Protection Advocacy for Individuals with Traumatic Brain Injury

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					Protection & Advocacy for
Individuals with Traumatic
   Brain Injury (PATBI)

   Report of 2006 Activities




           National Disability Rights Network
 


                 Protection and Advocacy for Individuals
                       with Traumatic Brain Injury

Background

The Traumatic Brain Injury (TBI) Act was authorized as part of the Children’s Health Act
of 2000 (P.L.106-310). As part of the TBI Act, Congress created the Protection and
Advocacy for Individuals with Traumatic Brain Injury (PATBI) program. In FY 2005,
Congress funded the program at $3.0 million. With this minimal funding, the PATBI
program has provided Protection & Advocacy (P&A) services, information and referral
(I&R), and training to over 185,000 individuals in the three years of its existence.

      Each year in our nation, 1.4 million individuals sustain a TBI. Incidence is
      generally higher among males, Native Americans, and children less than five.
      Approximately 475,000 TBIs occur among children ages 0-14.
      As of March 2007, more than 24,000 service members have been wounded in
      the current war, with TBI being called its “signature injury.” Data continue to
      demonstrate that TBI accounts for approximately two-thirds of the injuries
      suffered.

The last three Presidential budget proposals have recommended eliminating the PATBI
program. Fortunately, appropriators from both chambers and on both sides of the
political aisle recognize the importance of the PATBI program and continuing its
funding. Unfortunately, level funding and mandated across-the-board cuts leave only
$2.97 million to address the ever-growing needs of individuals with TBI. The President’s
recommendation to cut the program – repeated again in his FY 2008 budget proposal –
is unconscionable at a time when over 60 percent of those returning with injuries from
the war have TBI and are not able to access essential supports and services.

A Senate bill to reauthorize the TBI Act was introduced March 7, extending the TBI Act
programs for five more years. The bipartisan support for the TBI reauthorization sends
a positive message to appropriators to continue funding these programs at levels that
can adequately address the specific needs of this growing population of people with
disabilities.

         The National Disability Rights Network (NDRN) recommends
                   an FY 2008 appropriation of $6 million.

A $6 million appropriation would trigger a formula increasing the minimum allotments to
states and ensuring that each P&A can provide a significant PATBI program with an
appropriate level of staff time and expertise. Effective P&A services for people with TBI
can lead both to reduced government expenditures and increased productivity,
independence and community integration. However, advocates must possess
specialized skills, and the work is often time-intensive.

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Individuals with TBI have a wide array of P&A needs, including assistance with
returning to work; finding a place to live; accessing needed supports and services, such
as attendant care and assistive technology; and obtaining appropriate mental health,
family support, substance abuse, and rehabilitation services. These individuals –
including many of the tens of thousands of returning service members – often are
forced to remain in extremely expensive institutional settings far longer than necessary
because the community-based supports and services they need are not available.

In addition, many returning service members are not familiar with the range of
disability services available beyond those provided by Department of Defense (DOD)
and Veterans Affairs (VA). To this end, NDRN is seeking the addition of language to the
TBI reauthorization bill that would ensure that the P&A System has access to all
facilities – including DOD and VA facilities. NDRN is seeking access to all individuals in
these facilities to ensure they are receiving needed services in these settings and to
help plan their return to their home communities.

The TBI program should be continued and expanded to ensure that each state has the
resources necessary to maintain critical P&A services for the estimated 5.3 million
people who live with disabilities resulting from TBI. Following is just a sample of what
the PATBI program was able to accomplish with limited funds in FY 2006:

    •   Trained over 60,000 individuals on issues facing individuals with TBI, as well as
        the rights and resources available to children and adults with TBI and their
        families.

    •   Served individuals with disabilities living in all settings, including their own or a
        family or guardian’s home; community residential settings; public housing;
        nursing homes; and public and private institutions and hospitals, including VA
        hospitals.

    •   Assisted individuals with disabilities in addressing problems in access to health
        care and rehabilitation services; inappropriate institutionalization; housing; abuse
        and neglect; education; employment; financial benefits; guardianship/
        conservatorship; and transportation.

    •   Utilized a broad range of strategies – consistent with the sophisticated and
        comprehensive approach of the P&A System – to resolve individual’s issues,
        including short-term assistance; investigations; mediation and alternative dispute
        resolution, negotiation; and administrative hearings. Less than 3 percent of cases
        resulted in legal action being taken.

The Alabama P&A was contacted by the mother of a 14-year-old boy who suffered a
TBI as a toddler. The mother wanted her son to attend his home school with
appropriate supports and services. The school system proposed sending the student to

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a segregated school that offered a behavior strategies program. After reviewing the
boy's Individualized Education Plan (IEP) and other relevant documentation, PATBI staff
provided the parent with technical assistance regarding her son’s right to special
education services (SES) and how to improve her advocacy skills. As a result, the
student was placed at his home school with the support of a behavioral aide and a
comprehensive behavior plan, and school officials will receive an in-service training on
how to work with children with TBI.

