HD73 - Evaluating the Implementation of the Recommendations of the Commission on the Coordination of the Delivery of Services to Facilitate the Self-Sufficiency and Support of Persons With Physical and Sensory Disabilities


Executive Summary:
The 1992 Report of the Commission on the Coordination of the Delivery of Services to Facilitate Self-Sufficiency and Support of Persons with Physical and Sensory Disabilities (Disability Commission) recommended that in 1995 the Secretary of Health and Human Resources undertake an evaluation of Disability Commission activities to determine the impact of its efforts and identify potential modifications to future Commission activities. During the 1994 General Assembly, House Joint Resolution 83 (HJR 83) was approved requesting the Secretary to evaluate the implementation of recommendations made by the Disability Commission. Pursuant to the resolution, the Secretary of Health and Human Resources formed a task force comprised of consumers, representatives of disability services boards, and local service providers to assist in planning and conducting the evaluation. The Virginia Board for People with Disabilities provided staff support for the Task Force. Over a series of meetings in the Fall of 1994, the Task Force developed a comprehensive evaluation plan which was subsequently implemented in 1995.

To insure that the evaluation plan directly responded to the intent of HJR 83, the Task Force focused its activities in five areas:

1. The Disability Services Council and Disability Services Board network;
2. Prior and current funding initiatives of the Disability Commission;
3. Current interagency committees, task forces, and work groups
addressing the needs of individuals with disabilities;
4. Information and referral systems operated by state and local agencies;
5. Administrative recommendations contained in the initial report of the Disability Commission.

Evaluation of the Disability Services Council and the Disability Services Boards

The results of the evaluation of the Disability Services Boards (DSB) and the Disability Services Council (DSC) provide a picture of a service coordination system still in its early stages of growth and development. DSBs have primarily focused their activities on transportation services, accessibility issues, conducting their needs assessments, improving services for individuals with hearing impairments, and housing issues. Increasing community awareness, enhancing community services, and developing a Rehabilitative Services Incentive Fund proposal are identified most frequently as DSB accomplishments.

DSC members are clearly aware of the issues and challenges facing the Disability Services Boards. They emphasize the need for Boards to find active and committed members. The Council recognizes that the Boards are at various stages in their development and believe that an organization of DSBs would further assist the Boards in providing support and technical assistance through the exchange of ideas and information.

Findings and Conclusions

1. There is wide variation across the state as to the development and implementation of the Disability Services Boards.

2. The DSC members believe that the DSBs are meeting their original purpose and should not be redefined.

3. Greater sharing of information between the DSC and the DSBs needs to be accomplished in an effective and timely manner.

4. The DSB members need further clarification and refinement of their responsibilities and authority.

5. Local government has been supportive of the DSBs' efforts to establish the Boards and implement their activities.

6. The DRS liaison plays a key' role in providing the DSBs information and an understanding of the other organizations and agencies involved with the Boards.

7. The DSC believes that an organization of DSBs would further assist the Boards in providing support and technical assistance.

Evaluation of Funding Initiatives

Consumer Services Fund

The guidelines established for the Consumer Service Fund are responsive to its intended purpose. Approximately 190 applications per year are received for funding. The application review process effectively screens applications for need based on the "fund of last resort" principle that guides the Consumer Services Fund. The allocation to the Consumer Service Fund is fully utilized to provide a wide array of services to a population representative of persons with physical and sensory disabilities.

Findings and Conclusions

1. The Consumer Services Fund is effectively managed and appears to be fulfilling its intended purpose.

2. Because of the "short term nature of service intervention through the Consumer Services Fund, it is difficult to evaluate the longer term impact of these services.

3. Complete information is not available regarding the specific number of unfunded applications that met funding criteria but were turned down by the CSF screening committee because of lack of funds.

Rehabilitative Services Incentive Fund

A comprehensive evaluation of the impact to date of the Rehabilitation Services Incentive Fund (RSIF) is not possible because this program is currently in the process of completing the initial funding of awards to Disability Services Boards. All implementation activities to date are supportive of the RSIF achieving its purpose. It is important to note that the $500,000 RSIF appropriation leverages additional funds and support at the local level through the match process. For FY 1996, the first year of RSIF funding, that match total will be over $300,000.

Findings and Conclusions

1. In a number of instances, the RSIF DSB allocations and award levels involve small amounts of funds. Consideration is needed as to whether the $1,000 minimum allotment for a DSB establishes a "critical mass" of funds to allow for a significant impact on rehabilitation services in a community.

