On TargetVolume 19 • Special Edition

Disability Rights North CarolinaChampions 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.

FayettevilleJanuary 7, 20155:30–7:30 pmCFV Cancer Treatment & Cyberknife Center1638 Owen Drive

RaleighJanuary 9, 201512:00–2:00 pmWake Med Raleigh3000 New Bern Avenue

JacksonvilleJanuary 30, 201512:30–3:00 pmOnslow County Complex4024 Richlands Highway

WeldonFebruary 4, 201512:00–2:00 pmHalifax Community College100 College Drive (Continuing Education Building Room 401 A/B)

Charlotte

February 19, 20156:00–8:00 pmPark Road Baptist Church3900 Park Road

GreensboroFebruary 26, 201512:00–2:00 pmMaple Street Police Station1106 Maple Street

Winston-SalemFebruary 26, 20156:00–8:00 pmShepherd Center1700 Ebert Street

WilsonMarch 5, 20155:30–7:30 pmEastern NC School for the Deaf1311 US Hwy 301 N

ManteoMarch 13, 201512:30–2:30 pmDare County Center950 Marshall C. Collins Drive

AshevilleApril 9, 20155:30–7:30Linwood Crump-Shiloh Center121 Shiloh Road

Second Annual Conference

Save the date!Tuesday, April 14, 20158:30–4:30 pmThe 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 individual’s preferences and goals for their health and long-term services and support needs.

NC’s Transition PlanAs 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 HeardNorth 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 community@dhhs.nc.gov; include “HCBS” in the subject line. Please copy Disability Rights NC at community@disabilityrightsnc.org 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. 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.

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 oninvestigations 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 Carolina’s 100 counties

What was their relationship to disability?I am a person with a disability -- 155I have a family member with a disability - 363I work in the disability field - 318I am a person who cares about disability issues - 345

What disability did they identify with?

Developmental disability (including autism) – 396Intellectual disability or learning disability – 331Mental illness – 324Physical disability – 367Deaf or hard of hearing/hearing impaired – 172Blind or visually impaired – 181Traumatic brain injury - 198

What is their relationship to veterans?

I am a veteran – 37I am a current member of the U.S. armed forces – 1I have a close family member who is a veteran – 360I have a close family member who is a member of the U.S. armed forces – 104None 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 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 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

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 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.

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 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 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 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 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 Carolina’s 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 DHHS’s 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 Carolina’s 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 AccountsPAAT - Protection and Advocacy for Assistive TechnologyPABSS - Protection and Advocacy for Beneficiaries of Social SecurityPAIDD - Protection and Advocacy for Individuals with Developmental DisabilitiesPAIMI - Protection and Advocacy for Individuals with Mental IllnessPAIR - Protection and Advocacy for Individual RightsPATBI - Protection and Advocacy for Traumatic Brain InjuryPAVA - 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 Janice.willmott@disabilityrightsnc.org if you need assistance.

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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.

Disability Rights North CarolinaChampions for Equality and Justice3724 National DriveRaleigh, North Carolina 27612919-856-2195877-235-4210888-268-5535 TTY919-856-2244 fax

Upon request, information is available in alternate formats.

North Carolina’s Protection and Advocacy System

www.disabilityrightsnc.org