The Colorado P&A assisted a man who resided in a facility for approximately seven
years following a shotgun blast to the head. Mental-health issues complicated
addressing the TBI problems from this incident. An annual review found him ineligible
for continued TBI waiver services. PATBI assisted him in his ineligibility appeal and, as a
result, he was able to remain on the waiver for an additional year. He continues to
access services and supports for his brain injury and mental health issues through the
brain injury program at the VA.

The Connecticut P&A assisted a 61-year-old man who sustained TBI due to cardiac
and respiratory arrest resulting in a brain aneurysm. After living in several nursing
facilities, he ended up at Connecticut's largest state psychiatric hospital, where he
remained from 1991 to 2004. In 2004, the Department of Mental Health and Addiction
Services placed him in three-person community-living arrangement with 24-hour
staffing. He enjoyed his home and was involved in the community until the fall of 2006.
After a determination that he had deteriorated to the point where he should be placed
in a nursing home, staff contacted the PATBI program to ask for help on his behalf. The
PATBI advocate agreed to investigate, making it very clear that the man was her client
– not the staff. The advocate met with this man and his conservator, reviewed the
records, and interviewed staff. Clear gaps in services were found and the advocate
identified programmatic changes and supports that would enhance his life and address
the areas of deterioration in functioning. After a protracted meeting called by the PATBI
advocate, the team agreed to make several significant changes in his program and
follow-up meeting was scheduled for six weeks later. This meeting showed an entirely
different picture of this individual: he was actively participating in activities; eating
regular meals with dietary changes; had one-to-one support for bathing; was getting up
on his own at earlier times; and had even expressed a desire to take drum lessons. The
issue of placement in a nursing home was dropped and he remains in his home.

The Delaware P&A assisted a number of individuals with TBI with housing issues.
in one such case, a 35-year-old with TBI was "swindled" by a friend. He was led to
believe he was refinancing his home mortgage, but the transaction resulted in him
transferring the deed to his home to his "friend" for $1.00. The P&A filed suit and
negotiated a settlement n which title will be restored to this individual after finalization
of documents in FY 07.




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Two members of the same family were helped by the Georgia P&A. The P&A first
assisted a former Marine who had sustained a TBI and was arrested for assault soon
thereafter. The P&A identified this individual when he was wrongfully sent to a state
psychiatric hospital, misdiagnosed with mental illness and subjected to inappropriate
and harmful treatment. PATBI staff brought this misdiagnosis to the attention of the
hospital immediately and advocated for his discharge to the most integrated setting.
When speaking to this individual’s father, PATBI staff discovered the man’s brother also
was in the same state psychiatric hospital. A 29-year-old who sustained two separate
TBIs from car accidents, the brother also had been misdiagnosed with a mental illness
and subjected to inappropriate and harmful treatment. PATBI brought this misdiagnosis
to the attention of the hospital, which has agreed to provide this man with an
appropriate evaluation. PATBI is advocating for appropriate treatment and hospital
discharge for this individual.

A 56-year-old woman with a TBI who lived independently on Oahu contacted the
Hawaii P&A for assistance to resolve a dispute with her supervisor, the principal of the
school where she worked. She felt harassed by her employers and thought they needed
to be more understanding of her disability. After a ten-year practice of using flex-time
hours, and the staff complained she was reporting late to work. The PATBI advocate
asked the woman to locate documentation of her disability and point out that the school
knew about it and had agreed to make the accommodation. The advocate mediated the
dispute with the staff and principal and educated them on reasonable accommodations.
A tape recorder was purchased so the woman would not miss any information from
meetings conducted prior to her reporting time. The advocate also arranged for her to
discuss concerns with her union representative, and invited a university professor to do
an in-service on TBI for the staff.

The Illinois P&A represented a young woman with TBI who sought help in probate
court to defeat a petition by her guardian to have her sterilized against her wishes. The
judge found in favor of the woman with TBI, but gave her guardian an additional
opportunity to identify an expert who would support the guardian’s request for her
ward to be sterilized. In 2006, based on strong testimony – particularly by PATBI expert
witnesses – and the failure of the guardian to present credible expert witness testimony
in support of her position, the judge issued a final ruling in favor of the young woman
with TBI. The guardian filed an appeal, and the P&A continues to represent the young
woman. This case was featured on the front page of the Chicago Tribune in August
2005 and, because of the press coverage, the judge issued a gag order and ordered
that the file be sealed. Through its work on this issue, the P&A determined there is not
sufficient oversight of guardians seeking to involuntarily sterilize their wards, and two
meetings of disability advocates were convened to discuss the issue. The consensus
was that there needs to be a public policy change providing judicial oversight of
guardians contemplating making life-changing decisions for their wards. The P&A also
began a 50-state research project to determine how other states were addressing this
issue to determine what would be the optimal public policy effort in Illinois.

