VR evaluations and other formal evaluations required to
develop transition plans and services needed by our clients to
achieve meaningful post-secondary goals.
Obtain Corrective Action Plans from NC Department of Public
Instruction (DPI) for our clients and other students similarly
situated.
Participate in coalition meetings, i.e. Special Needs
Federation, etc.
Attend stakeholder meetings with DPI to address issues of
concern.
What is the case selection criteria?
Students with disabilities who are long-term suspended.
Who benefits?
Direct beneficiaries include students with disabilities who are
long-term suspended, referred to the criminal justice system,
illiterate and ill-prepared for post-secondary activities such as
employment and independent living. Our systemic administrative
complaints are an effective strategy for using limited resources
that positively impact students we cannot otherwise represent.
These cases often result in better trained teachers and
administrators as well as improved special education services for
more students within the school system. Our special education
training for juvenile court stakeholders provides more informed
advocates and counselors for special education students statewide.
The population served by this target typically include minority
students in poverty-sticken, rural counties.
Funding: IOLTA, PAIDD, PAIR
Target 5. Enforce the obligations of public entities and places
of public accommodation to provide equal access to programs and
services.
Why is this important?
People with disabilities regularly face discrimination and often
are denied the full and equal enjoyment of the services and
facilities offered by businesses, local municipalities, and the
State because of physical barriers or policies. This is a violation
of their rights guaranteed by the Americans with Disabilities Act
(ADA). Many state and local government agencies in North Carolina
do not have federally-required ADA Coordinators, leaving people
with disabilities limited recourse when these entities
discriminate. Equal access is essential for the visibility and full
integration of people with disabilities.
This year we will:
Increase compliance with the obligation of public entities by
educating policy makers on the requirement of ADA coordinators and
grievance procedures in state-level agencies and large
municipalities.
Continue systemic litigation to end discrimination and lack of
due process in the DMV Medical Certification Program.
Provide rights-based individual advocacy to clients being denied
equal access by public entities and to places of public
accommodation.
What is the case selection criteria?
People with disabilities who have been denied equal access to
public places, programs, or services.
Who benefits?
We all benefit when people with disabilities are fully
integrated into our communities. People with disabilities can
engage with their communities when barriers are removed. As
contributing members of society, they help build communities.
Funding: PAIDD, PAIR, PAAT
Target 6. Unnecessary institutionalization is reduced because
there are sufficient, appropriate community-based services.
Why is this important?
Unjustified institutional isolation of persons with disabilities
is the core problem addressed in the Olmstead decision.
Institutional placement severely diminishes the everyday life of
individuals including family relations, social contacts, work
options, economic independence, educational advancement, and
cultural enrichment. The bedrock principle of the ADA is that life
in the community provides opportunities for dignity, freedom,
choice, and a sense of belonging that are not possible in an
institutional environment. Through our monitoring and investigation
activities, we know that there are people in North Carolinas
state-operated psychiatric facilities who could be safely supported
in their own homes but are denied this freedom because of the lack
of community supports.
Unfortunately, community capacity, particularly for people with
complex needs, remains grossly inadequate. The transition to a
managed care system in North Carolina has led to even less
community capacity to provide services, particularly for those most
in need of comprehensive, high-fidelity wrap-around supports to
avoid institutionalization despite the fact that home and
community-based services cost less than institutional care.
This year we will:
Identify and advocate for people who do not need a hospital
level of care to be discharged from psychiatric hospitals.
Monitor the implementation of the DOJ settlement agreement,
particularly the performance of the MCOs and the development of new
service definitions.
Collaborate with other legal services organizations to expunge
criminal records as a barrier to housing and employment for
transitioning individuals with mental illness.
What is the case selection criteria?
Individuals with mental illness who qualify under the DOJ
settlement and have a criminal record that interferes with their
ability to access housing or employment.
Individuals with disabilities who want to receive, and are
appropriate for receiving, treatment and services in the
community.
Who benefits?
With the development of appropriate and accessible
community-based services, fewer people with disabilities including
mental illness will be forced into institutional settings.
Funding: PAIDD, PAIMI, PAIR
Target 7. Ensure people with mental illness in NC jails receive
appropriate mental health treatment.
