2008 Annual Report Protection and Advocacy for Individuals with

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2008 Annual Report Protection and Advocacy for Individuals with Powered By Docstoc

  2008             Protection and Advocacy for 
Annual           Individuals with Traumatic Brain 
 Report                       Injury
      900 SECOND STREET NE, SUITE 211 •  WASHINGTON, DC 20002‐3560 
          TEL: 202.408.9514 • FAX: 202.408.9520 • TTY: 202.408.9521 
August 2009

   Protection and Advocacy for Individuals with Traumatic Brain Injury (PATBI)
          Fiscal Year 2010 Appropriations Recommendation- $6 million

Background/ Funding History

The Traumatic Brain Injury (TBI) Act was authorized as part of the Children’s Health Act
of 2000. Within the TBI Act, Congress created a protection and advocacy program for
individuals with traumatic brain injuries. This enables every state to have a Protection
and Advocacy for Individuals with Traumatic Brain Injury (PATBI) program, funded at a
minimum of $50,000 per state. While its funding comes from the Maternal and Child
Health Block Grant, TBI is not a child-only issue. In fact, 68% of returning soldiers who
sustained a TBI are facing life-altering challenges at home.

In recent years there has been a dramatic increase in the number of individuals with
traumatic brain injuries – particularly because it is the signature injury of the wars in Iraq
and Afghanistan. Yet in past budget proposals, including Fiscal Year 2009, President
Bush recommended eliminating the PATBI program each year. Fortunately, each year
House and Senate appropriators restored funding. With an increase in the number of
individuals with TBI, funding levels must also increase.

Effective protection and advocacy services for people with traumatic brain injuries can
lead to reduced government expenditures and increased productivity, independence,
and community integration. However, advocates must possess specialized skills, and
their work is often time-intensive. In 2008, PATBI was funded at just $2.94 million, its
lowest level ever. While it is a positive sign that Congressional appropriators have
restored funding for PATBI each year, restoration alone does not address the growing
demand for services. NDRN recommends an appropriation of $6 million for PATBI
in FY2010.

                                            PATBI Appropriations Versus Inflation

       Millions of Dollars


                             3.2                                                    Appropriations
                              3                                                     Adjusted for inflation


                                   2004   2005   2006      2007   2008   2009
                                                   Fiscal Year
Current Program Responsibilities
The Centers for Disease Control estimates that at least 5.3 million Americans,
approximately 2% of the U.S. population, have a long-term or lifelong need for help to
perform daily activities as a result of a TBI. Additionally,

             1.4 million individuals sustain a TBI each year in the United States.
             Incidence is generally higher among males, Native Americans, and
              children younger than five.
             At least 19% of returning veterans from the Wars in Iraq and Afghanistan
              sustained a TBI.

Individuals with traumatic brain injuries have an array of protection and advocacy needs
including assistance returning to work, finding a home, accessing needed supports and
services such as attendant care and assistive technology, and obtaining appropriate
mental health, substance abuse, and rehabilitation services. Often these individuals,
including returning veterans, are forced to remain in extremely expensive institutional
settings far longer than necessary because community-based supports and services are
not available.
In line with TBI incidence data, the majority of individuals provided advocacy through
the PATBI program were male. In addition, while the PATBI program serves individuals
of all ages, the majority are between 26 and 64 years old. Consistent with the
sophisticated and comprehensive approach of the P&A system, the program utilizes a
broad range of strategies 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 result in legal action being taken.
To ensure each state has the resources necessary to maintain critical protection and
advocacy services for those currently living with a brain injury and the growing number
of people joining their ranks – including so many of our returning war veterans, PATBI
funding must be increased.
For more information, contact Eric Buehlmann or Kuna Tavalin at 202-408-9514, or

In 2008, the PATBI program:

      Responded to over 15,000 information and referral requests. In addition, the
       PATBI program trained over 66,000 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 over 1,200 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 Veterans Administration 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 following are examples of some of the work undertaken by the PATBI program in
the states and territories in 2008.


The Alabama Disabilities Advocacy Program (the AL P&A) was contacted by the parent
of a 15 year old boy, requesting assistance with eligibility for special education services.
PATBI staff found that the client was eligible to receive special education services for a
traumatic brain injury and an Individualized Education Program was developed for the
remainder of the school year. Because of PATBI staff intervention, the client received
academic support, speech services, occupational therapy, counseling, and physical
therapy. The school acknowledged the failure to identify and refer services in a timely
manner, and promised to provide compensatory education 4 times a week for the
remainder of the school year.


The Disability Law Center of Alaska (the AK P&A) assisted a client in obtaining Social
Security benefits shortly after his release from the Department of Corrections. PATBI
staff represented the client at the Social Security hearing, and as a result, the client
receives cash benefits and medical coverage. Because of PATBI staff involvement the
client obtained Social Security benefits, is able to live independently, and has now
moved into a small apartment.


The Arizona Center for Disability Law (the AZ P&A) assisted a 41 year old male in the
Vocational Rehabilitation program. The client received a traumatic brain injury in a
motocross racing accident in 2003, and had been obtaining extensive services from the
Vocational Rehabilitation program. The program was unsure about assisting the client
in completing the required training to become a commercial airline pilot. With the
assistance of the PATBI advocate, the Vocational Rehabilitation program approved the
client’s plan to obtain a Master’s degree in Aeronautical Science from a college. If the
client is unable to obtain Federal Aviation Administration medical clearance, the
program will provide him with job development services to find employment where he
can practice the skills and expertise he acquired with the Master’s degree. The client
maintained a 4.0 grade point average throughout the Master’s program.