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The Indiana PATBI advocated on behalf of a 10-year-old child with TIB and autism.
He had been placed on homebound services due to the frequency and severity of
behaviors. However, he was receiving these services only two hours a week and the
school had no plan in place to transition him back into the classroom. The PATBI
advocate assigned to his case reviewed information on the Individuals with Disabilities
Education Act (IDEA), as well as Indiana’s law on special education, and determined
that the child’s current IEP did not meet his needs and did not contain any transition
plan. Further, the school failed to provide personnel with specialized training in regard
to TBI, as required under state law. The advocate began attending case conferences
with the boy and his family. The school agreed to obtain additional assessments in
regard to his behavior and classroom issues, and began to develop a transition plan for
him to re-enter the classroom. The P&A also is close to completing an educational
packet regarding school-aged children who experience TBI. The packets will focus on
the educational rights of students with disabilities and be provided to all of the
rehabilitation hospitals in Indiana serving school-aged children with TBI for
dissemination upon the child’s discharge.

The Kansas P&A advocated that the 2006 Kansas Legislature eliminate the Home and
Community Based Services (HCBS) Head Injury Medicaid Waiver waiting list. The
Legislature approved a budget package that included funds to eliminate the waiting list.
The Kansas HCBS Waiver for persons with head injuries was the first of its kind in the
U.S. and includes those who experience traumatic, as well as organic, brain injuries.
 
A 34-year-old man with a brain injury and his family contacted the Maine P&A to
prevent improper discharge from a medical facility. The facility wanted to discharge him
to another facility outside of Maine, which would have made it impossible for his family
to continue their daily visits and endangered his health. The P&A intervened and
explained to facility staff how a discharge far from the man's family would violate his
rights, emphasizing the importance of making the discharge process more inclusive of
the man and his family. The medical facility's staff abandoned their attempts to place
the man outside the state and communicated more effectively with the man and his
family in the discharge planning process.

The mother of a 7-year-old Navajo girl with TBI approached the Native American
P&A for assistance because her daughter was not attending school. The school had
developed an IEP that recommended home-based educational services, but the mother
was not satisfied with the services and the school would not readmit the child. A PATBI
advocate attended a number of IEP meetings with the child’s guardian and advised the
mother of her child’s procedural rights. As a result of PATBI representation, the little girl
was able to return to school and participate in an educational setting with her peers.
She is now receiving appropriate educational services including one-on-one assistance
and physical, occupational, music, and speech-language therapies. Also as a result of
PATBI representation, the school developed a behavior intervention plan so the girl
would not be excluded from the general curriculum.

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An individual with TBI who lived in semi-independent housing contacted the Nebraska
P&A because he wanted to stop a guardian from being appointed. The man was
interviewed and an evaluation was completed. Although he needed to have a guardian,
the prospective guardian was not appropriate because she was not acting in his best
interests. Another appropriate, prospective guardian was found, and this issue was set
to go to litigation, but the first guardian stepped down before this became necessary.

The Nevada P&A continued its monitoring activities of individuals residing out-of-state
facilities, as well as in in-state facilities. The out-of-state monitoring visits to facilities
resulted in locating Nevada residents wishing to return to their families in Nevada. As a
result of P&A advocacy, a 38-year-old man with TBI came back from a placement in
Idaho to community-based placement in Nevada.

A man was living in a state-run facility. While in his teens, he had sustained a TBI and
had a history of impulsivity and fleeing from facilities. This flight included unauthorized
use of facility vehicles, which resulted in his involvement in the criminal justice system.
He recently failed community placement because, even with line-of-sight supervision,
he managed to run away and take an employee’s vehicle without permission. Quick
staff intervention narrowly averted a potential disaster and possible police and court
involvement. Community-placement staff declined to file criminal charges against the
client but, due to this incident, he was returned to his previous facility placement. The
North Dakota P&A worked with both the man and his team to explore assistive
technology solutions to facilitate his return to the community placement and prevent
further run-ins with the law. With P&A input, a number of devices were considered;
both the man and his team decided that the WanderGuard was the least intrusive
method of ensuring safety and keeping him out of trouble. He now wears a small,
lightweight, wristband that triggers an alarm when passing through a doorway leading
to the outside of the facility. As a result of P&A assistance, he was able to return to his
community placement – where his history of leaving placements became a non-issue
and he has not experienced any further difficulties with the Criminal Justice system.

The Ohio P&A has done a number of things in relation to students with TIB. PATBI is
partnering with Columbus Public Schools to pilot a project to better identify and serve
students with TBI. This pilot project implemented a screening tool to be used by school
psychologists and nurses to screen students for TBI. All kindergartners and any new
special education referrals will be screened. The project also includes an awareness
component and training for school personnel implementing the pilot project.

The Pennsylvania P&A helped a number of individuals remain in, or return to, the
community. PATBI staff assisted an individual with TBI when her father called to
complain of the sudden discontinuation of HCBS. Because of PATBI involvement, the
family reported feeling listened to and supported. A new provider was found; services
were resumed; and a long-delayed ramp was finally installed so the woman with TBI
could go in and out of her home. Parents of another individual with TBI and other

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disability issues contacted the P&A for assistance in getting their adult son brought back
from New Hampshire to receive services closer to his family. Because of the information
provided by PATBI staff, the family member was transferred to a rehabilitation hospital
in Erie, Penn., where he received services before moving back home with his family.

