Case 1:14-cv-00175-L-PAS Document 1 Filed 04/08/14 Page 1 of 30 PageID #: 1

UNITED STATES DISTRICT COURT DISTRICT OF RHODE ISLAND

IOIq f\P\i - 8 A 8: 33

UNITED STATES OF AMERICA,

Case No.

Plaintiff,

. COMPLAINT

v.

STATE OF RHODE ISLAND,

Defendant.

INTRODUCTION

1. The United States of Ametica alleges that Defendant, the State ofRhode Island

("State") has discriminated against individuals with intellectual and developmental disabilities

("I/DD") by unnecessarily segregating them or by placing thein at risk of unnecessary

segregation in violation of Title II of the Americans with Disabilities Act of 1990 ("ADA"), 42

U.S.C. §§ 12131-12134.

2.

The State has unnecessalily segregated thousands of individuals with IIDD in

sheltered workshops and facility-based day programs and in recent years has placed hundreds of

individuals with IIDD at risk of unnecessary segregation in such programs by failing to provide

them with employment, vocational, and day services in the most integrated setting appropriate to

their needs.

3. Sheltered workshops and facility-based day programs maintain many ofthe

hallmarks of other segregated settings: the physical layout is institutional in nature; individuals

work and participate in activities according to fixed, highly regimented schedules and routines;

individuals exercise very limited choice over the work and activities that they engage in

throughout the day; the duration of individuals' placements in the facility are for significantly