The Disability Rights Center (the AR P&A) assisted a 17 year old female with a
traumatic brain injury. The mother was unable to take the client to therapy sessions
because she worked five days a week. The PATBI coordinator referred the mother to a
local education agency for assistance with the client’s therapy and transportation. The
PATBI staff provided the mother with information on TBI and the center’s Parents' Guide
to Special Education and invited the mother to the Brain Injury Association of Arkansas
meeting. Because of PATBI intervention, the client currently receives the therapy she


Disability Rights California (the CA P&A) assisted a 20 year old individual with a
traumatic brain injury from an automobile accident. For the last six years, the client has
lived in various nursing facilities funded by Medi-Cal benefits from the county where the
accident took place. The client contacted PATBI staff when he could not transition out
of a nursing facility to his family home because his family home was located outside of
the county which paid his benefits. The county refused to transfer his Medi-Cal case to
the county where his family lived. PATBI staff facilitated communication between
supervisors in both counties, resulting in the transfer of his Medi-Cal case and a
successful transition out of the nursing facility.


The Legal Center (the CO P&A) assisted a client who received services to live
independently through a county agency. His primary care provider was going to be
away for two months, and the client needed a substitute care provider. The agency did
not have anyone trained to provide services under the Traumatic Brain Injury waiver.
Because of PATBI staff intervention, the agency trained a staff person who had
previously worked with the client. The PATBI attorney worked with the agency to help
develop contingency plans for such future occurences.


The Office of Protection and Advocacy for Persons with Disabilities (the CT P&A)
assisted a woman with a traumatic brain injury. The effects of the brain injury and
extreme sensitivity to touch caused the client to exhibit behavioral problems directed
towards personal care staff. The client requested assistance from the PATBI program
because she did not want to return to the nursing home. The PATBI advocate insisted
on accountability from service providers, and as a result of the PATBI intervention, the
client obtained additional services. She was discharged from a nursing home to a
community-based home, and developed her independence with the help of supports
from the state's Acquired Brain Injury waiver program. These services will allow the
client to remain living independently in the community.


Community Legal Aid Society (the DE P&A) adopted the lead role in opposing the
elimination of victims of brain injury from eligibility for services provided by Division of
Developmental Disabilities Services (DDDS), a major provider of residential and non-
residential services to persons with disabilities. Prompted by vigorous PATBI advocacy,
DDDS proposed to reinstate eligibility based on brain injury, but limited it to persons
functioning at a mental retardation level. PATBI staff promoted adoption of more liberal
eligibility standards, and the DDDS eventually adopted final regulations extending
eligibility to persons with brain injury and incorporating PATBI recommended

District of Columbia

University Legal Services (the DC P&A) investigated the death of a 65-year old with a
traumatic brain injury. The client’s attempts to apply and receive services from the
District of Columbia Department on Disability Services (DDS) were denied several times
due to his inability to provide adequate proof of a pre-eighteen diagnosis of his
intellectual disability. The client’s condition continued to deteriorate and though he was
eventually found eligible for services, the client became unconscious and subsequently
died without ever receiving any services from DDS. Because of the investigation by
PATBI staff, improvements have been made in the attainment of DDS services.


The Advocacy Center for Persons with Disabilities (the FL P&A) successfully assisted a
number of individuals with a variety of issues regarding Medicaid, housing, paratransit,
and higher education. In one example, PATBI staff assisted clients with Medicaid
issues, providing them with in-home supports and durable medical equipment. In
addition, PATBI staff helped an individual receive proper accommodations for higher
education. PATBI staff’s advocacy has allowed these individuals to receive deserved
services and live independently in the community.


The Children's Freedom Initiative is a collaborative effort to end the institutionalization of
children with disabilities. The Children's Freedom Initiative aims to achieve this goal
through changing legislation, sharing their experiences, coalition building, elevating the
issue, and requesting resource allocations in the budgets of various departments. In
Fiscal Year 2008, 26 children moved into homes in the community and 13 children have
providers. Additionally, a number of institutional placements have been deflected. As
part of this effort, the Georgia Advocacy Office (the GA P&A) has identified children in
facilities, provided individual protection and advocacy, advocated to deflect children with
disabilities from institutions, facilitated coordination among partners, and provided
technical assistance to facility administrators, state agencies, and child protection
caseworkers regarding available community-based resources.


Traumatic brain injury (TBI) transportation safety brochures are continually provided to
the Department of Motor Vehicles. Brochures are distributed by the PATBI program of
Guam Legal Services (the Guam P&A) as an ongoing effort to educate new drivers on
transportation safety and TBI related injuries caused by motor vehicle accidents. These
outreach efforts help increase public awareness and community education about the
PATBI program and TBI prevention, as individuals with traumatic brain injuries continue
to be an underserved population.


Hawaii Disability Rights Center (the HI P&A) assisted a 49 year old male who lived with
his family on the island of Maui and was denied a workplace accommodation. The
PATBI staff attorney worked with the client and his employer to create a proper
workplace accommodation for the client. Because of PATBI staff involvement, the client
and employer reached an agreement on a reasonable accommodation and the client
remains gainfully employed.


DisAbility Rights Idaho (the ID P&A) assisted a 40 year old male who was at risk of a
restrictive placement. The client had lived with his father, who had recently passed
away. The PATBI advocate provided short term assistance by collaborating with a local
church and family members to facilitate current evaluations needed to secure
community supports and services. The PATBI advocate assisted the client in applying
for Independent Living Center Advocacy Assistance, and provided information regarding
available Waiver Services and Special Needs trusts to secure his Medicaid eligibility.
Because of PATBI advocacy, the client avoided a restrictive placement and remained at


Equip for Equality (the IL P&A) assisted a man with a traumatic brain injury to move out
of a nursing home. The nursing home did not provide physical or occupational therapy
or a clean living environment. PATBI staff investigated the client’s situation and
advocated for the client to move to a clean facility that would meet his needs. The client
now has a long term goal of moving to a home in the community once he receives
proper rehabilitation.