The guardians of an 11-year-old boy with TBI contacted the Rhode Island P&A.
Among other things, the guardians opposed the school’s proposed Extended School
Year (ESY) program for the boy, asserting that it did not contain an appropriate social
skills component and was not offered in the least restrictive environment (LRE). PATBI
staff provided the guardians with information regarding the child’s rights and was
retained to attend several IEP meetings to advocate for an appropriate ESY program for
the boy. As a result of these negotiations, the school agreed to fund half of the four-
week ESY program the guardians preferred and provide transportation to and from that
program for its duration.

The South Dakota P&A staff continued to have a presence with the National Veterans
Services Officers/Congressional Forum to address and to be informed of the rising
numbers of wounded soldiers returning with TBI-related injuries. This partnership
allows PATBI staff the opportunity to keep abreast of the needs of returning soldiers
with TBI and the availability of VA rehabilitation services directly related to TBI.

Utah P&A staff assisted a 9-year-old student with TBI and his family. The family had
faced a long-running dispute over health-care planning, medical needs, and educational
supports to meet their son’s substantial in-school needs. PATBI staff worked with the
family on strategies for addressing his needs, and helped the family file a request for
mediation with the Utah State Office of Education. The family followed through on the
request and reported the mediation was “positive and professional;” they were “thrilled”
with the results.

The Virginia P&A received complaints regarding paratransit services in Richmond City/
Henrico County. Because of the number of complaints coming from one of the brain
injury clubhouses in the area, PATBI staff was compelled to look into this issue, going
to the Clubhouse to discuss with consumers and staff the problems they were
experiencing. The consumers began documenting the incidents, which proved to be a
great collaboration effort. Because of the documentation provided by this clubhouse,
the P&A entered into an arrangement with the paratransit service provider requiring it
to meet or exceed ADA standards for paratransit transportation by June 30, 2006. No
further complaints were received after this date. This systemic case not only helped
individuals with TBI, but also all those who use this paratransit service.




For more information, please contact NDRN at 202-408-9514.

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                              Problem Areas of Services Provided

                 Other (Includes all Items   Abuse   Architectural Accessibility
                        under 1%)             6%                1%
                           14%                                                       Assistive Technology
                                                                                              1%
      Unnecessary
    Institutionalization
             3%
                                                                                         Custody/ Parental Rights
                                                                                                   2%
Transportation
     1%


                                                                                                 Education
Rehabilitation Services                                                                            10%
          6%


    Neglect
     7%
                                                                                               Employment Discrimination
                                                                                                        6%


 Housing
   8%
                                                                                          Financial Benefits
                                                                                                 9%

                                                                                   Gov. Benefits/Services
                   Healthcare                                                              9%
                     14%                                            Guardianship/
                                                                   Conservatorship
                                                                        4%
                              Living Arrangements of Individuals Served


                                 Other   Unknown/ Not Provided   Community Residential
                                  1%             4%                   Home
              VA Hospital                                               6%
                 <1%
  Public Housing                                                                     Foster Care
       <1%                                                                               2%

                                                                                         Homeless/ Shelter
Public (State Operated)                                                                        1%
  Institution Setting
           4%
                                                                                          Legal Detention/ Jail/ Prison
                                                                                                     3%
Private Institution Setting
           3%
                                                                                             Nursing Facility
                                                                                                   9%




                   Independent                                                    Parental/ Guardian or Other
                       40%                                                               Family Home
                                                                                             27%
                   Ethnicity/Race of Individuals Served

                                   American Indian/
                           Other
                                    Alaskan Native    Arab American
                           <1%
                                         2%                <1%
  Unknown/ Not Provided
          2%
                                                               Asian
Multiracial/ Multiethnic                                        1%
          1%
                                                                  Black/ African American
                                                                            10%

                                                                        Hispanic/ Latino
                                                                             4%

                                                                       Native Hawaiian/ Other
                                                                           Pacific Islander
                                                                                 <1%




     White/ Caucasian
           78%
                     Geographic Location of Individuals Served                       Gender of Individuals Served




         Rural
         39%                                                                Female
                                                                             40%




                                                                  Urban/
                                                                 Suburban
                                                                   61%


                                                                                                                      Male
                                                                                                                      60%

                                                         Age of Individuals Served

                     1400

                     1200

                     1000

                     800

                     600




Individuals Served
                     400

                     200

                       0
                                 0 to 12           13 to 18            19 to 25        26 to 64         65 and over
                                                                     Age ( Years)
                                        Reasons for Closing Case Files
                    Lack of Resources     Not Within Priorities   Issue not Resolved in
                            1%                    4%                  Client's Favor
  Agency Withdrew From                                                     3%
         Case                                                                    Other
          1%                                                                      2%

 Conflict of Interest
        <1%

Case Lacked Legal Merit
         6%


Individual Not Responsive
        to Agency
            5%

Services Not Needed Due
to Death, Relocation, etc
           2%
                                                                                          All Issues Resolved in
                                                                                               Client’s Favor
                                                                                                    52%
  Individual Withdrew
       Complaint
          7%

