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On Target • Page 1
Volume 19 • Special Edition
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.
Second Annual
Conference
Save the date!
Tuesday, April 14, 2015
8:30–4:30 pm
The Friday Center
Chapel Hill, NC
Fayetteville
January 7, 2015
5:30–7:30 pm
CFV Cancer Treatment &
Cyberknife Center
1638 Owen Drive
Charlotte
February 19, 2015
6:00–8:00 pm
Park Road Baptist Church
3900 Park Road
Manteo
March 13, 2015
12:30–2:30 pm
Dare County Center
950 Marshall C. Collins Drive
Raleigh
January 9, 2015
12:00–2:00 pm
Wake Med Raleigh
3000 New Bern Avenue
Greensboro
February 26, 2015
12:00–2:00 pm
Maple Street Police Station
1106 Maple Street
Asheville
April 9, 2015
5:30–7:30
Linwood Crump-Shiloh Center
121 Shiloh Road
Jacksonville
January 30, 2015
12:30–3:00 pm
Onslow County Complex
4024 Richlands Highway
Winston-Salem
February 26, 2015
6:00–8:00 pm
Shepherd Center
1700 Ebert Street
Weldon
February 4, 2015
12:00–2:00 pm
Halifax Community College
100 College Drive
(Continuing Education Building
Room 401 A/B)
Wilson
March 5, 2015
5:30–7:30 pm
Eastern NC School for the Deaf
1311 US Hwy 301 N
Inside This Issue
HCBS Changes.......................... 2
NC Office on ADA...................... 3
From the Director..................... 4
About the Targets..................... 4
Survey Responses..................... 7
2015 Targets............................. 8
Page 2 • On Target
Big Changes Coming:
Final Rules for Home and Communitybased Services (HCBS)
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
Janice.willmott@disabilityrightsnc.
org if you need assistance.
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 individual’s preferences and goals for their
health and long-term services and support needs.
NC’s 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
On Target • Page 3
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 personcentered 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 community@
dhhs.nc.gov; 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.
Disability Rights North Carolina is a
federally mandated protection and
advocacy system with funding from
the U.S. Department of Health and
Human Services, the U.S. Department
of Education, and the Social Security
Administration. It is a 501(c)(3)
nonprofit organization.
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.
Page 4 • On Target
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. It’s 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. We’ve 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 Carolina’s
current population, that’s 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.
On Target • Page 5
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-toface 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.
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.
Page 6 • On Target
Legally-based Advocacy Including
Individual and Systems Advocacy
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.
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.
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.
Disability Rights NC moved to its new offices in May 2014. Stop by to visit
and see our new home.
On Target • Page 7
Who Responded to
the Survey?
any?
How M iduals
iv
712 ind n 99 of
gi
residin rolina’s
orth Ca
What was their relationship to disability? N 00 counties
1
Disability Rights NC Staff
Executive
Vicki Smith, Executive Director
Finance & Operations
Charlie Barnes, Chief Financial Officer
Janice Willmott, Chief Administrative
Officer
Karla Blackwell, Administrative
Assistant
Carolina Herrera, Receptionist
Allyson Hilliard, Accounting Assistant
Mavis Jones, Office Manager
Dennis Knight, IT Administrator
Haydee Martinez, Administrative
Assistant
Will McDowell, Office Aide/Work Study
Legal & Advocacy
What was their relationship to veterans?
Traumatic
brain injury
Blind or
visually
impaired
Deaf or
hearing
impaired
Physical disability
Mental illness
Intellectual disability
or learning disability
Developmental disability
(including autism)
What disability did they identify with?
April Giancola, Chief Legal Program
Officer
John Rittelmeyer, Director of Litigation
Cas Shearin, Director of Investigations
and Monitoring
Jennifer Bills, Senior Attorney
Tabitha Bryant, Attorney
Raven DeMonia, Paralegal
Yasmin Farahi, Attorney
Virginia Fogg, Attorney
Anthony Garcia-Copian, Intake
Specialist
Lisa Grafstein, Senior Attorney
Iris Green, Senior Attorney
Kady McDonald, Intake Specialist
Kishona Mimms, Investigator
Lisa Nesbitt, Attorney
Steve Noblitt, Advocate
Susan Pollitt, Senior Attorney
Lisa Rabon, Attorney
Mercedes Restucha-Klem, Attorney
Patrick Robertson, Investigator
Holly Stiles, Attorney
Kathy Smith, Advocate
Kristine Sullivan, Attorney
Debbie Thome, Advocate
Chris Trottier, Senior Attorney
Policy & Outreach
Elaine Whitford, Director of
Development
Corye Dunn, Director of Public Policy
Annaliese Dolph, Lobbyist
Gabrielle Martino, Advocate and
Outreach Coordinator
Page 8 • On Target
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 State’s compliance with
the new federal HCBS regulations. Collaborate with and train advocacy organizations
on issues related to the administration of the
State’s 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
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.
PABSS - Protection and Advocacy for
Beneficiaries of Social Security
IOLTA - North Carolina State Bar Plan for Interest
on Lawyers’ Trust Accounts
PATBI - Protection and Advocacy for Traumatic
Brain Injury
PAAT - Protection and Advocacy for Assistive
Technology
PAVA - Protection and Advocacy for Voting
Access
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
On Target • Page 9
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 children’s
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 Carolina’s 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
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Page 10 • On Target
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 waitlisted. 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 postsecondary 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 student’s 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.
On Target • Page 11
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
Page 12 • On Target
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 Carolina’s 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 wraparound 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
On Target • Page 13
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 Carolina’s 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 selfinjurious 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
Page 14 • On Target
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.
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
This year we will:
actual budget cuts. During the short session in
Promote compliance with standards for limited
2014, the General Assembly approved a $10 million
guardianship and restoration of competency.
funding reduction and the elimination of over 150
Identify factors that lead to over-use of general
full-time positions within the Early Intervention
guardianship and determine preliminary strategies Program. North Carolina’s obligation to provide
for addressing them.
early intervention services to all eligible infants
Identify factors that lead to over-reliance by
and toddlers cannot be circumvented because of
public guardians on institutional placements and
budget cuts. Early intervention services create the
determine preliminary strategies for addressing
foundation for the future success of infants and
them.
toddlers with disabilities. Provide training and technical assistance to
clerks, institutional guardians, and others on the
This year we will:
requirement to consider limited guardianship and
Conduct outreach to organizations such as the
the standards for restoration.
Pediatric Association, ECAC, and others regarding
Provide training and technical assistance to
the referral process of infants and toddlers for
public guardians regarding the Olmstead decision
early intervention services.
and how to avoid over-reliance on institutional
Monitor DHHS’s Division of Public Health
placements.
compliance with federal requirements under Part
C of IDEA.
Who benefits?
Educate stakeholders regarding the requirements
People with disabilities who face unnecessarily
and responsibilities of the Division of Public
restrictive guardianships.
Health to ensure that infants and toddlers
with developmental disabilities receive early
Funding: PAIDD
intervention services.
Represent individual clients on child find violations
related to identification, location, evaluation, and
provision of Early Intervention Services.
On Target • Page 15
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. Welldesigned 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 longterm, 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 Carolina’s
Page 16 • On Target
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
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North Carolina’s Protection and
Advocacy System
Upon request, information
is available in alternate formats.
3724 National Drive
Raleigh, North Carolina 27612
919-856-2195
877-235-4210
888-268-5535 TTY
919-856-2244 fax
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