2. The RSIF is consistent with the DRS effort to decentralize services and to support community service development.

Personal Assistant Services

The Personal Assistance Services program served 105 individuals with disabilities during Fiscal Year 1995. There are 300 individuals who are on a waiting list to receive services. The consumers who participate in the DRS Personal Assistance Services program have significant disabilities and are likely to have a health condition or existence of a disability other than their primary disability. These participants receive more paid hours of care than those individuals on the PAS waiting list and do not spend a significant portion of their personal funds to receive these services. Because those on the waiting list spend a substantially higher percentage of their own funds on personal assistance, the data suggest that the PAS program helps reduce a significant financial liability on the consumer, as well as provide support to unpaid family caregivers.

Findings and Conclusions

1. The PAS program has a dramatic impact on the independence and productivity of participants.

2. While available to individuals in all areas of the state, the PAS program is only meeting a small percentage of the identified need.

Long Term Case Management Program

The Long Term Rehabilitative Case Management (LTRCM) Program has been in place since 1989. Two separate studies were completed in FY 1994 involving LTRCM participants. Approximately 780/0 of persons surveyed reported being completely satisfied with the services received. Results of the second study indicated that LTRCM participants were linked to an average of four more service resources (13.9 compared to 9.3) than individuals on the waiting list.

Findings and Conclusions

1. The Long Term Case Management Program is assisting approximately 140 persons with physical disabilities access a wide array of community based rehabilitation services at a cost of approximately $2,000 - $2,500 per person per year.

2. Recent program data indicate that the LTRCM Program is able to assist approximately 20-25 new participants per year.

Cognitive Rehabilitation Program

The Cognitive Rehabilitation Program (CRP) is providing cognitive rehabilitation services to individuals consistent with the targeted population and program purpose. On balance, the response to the program by service recipients, service providers, and other participants is positive. CRP representatives have taken appropriate steps to strengthen the program based on the formal evaluation of the first year (FY 1994) outcomes.

The Cognitive Rehabilitation Program does appear to be achieving its purpose of assisting individuals with an acquired brain injury to achieve greater community integration, live in a less restrictive environment and move forward in their rehabilitation process. i: is difficult, however, to factor out specifically the contribution of cognitive rehabilitation services within the entire array of services provided to program participants.

Findings and Conclusions

1. Funds for this program are used to purchase cognitive rehabilitation services.

2. The annual appropriation for the CRP program is $200,000, and services are provided to 6-8 individuals.

Evaluation of the Accomplishments and Effectiveness of State-Level Interagency Committees

The myriad of interagency committees that currently exist in the Commonwealth must be judged independently, as opposed to assessing the impact of collaborative efforts as a whole when examining state agency activities during the past few years. A vehicle for interagency collaboration and cooperation, the Plan of Cooperation, did operate from 1986 until several years ago. While inactive, the Plan of Cooperation Committee has not been formally disbanded. Consideration should be given as to whether current interagency communication channels are sufficient, or whether the Plan of Cooperation Committee should be revitalized.

Findings and Conclusions

1. Many interagency boards, committees, councils, and workgroups currently exist that have accomplished many of the objectives of the Disability Commission.

2. The Plan of Cooperation, a focal point of interagency collaboration identified within the original Disability Commission report, is definitely not active, but the reasons for this are not clear.

Evaluation of the Efficiency of Existing Information and Referral (I & R) Programs

It is clear that consumers can get excellent information from very helpful people who answer the telephones at the I & R systems that were examined in this study. But other consumers can call the same I & R system with a similar need and receive very little information. There exists variability in scope of information, role of the person receiving the request for information, and data availability. Better preparation of staff and easily accessible resource information would certainly improve consistency within each system.

Findings and Conclusions

1. Currently, there does not exist a statewide I & R system capable of handling all of the potential calls from individuals with sensory and physical disabilities.

2. By all accounts the state's present information and referral network is only addressing a fraction of the current needs.

Evaluation of the Implementation of Commission Administrative Recommendations

Significant action has been taken to implement a large number of the recommendations contained in the original Disability Commission Report. Pilot projects and direct services have been expanded; existing resources have been creatively used to increase access to needed services and equipment; and interagency collaboration continues, although perhaps not always on a formal or consistent basis.

Findings and Conclusions

1. The administrative recommendations contained in the original Disability Commission Report stimulated a great deal of activity among Virginia state agencies.

2. It would be beneficial to examine the recommendations that did not receive a response from the state agencies responsible for implementation.