The client, a 53 year old woman, experienced a traumatic brain injury which resulted in
difficulties with short-term memory and specific cognitive functions. The client’s aunt
alleged that the client’s sister, the trustee for their parents’ estate, was financially
exploiting the client by spending $35,000 of the trust money allocated to the client on
herself and others. The client’s aunt contacted Indiana Protection and Advocacy
Services (the IN P&A) for assistance. A PATBI attorney contacted Adult Protective
Services, who did not find any evidence of a guardianship actually having been
assigned, and determined that the sister misused the client’s money. The client’s sister
was subsequently removed as the trustee. The client has now been fully reimbursed for
her sister’s unauthorized purchases.


Iowa Protection & Advocacy Services (the IA P&A) assisted a client with a traumatic
brain injury caused by an automobile accident who was displaced from work with the
City of Des Moines. The client requested assistance filing for Iowa Vocational
Rehabilitation Services, which would provide him employment and economic
independence. Because of efforts by PATBI staff, the client applied and was found
eligible for these services.


Disability Rights Center of Kansas (the KS P&A) received information from a family
member about a suspicious death at a state hospital. The PATBI staff immediately
interviewed witnesses and requested an independent autopsy. The PATBI investigation
showed that the person was restrained in a restraint chair and injected with a type of
chemical restraint before dying minutes later. A PATBI attorney has filed suit and the
case is currently in litigation.


A veteran with blindness contacted Kentucky Protection and Advocacy (the KY P&A)
because his healthcare, Tricare, did not cover necessary services related to blindness.
PATBI staff found that under the Tricare policy, health services are to be the same as
those covered by Medicare. Because Medicare did cover the expenses for services
needed by the client, PATBI staff assisted the veteran in getting the same necessary
services through Tricare.


The Advocacy Center (the LA P&A) was contacted by a woman diagnosed with a
traumatic brain injury. The client wanted to receive reasonable accommodations for
environmental sensitivity in her workplace. PATBI staff provided her with advice
concerning possible accommodations under federal law and she was successful in
advocating on her own behalf to create a better work environment.


The Disability Rights Center (the ME P&A) assisted a 23 year old woman, who suffered
a traumatic brain injury, after she was found ineligible for coverage under the state's
Medicaid program. In addition, her private insurance was threatening to stop coverage
of her stay in a rehabilitation facility. The PATBI attorney met with the woman's father to
review the denial, and assisted the client in navigating the private insurance dispute and
preparing for the possibility of applying for the state's Medicaid services again. After
getting an extension of the private insurance, the client was provided with an
appropriate discharge plan from the rehabilitation center and planned to return to the
state she had previously resided.


The Maryland Disability Law Center, (the MD P&A) assisted a client who received
Social Security benefits due to blindness and relied on Maryland’s paratransit
transportation system to get to work. Because of paratransit’s unreliability, she was
often late to work and on countless occasions waited an extensive amount of time for
paratransit to take her home at the end of the work day. The client believed that her
employer was discriminating against her due to her disability, and simultaneously,
Social Security attempted to discontinue her benefits. A PATBI advocate worked
closely with the client to improve her transportation service, request accommodations
from her employer, and reinstate her Social Security benefits.


Disability Law Center (the MA P&A) continues to reach out to underserved individuals
by conducting trainings across the state in the areas of special education, benefits, and
employment law. PATBI staff has conducted trainings in Spanish, Portuguese, Khmer,
and American Sign Language. By providing these needed trainings in additional
languages, individuals with traumatic brain injuries are given access to vital education
and employment information.


Michigan Protection and Advocacy Services (the MI P&A) contacted the social work
department at Walter Reed Army Medical Center to discuss information that could be
provided to returning Michigan service members. Informational packets were
developed and mailed to Walter Reed for dissemination. Each informational packet
included: a cover letter, Michigan Resource Guide, PATBI brochures, a Resources for
Persons with TBI & Their Families brochure, an Important Information About Working &
Caring for People with TBI brochure, a Resources for Veterans with TBI & Their
Families brochure, and a TBI fact sheet.

A senior with a traumatic brain injury (TBI) voluntarily moved from a country group home
into town so he could use public transportation and increase his community connections.
The new group home restricted his access to his personal funds and denied his
requests to purchase small supplies. His cell phone was taken away, he was not
permitted to open his mail, and he was not allowed to independently make
arrangements to access public transportation. Minnesota Disability Law Center (the MN
P&A) recommended that the client, with the help and support of the staff, create a
weekly schedule to include responsibilities, social events, and other appointments. As a
result of PATBI’s advocacy, the client can use his cell phone, open his own mail, access
his personal funds, organize his schedule, and arrange transportation for medical
appointments and social events in the community.


Disability Rights Mississippi (the MS P&A) assisted a middle-aged man who became a
quadriplegic as a result of an accident. The client had been living in a nursing home for
about seventeen years, but wanted to live in a community. With outreach and the
encouragement of PATBI staff, he moved to the community with attendant care services
for eighteen hours a day. With assistance from PATBI staff, scheduling has made it
possible for him not to be alone more than three hours at a time.


A mother called Disability Rights Montana (the MT P&A) on behalf of her daughter, a 17
year old brain injury survivor. Her daughter was terminated from her job, possibly
because of her disability. PATBI staff helped the mother file a Human Rights Bureau
complaint, help her daughter get retraining through Vocational Rehabilitation, get a
comprehensive evaluation of her daughters disability, and retrieve basic information
about obtaining a disability determination for Social Security benefits.


Nebraska Advocacy Services (the NE P&A) continues to work with Coercion Free
Nebraska (CFN) and serves as a member of their steering committee. CFN sponsored
mini-conferences focused on making facilities for children and youth coercion and
trauma-free. The PATBI staff planned, organized, and sponsored two days of
educational events which focused on legislative strategies for eliminating seclusion and
restraint in mental health facilities. Additionally, PATBI staff worked with the Nebraska
Consortium for Citizens with Disabilities to issue a report which called for the elimination
of restraint, seclusion and coercion.