Why is this important?
Jails are neither designed nor funded to provide mental health
treatment. Yet, with the erosion of public mental health services,
they increasingly have become de facto mental health facilities.
Too many people with mental illness are involved in criminal
justice systems, often as a result of untreated or undertreated
illness. Data confirms that people with mental illness continue to
be overrepresented in criminal justice settings. In Wake County, it
is estimated that 60 to 70 percent of Wake jail inmates have mental
health needs. The law is clear that every person in jail with a
serious medical need has a right to appropriate medical care,
including persons with serious mental illness. Suicide is the
leading cause of death in jail inmates. When not treated, people in
jail with a mental illness often get worse and leave jail sicker
than when they entered and are more likely to return to jail in a
revolving door phenomenon. As the New Freedom Commission on Mental
Health noted, jails are often an entry point to our community
mental health service system.
This year we will:
Conduct research to assess the services provided to NC jail
inmates with mental health needs, identify promising practices for
service delivery, and determine the number and location of suicides
in the last two years.
Promote cooperative agreements between LME/MCOs and sheriffs
addressing medication management, treatment, formal discharge
planning and support for screening and identification of inmates
with mental health needs in four counties.
What is the case selection criteria?
People with mental illness who are not receiving appropriate
mental health treatment in the four counties (to be
determined).
Who benefits?
We will work with people with mental illness and other
disabilities in four county jails, their families, the sheriffs and
staff who work in those prisons, and the communities. The Standards
of Care for mental health services in jails will increase across
North Carolina benefiting thousands of people and communities.
Funding: PAIMI
Target 8. Promote appropriate treatment for people with mental
disabilities in North Carolina prisons.
Why is this important?
As state mental hospitals have closed and community mental
health care remains underfunded and often unavailable, North
Carolinas prisons have increasingly become asylums. A recently
publicized report noted [t]here is probably no state where mental
health services have deteriorated as much as they have in North
Carolina over the last decade. North Carolina prisons house about
37,000 inmates. Based on national studies, nearly 20% of people in
prison have a serious mental illness. Through our direct work we
know prisoners with mental illness in North Carolina are:
disciplined for behaviors resulting from their disability; placed
in long-term segregation, sometimes for years, in lieu of
treatment; and resort to life threatening behavior (hanging, hunger
strikes, and self-injurious behavior) to get services.
Accomplishing necessary improvements will be severely challenged by
cultural habits of employees (custody over treatment) that are
pervasive and deeply embedded in the prison system.
This year we will:
Monitor four times a year in at least three prisons.
Participate on the Prison Advisory Committee (meets 5-6 times a
year).
Investigate serious reports of abuse or neglect.
Advocate for the following:
-Move inmates with serious mental illness out of long-term
segregation units to an alternative setting to receive out of cell
treatment;
-Clinical staff participate in the disciplinary proceedings of
inmates with serious mental illness;
-Reduction in mental health staff vacancies;
-CIT training for all prison staff;
-Improved screening and identification of inmates with serious
mental illness;
-Implementation of an effective suicide prevention policy;
-Open a treatment mall in the Central Prison Mental Health
Hospital;
-Inmates in the Prison Hospital receive ten hours of programming
out-of-cell each week and ten hours of unstructured time
out-of-cell each week; and
-Effective treatment planning and continuity of care.
Who benefits?
Improved mental health services will directly benefit inmates,
their families, and people who work in the prison system. Because
the majority of prisoners will be released to our communities, it
is critical they be prepared for successful reintegration.
Communities will benefit when recidivism decreases and people
successfully reintegrate.
Funding: PAIMI
Target 9. Individuals who need support in their decision-making
will have access to support without the imposition of uninterested
public guardians.
Why is this important?
People under guardianship lose the power to control the most
fundamental decisions about their lives. Disproportionately, people
with disabilities who have institutional or public guardians are
relegated to institutional living, subjected to unnecessary
restrictions on their freedoms, and subjected to neglect. Many
people with disabilities are placed under guardianships that are
more restrictive than necessary. This includes situations where
some support with decision-making is needed but limited
guardianship and other decision-making supports was never
considered. We see cases where individuals prefer to live in the
community and are capable of doing so but are kept
institutionalized because their guardians prefer
institutionalization. Increasingly, public guardians are viewed by
service providers as a resource for case management for people
being discharged from community hospitals and other settings.
