HD17 - Reevaluating of Policies Associated with Serving the Mentally Disabled

  • Published: 1987
  • Author: Department of Rehabilitative Services
  • Enabling Authority: House Joint Resolution 159 (Regular Session, 1986)

Executive Summary:
House Joint Resolution 159 directed the Department of Rehabilitative Services to examine and reevaluate its existing policies and practices in order to reduce policy, funding and regulatory barriers associated with serving the mentally disabled under current programs and, thereby, increase the employability of the mentally disabled population and assist them in finding and keeping jobs. A study group was convened which included representatives from the Department of Mental Health and Mental Retardation (OMH/MR), the Department of the Rights for the Disabled (ORO) and the Department of Rehabilitative Services (DRS). In keeping with current public priorities, the focus has been on the Chronically Mentally Ill (CMI) population. The study group looked at the involved service delivery systems, cooperative efforts and initiatives. DRS policies, procedures and practices which might constitute barriers were examined. Input on perceived barriers was solicited from and provided by the local Community Service Boards as well as the Statewide Vocational Rehabilitation/Mental Health (VR/MH) Collaborative Task Force.

DISCUSSION AND FINDINGS

DRS serves 179 disability groups and administers the Vocational Rehabilitation (VR) program for vocationally handicapped citizens of Virginia under federal regulations and accountability measures. Several points in the VR process were examined at which the Chronically Mentally Ill (CMI) may be discouraged from accessing VR services. These are: 1) referral, 2) case acceptance, and 3) client program planning. The review of the above areas demonstrates that State and federal VR policies and practices are geared to provide services to CMI clients. Indeed, around 20 percent of DRS's currently open cases and successful closures are CMI clients. A "successful closure" occurs when the client is effectively placed for at least 60 days in a reasonably permanent, individually appropriate gainful vocational situation in which he or she receives a wage commensurate with that paid others for similar work.

In practice it is the counselor's ability to determine the client's vocational potential, and his/her knowledge of service options, and needs for nontraditional rehabilitation programs and outcomes that appear to hold the key to more effective VR services to the CMI population. To this end, the study group felt that inter/intragency training and communications and the development of local psychosocial/vocational rehabilitation programs, within existing CSBs, needed attention.

Mutual understanding among DRS, DMH/MR and the local Community Services Boards (CSBs) is at times compromised because of different agency structures, accountability systems and outcome expectations. The cooperating agencies are struggling to fulfill client needs which were formerly met in state mental institutions. Further, resources allocated to the community have not kept pace with the needs of the increased numbers of clients following the deinstitutionalization process. DRS staff have withdrawn from the State mental institutions and are now concentrating on serving CSB clients in the localities. Building new cooperative relationships and effective client service strategies challenges limited budget and staff resources necessary to alleviate individual and societal problems associated with the non-rehabilitated CMI population. The issues identified by this study stem from the manner in which each agency carries out its mission, communicates with each other and defines its roles and responsibilities.

RECOMMENDATIONS

A sustained commitment on the part of DRS to serve CMI clients, on the part of DMH/MR and CSBs to emphasize vocational rehabilitation and on the part of the General Assembly to fund appropriate services and positions will allow the CMI client the opportunity to maximize his/her potential and carry his/her own weight in society. To more effectively serve the mentally ill population and assist them in finding and keeping jobs, the following recommendations are set forth:

GENERAL ASSEMBLY

1. That the General Assembly consider additional funding and staff positions to increase the number of innovative vocational rehabilitation projects in CSB psychosocial rehabilitation programs.

2. That the General Assembly consider increased support to insure adequate CSB Core Services, and for the establishment and provision of DRS and CSB operated Transitional and Supported Employment Services for the CMI population.

3. That as a means of increasing employer participation, the General Assembly explore the enactment of legislation creating a State Targeted Jobs Tax Credit to provide employers an incentive for hiring job-ready chronically mentally ill individuals.

DEPARTMENT OF REHABILITATIVE SERVICES

1. That DRS develop and deliver curricula for its staff stressing effective service delivery processes and outcomes for the CMI population.

2. That DRS develop and disseminate guidelines to all CSB staff for the effective screening and referral of CMI clients to DRS.

3. That DRS clearly articulate and disseminate the definitions for successful VR closures to DRS and CSB staff.

4. That DRS disseminate information defining Transitional and Supported Employment Services and DRS's associated programmatic and fiscal responsibilities and capacities to cooperating agencies.

5. That DRS with the CSBs institute pre-referral conferences and subsequent interagency staffings to provide effective feedback on mutual clients.

6. That DRS with the CSBs form local, joint job marketing teams in order to assure an effective and coordinated approach to the employer community.

7. That DRS with the CSBs further explore the opportunities associated with potential DRS-CSB contractual relationships for providing appropriate employment services (e.g. Transitional and Supported Employment Services).

8. That DRS, DMH/MR and the CSBs define their respective long-term commitment to the vocational rehabilitation of the CMI population, and reflect this in appropriate planning and budget documents.

DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

1. That DMH/MR encourage the CSBs to share confidential information (including third-party reports) to appropriate DRS staff on mutual clients. Statewide, uniform practices are needed.

2. That DMH/MR review practices regarding the CSBs billing DRS for services to mutual clients and issue guidance to the CSBs regarding standard and equitable practices. Statewide, uniform practices are needed.

3. That DMH/MR, with DRS, develop a glossary of relevant mental health and vocational rehabilitation terms to be distributed to all involved staff in each system.

COMMUNITY SERVICES BOARDS

1. That the CSBs, with DRS, negotiate and/or update written agreements that include specific, brief descriptions of locally available CSB and DRS services, a description of each agency's resources and responsibilities for each coordinated service, and a list of measurable objectives.

2. That the CSBs with DRS develop programs for interagency staff training specific to serving the CMI population, including definitions of agency's responsibilities and interagency interaction.