A 63 year old male traumatic brain injury survivor contacted Nevada Advocacy and Law
Center (the NV P&A) when a relative representing himself as the client’s guardian
attempted to force the client to move from his residence. PATBI staff determined the
client did not have a guardian and provided him with referrals to community support
services and information on self-advocacy. As a result of PATBI staff help, the client
continues to live independently in the community.

New Hampshire

Disability Rights Center (the NH P&A) advocated on behalf of individuals with brain
injuries who were denied the ability to apply for Medical Waiver services for the elderly
and chronically ill. As a part of their advocacy, PATBI staff negotiated with the state to
ensure all applications from elderly and chronically ill individuals were accepted and
processed. As a result of PATBI staff advocacy, the assisted clients are still able to live
independently in the community.

New Jersey

Disability Rights New Jersey (the NJ P&A) intervened on behalf of a 29 year old group
home resident with head injuries and neurological impairments. The PATBI staff was
contacted by the client’s mother, who reported allegations of neglect and poor care
within the group home. PATBI staff investigated the allegations and as a result, only a
provisional license was issued to the group home until all licensing requirements were
satisfied. PATBI staff also facilitated a team meeting with the client, his mother, and
agency staff to resolve the family’s complaints. The team discussed past complaints
and decided on a grievance procedure for the client and his mother for the future. The
group home license was later fully reinstated and the grievance procedure is working

New Mexico

Disability Rights New Mexico (the NM P&A) was contacted by the guardian of a young
man with a traumatic brain injury from a gang-related shooting. The client was being
treated and kept at a local children’s rehabilitation hospital long after he and his family
had requested his discharge. Through PATBI staff efforts, his admission to a residential
facility and his discharge from the hospital was facilitated. As a result, the client gained
access to services specifically for persons diagnosed with a traumatic brain injury and is
on his way to complete independence in the community.

New York

New York State Commission on Quality of Care and Advocacy for Persons with
Disabilities (the NY P&A) worked with an incarcerated individual seeking reasonable
accommodations on the GED exam. PATBI staff contacted Prisoners Legal Services
and the Department of Corrections and instructed the inmate on how to request the
appropriate accommodations. The young man was successful and passed his GED

North Carolina

The mother of an individual with a severe traumatic brain injury (TBI) and Iife
threatening obesity related to his TBl contacted Disability Rights North Carolina (the NC
P&A) because he was not receiving appropriate services from Independent Living
Services (IL), such as an exercise program. PATBI staff contacted the IL counselor
assigned to the case to encourage an extension on the duration of recreational therapist
services beyond what is customary. lL agreed to the request and the client is currently
receiving the requested services leading to a more healthful life.

North Dakota

North Dakota Protection and Advocacy Project (the ND P&A) completed outreach to a
Veterans Hospital to increase awareness of the Protection and Advocacy system and
the PATBI program and services. As part of outreach efforts, a panel of veterans were
invited to attend PATBI training to educate PATBI staff on the services available to
veterans as well as increase the awareness of the PATBI program to veterans groups.
As a result of the outreach efforts, PATBI staff and several groups involved with
veterans affairs received a better education of available programs and services.


An individual with a traumatic brain injury was denied a Medicaid waiver due to his
income level. The client’s wife appealed but did not understand the appeal process.
Ohio Legal Rights Service (the OH P&A) provided representation, working with the
client and his wife to present medical bills and countable income using all allowable
exemptions and disregards in accordance with state rules. As a result, the client won
the appeal and received a waiver, allowing him to live at home with his wife with
necessary supports and services.


In Oklahoma, many children in shelters are removed from their homes due to trauma
and abuse that often lead to undiagnosed TBIs. Due to the lack of diagnosis, these
children are not granted the opportunity for an appropriate education, despite immediate
identification of learning difficulties by the psychologists who work with these
individuals. As a result of action by Oklahoma Disability Law Center (the OK P&A), an
urban shelter for abused and traumatized children that was not providing appropriate
educational opportunities to their boarders, allowed these students to attend school and
receive an appropriate education. The P&A identified similar shelters in other locations
in Oklahoma, and has begun to address this as a statewide issue.

Disability Rights Oregon (the OR P&A) assisted a client who wished to terminate his
guardianship and move to a less restrictive environment than his current locked
facility. PATBI staff worked with the facility where the client lived to modify house rules
and address the staff’s treatment of residents. With the assistance of PATBI staff, the
client no longer lives in a locked facility and has fewer restrictions on his participation in
the community. This includes his ability to attend the Veteran’s Administration for
treatment 5 days a week and getting a new primary care physician.


As one example of the advocacy work of the Disability Rights Network of Pennsylvania
(the PA P&A), PATBI staff worked with an individual with a traumatic brain injury (TBI) in
a mentoring capacity. PATBI staff held individual meetings with the client, and as a
result of her mentoring relationship with PATBI staff, she expressed feeling more
confident in her ability to advocate on her own behalf. Using her strengthened skills in
self-advocacy, the client advocated for an improvement in the information offered to
individuals applying for the Head Injury Program, a program with which she holds
previous experience.

Puerto Rico

The Office of the Governor/Ombudsman for Persons with Disabilities (the PR P&A) was
contacted by a high school business marketing teacher who sustained a traumatic brain
injury when she fell down a stairwell at work, resulting in grand mal epilepsy. Her duties
included tending the school store and driving around to supervise business projects run
by her students. As a result of her accident, she could no longer drive and her retention
and concentration skills were hindered. She asked for an aide at work to help her fulfill
her duties, as a reasonable accommodation, but received no response. After PATBI
staff set up a mediation meeting with her school, she was granted a fellow teacher to
help her with the accounts at the school store and drive her so she could supervise her
students’ business projects.