           Other Representation
                 Obtained
                   3%

                             Some Issues Resolved in
                                 Client’s Favor
                                      14%
                              Highest Intervention Strategy


                       Admin. Hearing   Legal Remedy/ Litigation
                            2%                   2%
                                                                   Class Action Suits
     Mediation/ Alternative                                              <1%
      Dispute Resolution
             1%


      Negotiation
        16%



Investigation/ Monitoring
           9%




Systemic/ Policy Activities
           2%                                                                 Short Term Assistance
                                                                                       68%
      NATIONAL PATBI PROGRAM STATISTICS (FY06)
PART I: NON-CASE SERVICES

A. INFORMATION AND REFERRAL SERVICES (I&R)

1. Total Individuals Receiving I&R Services                                                    3,194
2. Total Number of I&R requests during the Fiscal Year                                         9,467

B. TRAINING ACTIVITIES

1. Number of Trainings Presented by Staff                                                      1,082
2. Number of Individuals Who Attended These Trainings                                         61,632

C. INFORMATION DISSEMINATED TO THE PUBLIC

1. Radio and TV Appearances by Agency Staff                                                       108
2. Newspaper/Magazine/Journal Articles Prepared by Agency Staff                                   358
3. PSAs/Videos Aired by the Agency                                                                258
4. Website Hits                                                                             8,244,957
5. Publications/Booklets/Brochures Disseminated by the Agency                                176,257

6. External Media Coverage of Agency Activities
                            Newspaper/                                         Publications/
 Radio/TV Coverage                                    PSAs/Videos
                         Magazines/Journal                                   Booklets/Brochures
      7,680,868                24,290,374                  12                      46,377

PART II: CASE-SERVICES

 A. INDIVIDUALS SERVED
1. Individuals
 a. Individuals Served Receiving Advocacy at Start of Fiscal Year (carryover from prior)          670
 b. Additional Individuals Served During Fiscal Year (new for fiscal year)                     1,200
 c. Total Number of Individuals Served During Fiscal Year (a + b)                              1,871
 d. Total Number of Individuals with Cases that Were Closed During Fiscal Year                 1,116
 e. Total Individuals Still Being Served at the End of the Fiscal Year                            770
2. Services
 a. Number of Cases/Service Requests Open at Start of Fiscal Year (carryover from prior)          763
 b. Additional Cases/Service Requests Opened During Fiscal Year (new for fiscal year)          1,750
 c. Total Number of Cases/Service Requests During Fiscal Year (a + b)                          2,538
 d. Total Number of Cases/Service Requests that Were Closed During Fiscal Year                 1,531
 e. Total Number of Cases/Service Requests Open at the End of the Fiscal Year                  1,008
B. PROBLEM AREAS/COMPLAINTS OF INDIVIDUALS SERVED
Complaint
1. Abuse (total)                                          103
  a. Inappropriate Use of Restraint & Seclusion            11
  b. Involuntary Treatment                                 7
  c. Physical, Verbal, & Sexual Assault                   27
  d. Other                                                 49
2. Access to Records                                       6
3. Advance Directives                                      0
4. Architectural Accessibility                            22
5. Assistive Technology (total)                           25
  a. Augmentative Comm. Devices                            3
  b. Durable Medical Equipment                            11
  c. Vehicle Modification/Transportation                   2
  d. Other                                                 9
6. Civil Commitment                                        7
7. Custody/Parental Rights                                 27
8. Education (total)                                      181
  a. FAPE: IEP/IFSP Planning/Development/Implementation    70
  b. FAPE: Discipline/Procedural Safeguards               20
  c. FAPE: Eligibility                                     13
  d. FAPE: Least Restrictive Environ.                     23
  e. FAPE: Multi-disciplinary Evaluation/Assessments       7
  f. FAPE: Transition Services                            12
  g. Other                                                 34
9. Employment Discrimination (total)                      97
  a. Benefits                                              8
  b. Hiring/Termination                                   45
  c. Reasonable Accommodations                            21
  d. Service Provider Issues                               2
  e. Supported Employment                                  5
  f. Wage and Hour Issues                                  2
  g. Other                                                 10
10. Employment Preparation                                18
11. Financial Benefits (total)                                             163
  a. SSDI Work Incentives                                                   8
  b. SSI Eligibility                                                        71
  c. SSI Work Incentives                                                    5
  d. Social Security Benefits Cessation                                     8
  e. Welfare Reform                                                          0
  f. Work Related Overpayments                                              8
  g. Other Financial Entitlements                                          53
12. Forensic Commitment                                                     10
13. Government Benefits/Services                                           149
14. Guardianship/Conservatorship                                            83
15. Healthcare (total)                                                     235
  a. General Healthcare                                                    71
  b. Medicaid                                                               99
  c. Medicare                                                               17
  d. Private Medical Insurance                                             15
  e. Other                                                                  33
16. Housing (total)                                                        137
  a. Accommodations                                                        18
  b. Architectural Barriers                                                 3
  c. Landlord/Tenant                                                        23
  d. Modifications                                                           6
  e. Rental Denial/Termination                                             23
  f. Sales/Contracts/Ownership                                              7
  g. Subsidized Housing/Section 8                                           23
  h. Zoning/Restrictive Covenants                                           1
  i. Other                                                                  22
17. Immigration                                                              0
18. Neglect (total)                                                        121
  a. Failure to Provide Necessary or Appropriate Medical Treatment         42
  b. Failure to Provide Necessary or Appropriate Mental Health Treatment    7
  c. Failure to Provide Necessary or Appropriate Personal Care & Safety    22
  d. Other                                                                  47
19. Post-Secondary Education                                                8
20. Non-Medical Insurance                                                   16
21. Privacy Rights                                                           9
22. Rehabilitation Services (total)                      106
  a. Communications Problems (Individuals/Counselor)      3
  b. Conflict About Services To Be Provided               20
  c. Individual Requests Information                      6
  d. Non-Rehabilitation Act                               0
  e. Private Providers                                     6
  f. Related to Application/Eligibility Process           8
  g. Related to IWRP Development/Implementation           2
  h. Related to Title I of ADA                            0
  i. Other Rehabilitation Act-related problems            4
23 Suspicious Death                                        5
24. Transportation (total)                                22
  a. Air Carrier                                           1
  b. Paratransit                                           3
  c. Public Transportation                                5
  d. Other                                                 8
25. Unnecessary Institutionalization                      54
26. Voting (total)                                         0
  a. Accessible Polling Place / Equipment                 0
  b. Registration                                          0
  c. Other                                                 0
27. Other                                                123