Public guardians, confronted with trying to meet needs that used to
be met by the behavioral health system, look to institutional
placements as the answer. People who try to have their competency
restored face an uphill battle navigating the court process.
This year we will:
Promote compliance with standards for limited guardianship and
restoration of competency.
Identify factors that lead to over-use of general guardianship
and determine preliminary strategies for addressing them.
Identify factors that lead to over-reliance by public guardians
on institutional placements and determine preliminary strategies
for addressing them.
Provide training and technical assistance to clerks,
institutional guardians, and others on the requirement to consider
limited guardianship and the standards for restoration.
Provide training and technical assistance to public guardians
regarding the Olmstead decision and how to avoid over-reliance on
institutional placements.
Who benefits?
People with disabilities who face unnecessarily restrictive
guardianships.
Funding: PAIDD
Target 10. Ensure that infants and toddlers (birth to 3) have
access to appropriate services within the required timelines.
Why is this important?
Part C of the IDEA requires that each child younger than three
who has a developmental delay be identified and provided early
intervention services to correct or reduce that delay. The
importance of early intervention services for infants and toddlers
who have developmental disabilities is well-documented. The period
between birth and three years is a crucial learning period for
infants and toddlers. Research documents that children who are not
ready to learn in kindergarten are more likely to struggle in
school, become teen parents, engage in criminal activities, and
suffer from depression.
The promise of early intervention services under IDEA, however,
has been abandoned in North Carolina with threatened eligibility
restrictions and actual budget cuts. During the short session in
2014, the General Assembly approved a $10 million funding reduction
and the elimination of over 150 full-time positions within the
Early Intervention Program. North Carolinas obligation to provide
early intervention services to all eligible infants and toddlers
cannot be circumvented because of budget cuts. Early intervention
services create the foundation for the future success of infants
and toddlers with disabilities.
This year we will:
Conduct outreach to organizations such as the Pediatric
Association, ECAC, and others regarding the referral process of
infants and toddlers for early intervention services.
Monitor DHHSs Division of Public Health compliance with federal
requirements under Part C of IDEA.
Educate stakeholders regarding the requirements and
responsibilities of the Division of Public Health to ensure that
infants and toddlers with developmental disabilities receive early
intervention services.
Represent individual clients on child find violations related to
identification, location, evaluation, and provision of Early
Intervention Services.
What is the case selection criteria?
Infants and toddlers (up to three) at risk of having or with
disabilities who may qualify for Early Intervention Services under
Part C of the IDEA but have been denied an evaluation and
subsequent services due to child find violations.
Who benefits?
Early intervention services are designed to mitigate the factors
that place children at risk of poor outcomes. Such programs provide
supports for the parents, the children, or the family as a whole.
Many of these children will have the need for services
significantly reduced as they grow and develop as a result of early
intervention. Well-designed early intervention programs have been
found to generate a return to society ranging from $1.80 to $17.07
for each dollar spent.
Funding: PAIDD
Target 11. People with disabilities are able to exercise their
right to vote.
Why is this important?
Throughout the United States, there is a significant gap between
the participation rates of voters who have disabilities and voters
without disabilities. While this is a significant national issue,
the participation disparity in North Carolina is more than double
the national gap. In 2008, only 55% of people with disabilities
voted in our state. Because voting is a vital step in community
integration, it is imperative that we work on voting accessibility
for individuals who have disabilities. Through this target, we will
decrease the voter gap by increasing voter registrations as well as
civic engagement among people with disabilities.
This year we will:
Increase voter registration among individuals with disabilities
and eliminate barriers to voting.
Work with community partners to reach people through outreach
and education, as well as monitor the implementation of new
initiatives.
Collaborate with various community partners to educate people
with disabilities about their voting rights.
Conduct outreach and educational sessions to people with
disabilities who live and/or work in congregate facilities
throughout North Carolina.
Monitor the implementation of Multipartisan Assistance Teams
(MATs) in at least ten counties.