Rhode Island

Rhode Island Disability Law Center (the RI P&A) assisted an elderly client with a
traumatic brain injury and orthopedic impairments who was experiencing difficulty in
securing appropriate rehabilitation services from a rehabilitation center. PATBI staff
contacted the client’s clinician to determine the needed rehabilitation services and then
facilitated the client’s receipt of the needed services by contacting the center, which
agreed to provide the outpatient cognitive/speech therapy and physical therapy
rehabilitation. As a result of PATBI staff efforts, the client is now receiving necessary
services from the center.
South Carolina

Protection and Advocacy for People with Disabilities (the SC P&A) assisted a 9 year old
boy with a traumatic brain injury resulting in a mental disability, vision impairment, and a
seizure disorder. The school had placed the client on a temporary home-based
placement last school year. However, the school did not allow the client to return
because it did not have any staff who could administer his suppository seizure
medication. The PATBI advocate attended an Individualized Education Program (IEP)
meeting, addressing the client’s placement and health care needs. As a result of PATBI
staff intervention, the school hired a trained personal aide to administer the seizure
medication to the client, and a new IEP was developed to include detailed instructions if
the client experiences a seizure at school.

South Dakota

South Dakota Advocacy Services (the SD P&A) advocated for appropriate educational
services for a ten year old student with a traumatic brain injury. In the classroom setting,
he was openly defiant and threatening. The school district recommended a 45-day
placement for evaluation or homebound instruction. PATBI staff attended an
Individualized Educational Program meeting and advocated for appropriate educational
services in the least restrictive environment and additional testing. The school district
agreed to a neuropsychological evaluation, a one-on-one aide, and a more appropriate
positive behavioral intervention plan.


Disability Law and Advocacy Center of Tennessee (the TN P&A) conducted training to
inform service providers and traumatic brain injury (TBI) survivors seeking to obtain
information about employment laws under the Americans with Disabilities Act.
Attendees included employees from the Tennessee Rehabilitation Center TBI Center’s
Job Placement Specialists, therapy providers, hospital staff, and the Brain Injury
Association of Tennessee and survivors. As a result of PATBI efforts, service providers
and TBI survivors were better informed of their legal rights under employment laws.


The client, a high school student who acquired a brain injury in a car accident, is unable
to express himself verbally when he becomes frustrated due to this traumatic brain
injury. Because the school was not prepared to teach an individual with a traumatic
brain injury, the school recommended that he be home-schooled. Advocacy, Inc. (the
TX P&A) assisted with the development of a Behavior Improvement Plan, an
appropriate Individualized Education Program (IEP), and transition services. The client
is now doing well in school and making good progress on his IEP goals.

The Disability Law Center (the UT P&A) filed suit in federal court on behalf of an
individual who wanted to open a licensed residential treatment center for young women,
some of whom have serious emotional impairments. The town agreed to grant the
necessary municipal license after PATBI filed suit. This case will have a direct impact
on the community by creating a residential opportunity for 16 young women with
emotional disabilities. Also, the case will continue the ongoing effort of the PATBI to
educate town municipal officials in Utah about their obligation to permit an expansion of
residential opportunities for individuals with disabilities.


Vermont Protection and Advocacy (the VT P&A) conducted three traumatic brain injury
(TBI) legal clinics for returning Iraq War veterans and their families. The clinics utilized
the revised Resource Manual for TBI survivors and their families. PATBI staff
collaborated with local veterans organizations to set up and advertise the clinics. As a
result of PATBI outreach efforts, many TBI survivors as well as local veterans
organizations are better able to take advantage of available services.

Virgin Islands

Disability Rights Center of the Virgin Islands (the VI P&A) assisted a 31 year old woman
diagnosed with mental illness. She contacted PATBI after being terminated from her
job for requesting leave for mental health treatment. The employer sought no objective
medical evidence prior to making the adverse employment action. A PATBI attorney
filed a charge of discrimination with the state human rights agency and negotiated a
settlement with the employer's counsel. The settlement includes fair compensatory
damages, back pay, and attorneys’ fees. The client will also receive a positive work


The Virginia Office for Protection and Advocacy (the VA P&A) represented a 14 year old
male diagnosed with a traumatic brain injury. The client's mother claimed that her
child's Individualized Education Program (IEP) was inadequate and upon multiple
meetings with the school, teachers admitted they "don't know what to do" with her son’s
disability. The client's mother had four different physician evaluations stating that a
private placement is the only adequate solution to meet the client's needs, and a PATBI
advocate communicated this concern to the school, which subsequently agreed to
homebound instruction. Because of PATBI staff, the client acquired adequate
educational services through homebound placement.

Disability Rights Washington (the WA P&A) helped to secure approximately $600,000 in
additional funds for expanding a media campaign, administering a major conference to
address a wide range of traumatic brain injury (TBI) issues, providing scholarships for
attendees with TBI, and creating a resource coordination program for individuals with
TBI who do not have case mangers specific to their TBI-related needs. As a result of
these PATBI efforts, awareness of underutilized services designed for people with
traumatic brain injuries was expanded.

West Virginia

The client, an individual with a traumatic brain injury and mental illness, requested help
from West Virginia Advocates (the WV P&A) to leave a state psychiatric hospital. A
PATBI advocate was instrumental in linking the person and his family with a variety of
community support services and supplemental contact information. Because of the help
of PATBI staff, the client was discharged to his father’s home and living independently
in the community.


Disability Rights Wisconsin (the WI P&A) continues to look at working conditions and
the lack of opportunities for individuals with disabilities in sheltered workshops. PATBI
staff and People First of Wisconsin reviewed licenses, finding that over 300 people
working in segregated settings earning less than minimum wage have a brain
injury. PATBI staff and People First of Wisconsin continue to advocate that the
Wisconsin Department of Workforce Development provide community-based,
competitive employment opportunities for all people with disabilities currently working in
segregated employment. Because of their advocacy work on this topic, PATBI staff and
People First of Wisconsin received an award from the Governor’s Committee for People
with Disabilities.