C. REASONS FOR CLOSING CASE FILES

 a. All Issues Resolved in Client’s Favor                654
 b. Some Issues Resolved in Client’s Favor               181
 c. Other Representation Obtained                         39
 d. Individual Withdrew Complaint                         84
 e. Services Not Needed Due to Death, Relocation, etc.    19
 f. Individual Not Responsive to Agency                  68
 g. Case Lacked Legal Merit                               69
 h. Conflict of Interest                                   2
 i. Agency Withdrew from Case                             10
 j. Lack of Resources                                     18
 k. Not Within Priorities                                 53
 l. Issue Not Resolved in Client’s Favor                  35
 m. Other                                                 27
D. HIGHEST INTERVENTION STRATEGY

 Interventions
 1. Short Term Assistance                                  889
 2. Systemic/Policy Activities                              32
 3. Investigation/Monitoring                               118
 4. Negotiation                                            217
 5. Mediation/Alternative Dispute Resolution                10
 6. Administrative Hearing                                 24
 7. Legal Remedy/Litigation                                25
 8. Class Action Suits                                       1

PART III: STATISTICAL INFORMATION FOR INDIVIDUALS SERVED

A. AGE OF INDIVIDUALS SERVED
Age
0 to 12                                 95
13 to 18                               102
19 to 25                               178
26 to 64                             1,205
65 and over                             37

B. GENDER OF INDIVIDUALS SERVED
Male           975
Female             643

C. RACE/ETHNICITY OF INDIVIDUALS SERVED
Race/Ethnicity
1. American Indian/Alaskan Native                                  29
2. Arab American                                                    0
3. Asian                                                           16
4. Black/African American                                         167
5. Hispanic/ Latino                                                67
6. Native Hawaiian/Other Pacific Islander                          11
7. White/Caucasian                                               1,260
8. Multiracial/Multiethnic                                         23
9. Race/Ethnicity Unknown                                          37
10. Other Than Above                                                9
D. LIVING ARRANGEMENTS OF INDIVIDUALS SERVED
Arrangement
1. Community Residential Home                                                                 102
2. Foster Care                                                                                 24
3. Homeless/Shelter                                                                            17
4. Legal Detention/Jail/Prison                                                                 54
5. Nursing Facility                                                                           148
6. Parental/Guardian or Other Family Home                                                     449
7. Independent                                                                                687
8. Private Institutional Setting                                                               51
9. Public (State Operated) Institutional Setting                                               74
10. Public Housing                                                                               4
11. VA Hospital                                                                                  2
12. Other*                                                                                     21
13. Unknown/Not Provided                                                                       69

E. GEOGRAPHIC LOCATION
Geographic Location
1. Urban/Suburban                                                                             976
2. Rural                                                                                      635

PART IV: SYSTEMIC ACTIVITIES AND LITIGATION

A. SYSTEMIC ACTIVITIES

1. Number of Policies/Practices Changed as a Result of Non-Litigation Systemic Activities   10,362

B. LITIGATION/CLASS ACTIONS

1. Total Number of Non-Class Action Lawsuits Filed                                             22
   a. Number of Non-Class Action Lawsuits Filed During Fiscal Year (new for fiscal year)       12
   b. Number of Non-Class Action Lawsuits Filed at Start of Fiscal Year (carryover
                                                                                               10
      from prior fiscal year)
2. Total Number of Class Action Lawsuits Filed                                                 12
  a. Number of Class Action Lawsuits Filed During Fiscal Year (new for fiscal year)              1
  b.Number of Class Action Lawsuits Filed at Start of Fiscal Year (carryover from
                                                                                               11
     prior fiscal year)