Educate policy makers in local boards of elections on their
responsibilities related to MATs.
Identify best practices and make recommendations to the State
Board of Elections for improving the structure of the MAT
program.
Work with Division of State Operated Healthcare Facilities to
improve their guidance to staff on maximizing residents access to
voting.
Who benefits?
Through individual outreach and education, we will impact
approximately 1,000 people in the coming year. Our policy work will
have long-term, systemic impact on all individuals who have
disabilities in North Carolina, particularly those who live in
facilities.
Funding: PAVA
Target 12. Ensure a continuum of TBI services allowing for
successful transition from facility-based care to less restrictive
environments.
Why is this important?
In spite of the heightened awareness of the causes and effects
of traumatic brain injuries (TBI) from football injuries and
returning Veterans, there are few services for North Carolinians
with TBI beyond the initial trauma/critical care provided
immediately after the injury. People with behaviors related to
their TBI are routinely directed to inappropriate services (both
residential and otherwise) that fail to take into account the TBI
aspect of those behaviors. The integration mandate of Olmstead has
not been implemented with respect to people with TBI. We have
received an increasing number of calls related to individuals with
TBI who cannot obtain services because their MCO has no money for
TBI. Additionally, there are people with TBI in state hospitals who
do not need to be there but have no place else to go. North
Carolinas General Assembly has tasked DHHS with developing a TBI
Waiver, but the Waiver has not been funded to date. No matter what
form new TBI services take, the issue of provider capacity remains
because there are too few providers.
This year we will:
Monitor Medicaid Reform specifically as it relates to integrated
health and behavioral healthcare.
Investigate the number of individuals with TBI that are
languishing in state hospitals because there is no place else for
them to go.
Provide input into the content of the waiver as DHHS develops
it.
Determine the number of people in the TBI population and
identify possible residential services or the need for expanded
provider capacity.
What is the case selection criteria?
People with TBI who are in inappropriate institutional settings
because of the lack of community services.
Who benefits?
People with a traumatic brain injury (and their families) who do
not have access to appropriate community-based services.
Funding: PAIDD, PAIR, PATBI
Funding Acronyms
The funding for our work on the Targets comes from seven federal
grants and one grant from the NC State Bar. The grants are for
varying amounts of funding ranging in fiscal year 2014 from $37,740
to $1,089,450. Each year, we carefully plan the expenditure of the
grant funds across the Targets and activities conducted under the
three core P&A functions not included in the Targets.
IOLTA - North Carolina State Bar Plan for Interest on Lawyers
Trust Accounts
PAAT - Protection and Advocacy for Assistive Technology
PABSS - Protection and Advocacy for Beneficiaries of Social
Security
PAIDD - Protection and Advocacy for Individuals with
Developmental Disabilities
PAIMI - Protection and Advocacy for Individuals with Mental
Illness
PAIR - Protection and Advocacy for Individual Rights
PATBI - Protection and Advocacy for Traumatic Brain Injury
PAVA - Protection and Advocacy for Voting Access
Disability Rights NC Board of Directors
Kathy Boyd, Chair (Wake Forest)
Janna Shisler, Chair-Elect (Chapel Hill)
Cheryl Mulloy-Villemagne, Treasurer (Waynesville)
D. Jones, Secretary (Greenville)
Pat McGinnis, PAIMI Advisory Council Chair (Marion)
Rusty Bradstock (Greensboro)
Bill Donohue (Winston-Salem)
Lourdes Fernandez (Holly Springs)
Shelly Stephens (Murphy)
Kim Taylor (Statesville)
Charles Walker (Raleigh)
Deborah Whitfield (Charlotte)
Get involved!
We are now accepting applications for new board members from
every region in the state. Go to our website for more information
and to download the application packet. Contact Janice Willmott at
[email protected] if you need assistance.
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Disability Rights North Carolina is a federally mandated
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Disability Rights North Carolina
Champions for Equality and Justice
3724 National Drive
Raleigh, North Carolina 27612
919-856-2195
877-235-4210
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919-856-2244 fax
Upon request, information
is available in alternate formats.
North Carolinas Protection and
Advocacy System
www.disabilityrightsnc.org