Wyoming Protection and Advocacy System (the WY P&A) assisted a young female
client who received a brain injury from her abusive birth father at 4 days old. Until her
junior year in high school, the client had been inappropriately identified. Therefore, her
Individualized Education Program (IEP) accommodations were not appropriate and her
speech therapy was ineffective. PATBI staff attended two IEP meetings in which she
was correctly identified with a traumatic brain injury, her IEP was written to adequately
meet her needs, and her speech therapy services were modified.
                              Problem Areas of Services Provided

                                                  Abuse   Architectural Accessibility
                 Other (Includes all items
                       (                                             1%
                        under 1%)                   %
                           14%                                                          Assistive Technology
                                                                                            Custody/ Parental Rights
Transportation                                                                                        1%

Rehabilitation Services

  8%                                                                                              Employment Discrimination

                                                                                            Financial Benefits
                                                                          Gov. Benefits/Services
                                 G di     hi /                                    8%
                             Ethnicity/Race of Individuals Served

                                                American Indian/
                                                 Alaskan Native    Arab American
                                                      2%                <1%
        Unknown/ Not Provided
Multiracial/ Multiethnic
          3%                                                                  Black/ African American

                                                                                    Hispanic/ Latino

                                                                                    Native Hawaiian/ Other
                                                                                        Pacific Islander

                     White/ Caucasian
                                     Living Arrangements of Individuals Served

                                              Unknown/ Not Provided   Community Residential
                                      Other                                Home
                                       2%             6%
             VA Hospital                                                     5%
                <1%                                                                    Foster Care
 Public Housing
                                                                                        Homeless/ Shelter
Public (State Operated)
  Institution Setting
           4%                                                                             Legal Detention/ Jail/ Prison
Private Institution Setting
                                                                                              Nursing Facility

                                                                                        Parental/ Guardian or Other
                                                                                               Family Home

                      Geographic Location of Individuals Served                        Gender of Individuals Served




                                                          Age of Individuals Served



Individuals Served





                                  0 to 12           13 to 18             19 to 25        26 to 64         65 and over
                                                                       Age ( Years)
                                    Highest Intervention Strategy

                                             Legal Remedy/ Litigation
                            Admin. Hearing

     Mediation/ Alternative
      Dispute Resolution


Investigation/ Monitoring

   Systemic/ Policy Activities

                                                                        Short Term Assistance
                                      Reasons for Closing Case Files
                                                       Issue not Resolved in
                               Not Within Priorities       Client's Favor
Agency Withdrew From          Lack of 3%                                  Other
       Case                  Resources                                     7%
        1%                      2%

             Conflict of Interest
    Case Lacked Legal Merit

 Individual Not Responsive
         to Agency
Services Not needed Due
to Death, Relocation, etc                                                         All Issues Resolved in
           1%                                                                          Client’s Favor
   Individual Withdrew

     Other Representation
                     Some Issues Resolved in
                          Client’s Favor


1. Total Individuals Receiving I&R Services                                                     3,511
2. Total Number of I&R requests during the Fiscal Year                                         15,100


1. Number of Trainings Presented by Staff                                                       1,334
2. Number of Individuals Who Attended These Trainings                                          66,849


1. Radio and TV Appearances by Agency Staff                                                       142
2. Newspaper/Magazine/Journal Articles Prepared by Agency Staff                                   118
3. PSAs/Videos Aired by the Agency                                                                 30
4. Website Hits                                                                             13,373,719
5. Publications/Booklets/Brochures Disseminated by the Agency                                 264,546

6. External Media Coverage of Agency Activities
                            Newspaper/                                         Publications/
 Radio/TV Coverage                                    PSAs/Videos
                         Magazines/Journal                                   Booklets/Brochures
          56                       337                      8                      40,358