C. DEATH INVESTIGATIONS
 1. Number of Formal Death Reports Received                                                    18
 2. Number of Informal/External Death Reports Received                                         10
 3. Number of Death Investigations                                                             26

PART V: AGENCY ADMINISTRATION

A. GRIEVANCES FILED
PATBI grievances filed against the agency during the fiscal year                                 8
           FY 2006 PATBI Program Allotments
STATE            ALLOTMENT     STATE             ALLOTMENT
ALABAMA              $50,000   NEW HAMPSHIRE         $50,000
ALASKA               $50,000   NEW JERSEY            $58,529
ARIZONA              $50,772   NEW MEXICO            $50,000
ARKANSAS             $50,000   NEW YORK              $83,478
CALIFORNIA          $118,664   NORTH CAROLINA        $57,666
COLORADO             $50,000   NORTH DAKOTA          $50,000
CONNECTICUT          $50,000   OHIO                  $65,471
DELAWARE             $50,000   OKLAHOMA              $50,000
DISTRICT OF
COLUMBIA             $50,000   OREGON                $50,000
FLORIDA              $76,406   PENNSYLVANIA          $67,663
GEORGIA              $57,990   PUERTO RICO           $50,000
HAWAII               $50,000   RHODE ISLAND          $50,000
IDAHO                $50,000   SOUTH CAROLINA        $50,000
ILLINOIS             $67,989   SOUTH DAKOTA          $50,000
INDIANA              $53,016   TENNESSEE             $52,092
IOWA                 $50,000   TEXAS                 $87,908
KANSAS               $50,000   UTAH                  $50,000
KENTUCKY             $50,000   VERMONT               $50,000
LOUISIANA            $50,000   VIRGINIA              $55,373
MAINE                $50,000   WASHINGTON            $52,575
MARYLAND             $51,164   WEST VIRGINIA         $50,000
MASSACHUSETTS        $53,650   WISCONSIN             $51,322
MICHIGAN             $62,129   WYOMING               $50,000
MINNESOTA            $50,273   NATIVE AMERICAN       $20,000
MISSISSIPPI          $50,000   AMERICAN SAMOA        $20,000
MISSOURI             $51,869   GUAM                  $20,000
                               NORTHERN
MONTANA              $50,000   MARIANAS              $20,000
NEBRASKA             $50,000   VIRGIN ISLAND         $20,000
NEVADA               $50,000   TOTAL              $2,975,999
                             STATE LIST OF P&As/CAPs


            ALABAMA                                  DELAWARE
Alabama Disabilities Advocacy Program        Community Legal Aid Society, Inc.
           www.adap.net                            www.declasi.org

Division of Rehabilitation Services and          United Cerebral Palsy, Inc.
  Children's Rehabilitation Services
            www.sacap.org                       DISTRICT OF COLUMBIA
                                                 University Legal Services
               ALASKA                                www.uls-dc.org
   Disability Law Center of Alaska
            www.dlcak.org                              FLORIDA
                                             Advocacy Center for Persons with
             ASIST, Inc.                               Disabilities
   http://home.gci.net/~alaskacap/              www.advocacycenter.org

         AMERICAN SAMOA                                 GEORGIA
    Client Assistance Program and              Georgia Advocacy Office, Inc.
        Protection & Advocacy                        www.thegao.org

             ARIZONA                         Georgia Client Assistance Program
   Arizona Center for Disability Law               www.georgiacap.com
       www.azdisabilitylaw.org
                                                         GUAM
              ARKANSAS                              Guam Legal Services
     Disability Rights Center, Inc.
     www.arkdisabilityrights.org                  Parent-Agencies Network

           CALIFORNIA                                    HAWAII
     Protection & Advocacy, Inc.               Hawaii Disability Rights Center
           www.pai-ca.org                      www.hawaiidisabilityrights.org

    Department of Rehabilitation                          IDAHO
     www.rehab.cahwnet.gov                              Co-Ad, Inc.
                                              http://users.moscow.com/co-ad
           COLORADO
         The Legal Center                               ILLINOIS
       www.thelegalcenter.org                     Equip for Equality, Inc.
                                                 www.equipforequality.org
           CONNECTICUT
 Office of Protection & Advocacy for          Illinois Client Assistance Program
       Persons with Disabilities                  www.dhs.state.Il.us/ors/cap
       www.state.ct.us/opapd/
              INDIANA                              MASSACHUSETTS
   Indiana Protection and Advocacy              Disability Law Center, Inc.
               Services                             www.dlc-ma.org
          www.IN.gov/ipas
                                           Massachusetts Office on Disability
                IOWA                     www.state.ma.us/mod/MSCAPBRO.html
 Iowa Protection & Advocacy Services,
                 Inc.                                  MICHIGAN
            www.ipna.net                 Michigan Protection & Advocacy Services
                                                     www.mpas.org
 Division on Persons with Disabilities
www.state.ia.us/government/dhr/pd/clie               MINNESOTA
          nt_assist_program                  Minnesota Disability Law Center
                                                    www.mndlc.org
                KANSAS
   Disability Rights Center of Kansas                MISSISSIPPI
           www.drckansas.org                Mississippi Protection & Advocacy
                                                          System
            KENTUCKY                               www.mspas.com-ms
  Kentucky Protection and Advocacy
           www.kypa.net                           Easter Seal Society
                                                www.mississippicap.com
      Client Assistance Program
          http://kycap.ky.gov                          MISSOURI
                                         Missouri Protection & Advocacy Services
           LOUISIANA                              www.moadvocacy.org
          Advocacy Center
         www.advocacyla.org                           MONTANA
                                               Montana Advocacy Program
                 MAINE                              www.mtadv.org
        Disability Rights Center
           www.drcme.org                          NATIVE AMERICAN
                                          Native American Disability Law Center,
            CARES, Inc.                                   Inc.
          www.caresinc.org                       www.nativelegalnet.org

            MARYLAND                                 NEBRASKA
    Maryland Disability Law Center          Nebraska Advocacy Services, Inc.
         www.mdlcbalto.org                 www.nebraskaadvocacyservices.org

Maryland State Department of Education          Client Assistance Program
  Division of Rehabilitation Services/             www.cap.state.ne.us
    Maryland Rehabilitation Center
         www.dors.state.md.us
             NEVADA                          NORTHERN MARIANAS ISLANDS
 Nevada Advocacy & Law Center, Inc.           Northern Marianas Protection and
          www.ndalc.org                            Advocacy System, Inc.
                                                     www.NMPASI.com
        Client Assistance Program
http://detr.state.nv.us/rehab/reh_cap.htm                   OHIO
                                                   Ohio Legal Rights Service
          NEW HAMPSHIRE                             www.state.oh.us/olrs/
        Disabilities Rights Center
            www.drcnh.org                              OKLAHOMA
                                             Oklahoma Disability Law Center, Inc.
 Governor’s Commission on Disability           www.oklahomadisabilitylaw.org
www.state.nh.us/disability/caphomepag
               e.html                          Oklahoma Office of Handicapped
                                                          Concerns
           NEW JERSEY                         www.ohc.state.ok.us/~ohc/cap.htm
New Jersey Protection & Advocacy, Inc.
          www.njpanda.org                                OREGON
                                                   Oregon Advocacy Center
            NEW MEXICO                              www.oradvocacy.org
      Protection & Advocacy, Inc.
          www.nmpanda.org                             PENNSYLVANIA
                                                  Disability Rights Network of
             NEW YORK                                     Pennsylvania
 NYS Commission on Quality of Care &                    www.drnpa.org
 Advocacy for Persons with Disabilities
      www.cqcapd.state.ny.us                   Center for Disability Law & Policy
                                                 www.equalemployment.org
         NORTH CAROLINA
Governor's Advocacy Council for Persons                  PUERTO RICO
            with Disabilities                 Office of the Governor Ombudsman
           www.Gacpd.com                                 for the Disabled
                                                     www.oppi.gobierno.pr
 North Carolina Department of Health
          & Human Services                            RHODE ISLAND
        http://cap.state.nc.us              Rhode Island Disability Law Center, Inc.
                                                        www.ridlc.org
          NORTH DAKOTA
  North Dakota Protection & Advocacy
                Project
          www.ndpanda.org

North Dakota Client Assistance Program
       http://www.nd.gov/cap/
         SOUTH CAROLINA                            VIRGIN ISLANDS
Protection & Advocacy for People with     Disability Rights Center of the Virgin
           Disabilities, Inc.                             Islands
 www.protectionandadvocacy-sc.org                     http://drcvi.org

  Division of Ombudsman & Citizen                       VIRGINIA
               Services                 Virginia Office for Protection & Advocacy
   www.govoepp.state.sc.us/cap/                   www.vopa.state.va.us

        SOUTH DAKOTA                               WASHINGTON
  South Dakota Advocacy Services                Washington P&A System
       www.sdadvocacy.com                        www.wpas-rights.org

             TENNESSEE                         Client Assistance Program
 Disability Law & Advocacy Center of           www.washingtoncap.org
              Tennessee
           www.DLACTN.org                        WEST VIRGINIA
                                             West Virginia Advocates, Inc.
            TEXAS                              www.wvadvocates.org
         Advocacy, Inc.
       www.advocacyinc.org                           WISCONSIN
                                               Disability Rights Wisconsin
              UTAH                             www.disabilityrightswi.org
      Disability Law Center
    www.disabilitylawcenter.org           Department of Agriculture Trade &
                                                Consumer Protection
           VERMONT
Vermont Protection & Advocacy, Inc.                   WYOMING
          www.vtpa.org                      Wyoming Protection & Advocacy
                                                     System, Inc.
   Vermont Disability Law Project              http://wypanda.vcn.com
       www.vtlegalaid.org
900 Second Street, NE, Suite 211
Washington, DC 20002
Tel: 202.408.9514
Fax: 202.408.9520
TTY: 202.408.9521
www.ndrn.org
info@ndrn.org