1. Individuals
 a. Individuals Served Receiving Advocacy at Start of Fiscal Year (carryover from prior)          905
 b. Additional Individuals Served During Fiscal Year (new for fiscal year)                       1,222
 c. Total Number of Individuals Served During Fiscal Year (a + b)                               2,127
 d. Total Number of Individuals with Cases that Were Closed During Fiscal Year                  1,258
 e. Total Individuals Still Being Served at the End of the Fiscal Year                            881
2. Services
 a. Number of Cases/Service Requests Open at Start of Fiscal Year (carryover from prior)        1,224
 b. Additional Cases/Service Requests Opened During Fiscal Year (new for fiscal year)            1,468
 c. Total Number of Cases/Service Requests During Fiscal Year (a + b)                           2,692
 d. Total Number of Cases/Service Requests that Were Closed During Fiscal Year                  1,365
 e. Total Number of Cases/Service Requests Open at the End of the Fiscal Year                   1,325
1. Abuse (total)                                          100
  a. Inappropriate Use of Restraint or Seclusion          15
  b. Involuntary Treatment                                11
  c. Physical, Verbal, or Sexual Assault                  26
  d. Other                                                 48
2. Access to Records                                       3
3. Advance Directives                                      3
4. Architectural Accessibility                            22
5. Assistive Technology (total)                            30
  a. Augmentative Comm. Devices                            6
  b. Durable Medical Equipment                             9
  c. Vehicle Modification/Transportation                   2
  d. Other                                                 13
6. Civil Commitment                                        10
7. Custody/Parental Rights                                 17
8. Education (total)                                      191
  a. FAPE: IEP/IFSP Planning/Development/Implementation    89
  b. FAPE: Discipline/Procedural Safeguards               21
  c. FAPE: Eligibility                                     24
  d. FAPE: Least Restrictive Environ.                     23
  e. FAPE: Multi-disciplinary Evaluation/Assessments       2
  f. FAPE: Transition Services                             9
  g. Other                                                 23
9. Employment Discrimination (total)                      121
  a. Benefits                                              11
  b. Hiring/Termination                                   44
  c. Reasonable Accommodations                            43
  d. Service Provider Issues                               9
  e. Supported Employment                                  6
  f. Wage and Hour Issues                                  2
  g. Other                                                 6
10. Employment Preparation                                 20
11. Financial Benefits (total)                                             152
  a. SSDI Work Incentives                                                   0
  b. SSI Eligibility                                                        47
  c. SSI Work Incentives                                                    2
  d. Social Security Benefits Cessation                                    12
  e. Welfare Reform                                                          1
  f. Work Related Overpayments                                             18
  g. Other Financial Entitlements                                          72
12. Forensic Commitment                                                     7
13. Government Benefits/Services                                           128
14. Guardianship/Conservatorship                                            90
15. Healthcare (total)                                                     173
  a. General Healthcare                                                    50
  b. Medicaid                                                               69
  c. Medicare                                                               24
  d. Private Medical Insurance                                             11
  e. Other                                                                  19
16. Housing (total)                                                        128
  a. Accommodations                                                        30
  b. Architectural Barriers                                                 4
  c. Landlord/Tenant                                                        31
  d. Modifications                                                           3
  e. Rental Denial/Termination                                             16
  f. Sales/Contracts/Ownership                                              4
  g. Subsidized Housing/Section 8                                           22
  h. Zoning/Restrictive Covenants                                           5
  i. Other                                                                  13
17. Immigration                                                              2
18. Neglect (total)                                                        111
  a. Failure to Provide Necessary or Appropriate Medical Treatment         24
  b. Failure to Provide Necessary or Appropriate Mental Health Treatment   20
  c. Failure to Provide Necessary or Appropriate Personal Care & Safety    22
  d. Other                                                                  45
19. Post-Secondary Education                                                21
20. Non-Medical Insurance                                                   7
21. Privacy Rights                                                          22
22. Rehabilitation Services (total)                       69
  a. Communications Problems (Individuals/Counselor)      2
  b. Conflict About Services To Be Provided               25
  c. Individual Requests Information                      10
  d. Non-Rehabilitation Act                               2
  e. Private Providers                                     9
  f. Related to Application/Eligibility Process           8
  g. Related to IWRP Development/Implementation           9
  h. Related to Title I of ADA                            2
  i. Other Rehabilitation Act-related problems            2
23 Suspicious Death                                        2
24. Transportation (total)                                22
  a. Air Carrier                                           1
  b. Paratransit                                           8
  c. Public Transportation                                6
  d. Other                                                 7
25. Unnecessary Institutionalization                      27
26. Voting (total)                                         4
  a. Accessible Polling Place / Equipment                 0
  b. Registration                                          0
  c. Other                                                 4
27. Other                                                 99


 a. All Issues Resolved in Client’s Favor                652
 b. Some Issues Resolved in Client’s Favor               186
 c. Other Representation Obtained                         52
 d. Individual Withdrew Complaint                         94
 e. Services Not Needed Due to Death, Relocation, etc.    12
 f. Individual Not Responsive to Agency                  60
 g. Case Lacked Legal Merit                               58
 h. Conflict of Interest                                   1
 i. Agency Withdrew from Case                             8
 j. Lack of Resources                                     22
 k. Not Within Priorities                                 45
 l. Issue Not Resolved in Client’s Favor                  20
 m. Other                                                 94

 1. Short Term Assistance                                  843
 2. Systemic/Policy Activities                              10
 3. Investigation/Monitoring                                99
 4. Negotiation                                            191
 5. Mediation/Alternative Dispute Resolution                10
 6. Administrative Hearing                                 37
 7. Legal Remedy/Litigation                                21
 8. Class Action Suits                                       0


0 to 12                                 80
13 to 18                               147
19 to 25                               184
26 to 64                             1,225
65 and over                             47

Male         1,060
Female             623

1. American Indian/Alaskan Native                                  34
2. Arab American                                                    4
3. Asian                                                           18
4. Black/African American                                         165
5. Hispanic/ Latino                                                96
6. Native Hawaiian/Other Pacific Islander                           7
7. White/Caucasian                                               1,215
8. Multiracial/Multiethnic                                         44
9. Race/Ethnicity Unknown                                         102
10. Other Than Above                                                0
1. Community Residential Home                                                                84
2. Foster Care                                                                               16
3. Homeless/Shelter                                                                          25
4. Legal Detention/Jail/Prison                                                               65
5. Nursing Facility                                                                         129
6. Parental/Guardian or Other Family Home                                                   416
7. Independent                                                                              703
8. Private Institutional Setting                                                             49
9. Public (State Operated) Institutional Setting                                              77
10. Public Housing                                                                            9
11. VA Hospital                                                                               3
12. Other*                                                                                   30
13. Unknown/Not Provided                                                                     96

Geographic Location
1. Urban/Suburban                                                                           1089
2. Rural                                                                                     581



1. Number of Policies/Practices Changed as a Result of Non-Litigation Systemic Activities   308


1. Total Number of Non-Class Action Lawsuits Filed                                           20
   a. Number of Non-Class Action Lawsuits Filed During Fiscal Year (new for fiscal year)      8
   b. Number of Non-Class Action Lawsuits Filed at Start of Fiscal Year (carryover
      from prior fiscal year)
2. Total Number of Class Action Lawsuits Filed                                                4
  a. Number of Class Action Lawsuits Filed During Fiscal Year (new for fiscal year)           0
  b.Number of Class Action Lawsuits Filed at Start of Fiscal Year (carryover from
     prior fiscal year)

 1. Number of Formal Death Reports Received                                                   3
 2. Number of Informal/External Death Reports Received                                       13
 3. Number of Death Investigations                                                           11


PATBI grievances filed against the agency during the fiscal year                              10
           FY 2008 PATBI Program Allotments
STATE                  ALLOTMENT     STATE               ALLOTMENT
ALABAMA                    $50,000   NEW HAMPSHIRE            $50,000
ALASKA                     $50,000   NEW JERSEY               $57,616
ARIZONA                    $50,599   NEW MEXICO               $50,000
ARKANSAS                   $50,000   NEW YORK                 $80,185
CALIFORNIA                $112,014   NORTH CAROLINA           $56,836
COLORADO                   $50,000   NORTH DAKOTA             $50,000
CONNECTICUT                $50,000   OHIO                     $63,896
DELAWARE                   $50,000   OKLAHOMA                 $50,000
DISTRICT OF COLUMBIA       $50,000   OREGON                   $50,000
FLORIDA                    $73,788   PENNSYLVANIA             $65,879
GEORGIA                    $57,129   PUERTO RICO              $50,000
HAWAII                     $50,000   RHODE ISLAND             $50,000
IDAHO                      $50,000   SOUTH CAROLINA           $50,000
ILLINOIS                   $66,174   SOUTH DAKOTA             $50,000
INDIANA                    $52,629   TENNESSEE                $51,793
IOWA                       $50,000   TEXAS                    $84,193
KANSAS                     $50,000   UTAH                     $50,000
KENTUCKY                   $50,000   VERMONT                  $50,000
LOUISIANA                  $50,000   VIRGINIA                 $54,762
MAINE                      $50,000   WASHINGTON               $52,231
MARYLAND                   $50,954   WEST VIRGINIA            $50,000
MASSACHUSETTS              $53,203   WISCONSIN                $51,097
MICHIGAN                   $60,873   WYOMING                  $50,000
MINNESOTA                  $50,148   NATIVE AMERICAN          $20,000
MISSISSIPPI                $50,000   AMERICAN SAMOA           $20,000
MISSOURI                   $51,592   GUAM                     $20,000
MONTANA                    $50,000   NORTHERN MARIANAS        $20,000
NEBRASKA                   $50,000   VIRGIN ISLAND            $20,000
NEVADA                     $50,000   TOTAL                 $2,947,591
                                      LIST OF P&AS

            ALABAMA                                        FLORIDA
Alabama Disabilities Advocacy Program            Advocacy Center for Persons with
    Disability Law Center of Alaska                           GEORGIA
                              Georgia Advocacy Office, Inc.
    Client Assistance Program and                             GUAM
        Protection & Advocacy                            Guam Legal Services

             ARIZONA                                           HAWAII
   Arizona Center for Disability Law                 Hawaii Disability Rights Center             

            ARKANSAS                                              IDAHO
       Disability Rights Center                           DisAbility Rights Idaho          

            CALIFORNIA                                        ILLINOIS
      Disability Rights California                      Equip for Equality, Inc.             

           COLORADO                                         INDIANA
         The Legal Center                        Indiana Protection and Advocacy                                Services
  Office of Protection & Advocacy for                          IOWA
        Persons with Disabilities              Iowa Protection & Advocacy Services,                                  Inc.
  Community Legal Aid Society, Inc.                           KANSAS                          Disability Rights Center of Kansas
      University Legal Services                           KENTUCKY
                        Kentucky Protection and Advocacy
           LOUISIANA                                NEVADA
         Advocacy Center                 Nevada Advocacy & Law Center, Inc.              

                MAINE                             NEW HAMPSHIRE
       Disability Rights Center                Disabilities Rights Center

           MARYLAND                                 NEW JERSEY
   Maryland Disability Law Center            Disability Rights New Jersey                    

         MASSACHUSETTS                               NEW MEXICO
      Disability Law Center, Inc.            Disability Rights New Mexico

             MICHIGAN                                NEW YORK
  Michigan Protection and Advocacy       NYS Commission on Quality of Care &
              Services                   Advocacy for Persons with Disabilities

           MINNESOTA                             NORTH CAROLINA
   Minnesota Disability Law Center          Disability Rights North Carolina

             MISSISSIPPI                         NORTH DAKOTA
     Disability Rights Mississippi       North Dakota Protection & Advocacy                        Project
   Missouri Protection & Advocacy         NORTHERN MARIANA ISLANDS
              Services                    Northern Marianas Protection and                      Advocacy System, Inc.
      Disability Rights Montana                           OHIO               Ohio Legal Rights Service
Native American Disability Law Center,             OKLAHOMA
                Inc.                     Oklahoma Disability Law Center, Inc. 

           NEBRASKA                                   OREGON
  Nebraska Advocacy Services, Inc.            Disability Rights Oregon 
          PENNSYLVANIA                                VIRGINIA
      Disability Rights Network of          Virginia Office for Protection &
             Pennsylvania                             Advocacy

             PUERTO RICO                          WASHINGTON
  Office of the Governor/Ombudsman          Disability Rights Washington
      for Persons with Disabilities
                                                 WEST VIRGINIA
           RHODE ISLAND                     West Virginia Advocates, Inc.
Rhode Island Disability Law Center, Inc.
         SOUTH CAROLINA                      Disability Rights Wisconsin
Protection & Advocacy for People with
           Disabilities, Inc.                  WYOMING
                                           Wyoming Protection & Advocacy
          SOUTH DAKOTA                             System, Inc.
   South Dakota Advocacy Services     

 Disability Law & Advocacy Center of

           Advocacy, Inc.

        Disability Law Center

    Vermont Protection & Advocacy

 Disability Rights Center of the Virgin
900 Second Street, NE, Suite 211
Washington, DC 20002
Tel: 202.408.9514
Fax: 202.408.9520
TTY: 202.408.9521