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long periods of time; and, importantly, in both settings, individuals with disabilities are not able to interact with individuals without disabilities to the fullest extent possible.
4. For example, individuals with IIDD in Rhode Island sheltered workshops perfonn rote, manual tasks, in facilities with only other individuals with IIDD except for paid staff, such as repetitively assembling cardboard jewelry boxes, putting tops on lotion bottles, placing stickers on boxes of dog biscuits, placing stoppers onto medical syringes, and taking wrappers off bars of soap. Persons with IIDD in sheltered workshops typically earn wages that are well below minimum wage. The average hourly wage of sheltered workshop participants in Rhode Island is approximately $2.21 per hour. Individuals with IIDD in Rhode Island typically remain in sheltered workshops for decades at a time.
5. Likewise, in Rl1ode Island, individuals with IIDD in facility-based day programs typically perfonn organized group activities, in facilities with only other people with IIDD except for paid staff, like coloring, completing puzzles, watching movies, playing games, and doing arts and crafts. Like individuals in sheltered workshops, individuals in facility-based day programs typically remain there for decades at a time.
6. By contrast, supported employment and integrated day services are designed with the purpose of allowing individuals with disabilities to interact with individuals without disabilities to the fullest extent possible. Supported employment services typically include the services necessary to find, place, maintain, and provide ongoing suppmi to individuals with IIDD in integrated, competitive employment settings in the community. Such services include job discovery, vocational assessment, job coaching, and job training that enable individuals to access jobs in typical work settings in the cmmnunity where they interact with non-disabled coworkers, customers, and peers.
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7. For example, the small portion of individuals with IIDD in Rhode Island receiving supported employment services have received services and supports to allow them to find, obtain, and maintain competitive wage jobs in clerical/office settings, food service and customer service venues, state and local governments, small businesses, and large corporations. Many of these individuals receive ongoing job coaching and job training from employment specialists in adjusting to ongoing workplace demands and in leaming new skills on the job. Other individuals have acclimated to the competitive, integrated work setting to such an extent that their job coaches have partially or almost entirely faded as their on-site services and co-workers provide them with natural supports while on the job. Some individuals have requested specific training in particular tasks to allow them to qualify for advancement and promotion opportunities in the workplace. Individuals with IIDD who receive supported employment services eam competitive wages, sometimes receive retirement benefits and health insurance, and often live independently in their own apartments.
8. Integrated day services are services that allow persons with IIDD to engage in self-directed activities in the cmmnunity at times, :fi:equencies, and with persons of their choosing, and to interact to the fullest extent possible with non-disabled peers when such persons are not working or receiving residential services. For instance, integrated day services allow individuals with I/DD to pa1iicipate in and gain membership in mainstream cmmnunity-based recreational, social, educational, cultural, and athletic activities, including community volunteer activities and training activities.
9. For example, some individuals with IIDD receiving integrated day services in Rhode Island regularly pmiicipate in activities like cooking classes, volunteer oppmiunities, going to restaurants and to the movies, taking sailing lessons, bowling, and engaging in
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impromptu activities with friends and family members. Many ofthese individuals also receive support in adjusting to unstmctured cmmnunity daytime activities, like mtming errands and leaming new social and employment-related skills, such as money management.
10. Statewide, persons who receive supported employment and integrated day services are far outnumbered by the individuals who remain unnecessarily-and often indefinitely-confined to facility-based settings, including sheltered workshops and facilitybased day programs.
11. Title II of the ADA prohibits the unnecessary segregation of persons with disabilities. 42 U.S.C. § 12132; Olmstead v. L.C., 527 U.S. 581, 600 (1999). It requires states and other public entities to "administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities." 28 C.P.R.§ 35.130(d); see also 29 U.S.C. § 794(a); 28 C.P.R.§ 41.51(d).
12. Rhode Island has discriminated against individuals with IIDD by planning, funding, stmcturing, and administering its system of providing employment, vocational, and day services in a manner that unnecessarily over-relies on segregated day activity services for individuals with IIDD, to the exclusion of integrated altematives like integrated supported employment and integrated day services.
13. In addition, the State has cmTespondingly failed to plan, fund, stmcture, and adni.inister integrated vocational and transition services for students with I/DD to allow students with IIDD to make the infonned choice to work or to receive meaningful services that will allow them to work in integrated settings after exiting secondary school. Because the State does not make available adequate or effective integrated vocational and transition services, including supported employment services, to students with I/DD who qualify for and do not oppose such
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services, such students are placed at serious risk of entering a sheltered workshop or facilitybased day program after exiting school.
14. For example, in recent years, hundreds of students with IIDD exiting secondary school have entered sheltered workshops and facility-based day programs, mimy without having received access to timely infonnation prior to their exit from school about integrated supported employment and integrated day services, or access to the appropriate services and supports-like integrated transition and work-preparation services, including mentorships, internships, or trial work experiences-that would allow them to make a meaningful choice to work in postsecondary integrated employment settings or to participate in integrated activities at times when they are not working or receiving residential services.
15. Many persons with I/DD who receive services and supports from the State are capable of, and not opposed to, receiving integrated supported employment and integrated day services where they would have the opportunity to access individual jobs in typical work settings that pay minimum wage or higher, and to participate in self-directed activities in the community when they are not receiving employment or residential services.
16. The mmecessary segregation of people with IIDD in sheltered workshops and segregated day programs contravenes one of the primary purposes of the ADA-to end the isolation and segregation of individuals with disabilities. As Congress stated in the findings and purpose section of the ADA: "[H]istorically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such fonns of discrimination against individuals with disabilities continue to be a serious and pervasive social problem[.]" 42 U.S.C. § 12101(a)(2).
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JURISDICTION AND VENUE 17. This Court has jurisdiction of this action under Title II of the ADA, 42 U.S.C. §§ 12131-12134, and 28 U.S.C. §§ 1331, 1345. The Court may grant the relief sought in this action pursuant to 28 U.S.C. §§ 2201(a), 2202. 18. Venue is proper in the District of Rhode Island under 28 U.S.C. § 1391 because a substantial part of the acts and omissions giving rise to this action occurred in Rhode Island. 28
u.s.c. § 1391(b).
PARTIES 19. Plaintiff is the United States of America. 20. Defendant is the State of Rhode Island, which is a public entity within the meaning ofthe ADA, 42 U.S.C. § 12131(1), and is therefore subject to Title II ofthe ADA, 42 U.S.C. § 12131 et seq., and its implementing regulations, 28 C.F.R. pt. 35.
STATUTORY AND REGULATORY BACKGROUND A. The Americans with Disabilities Act and Olmstead v. L.C., 527 U.S. 581 (1999)
21. The ADA provides that "no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity."
42 u.s.c. § 12132.
22. Congress enacted the ADA in 1990 "to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities[.]" 42 U.S.C. § 12101(b)(1). Among the specific issues the ADA addresses are "segregation" and actions that prevent persons with disabilities fiom "fully patiicipat[ing] in all aspects of society[.]" !d. §§ 12101(a)(1), (5).
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23. In enacting the ADA, Congress found that "people with disabilities, as a group, occupy an inferior status in our society,' and are severely disadvantaged socially, vocationally, economically, and educationally; [and] the Nation's proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living, and economic self-sufficiency for such individuals[.]" Id. §§ 12101(a)(6)-(7). Congress explicitly recognized that "the continuing existence ofunfair and unnecessary discrimination and prejudice denies people with disabilities the opportunity to compete on an equal basis and to pursue those opportunities for which our free society is justifiably famous[,]" therefore resulting in "dependency and nonproductivity." Id. § 12101(a)(8)
24. The ADA was also intended to enable individuals with disabilities to gain economic independence and to "move proudly into the economic mainstream of American life." President George H.W. Bush, Remarks at the Signing of the Americans with Disabilities Act (July 26, 1990), available at http://www.eeoc.gov/eeoc/history/35th/videos/ada_signing_text.html.
25. Title II ofthe ADA prohibits discrimination on the basis of disability by public entities. 42 U.S.C. § 12132. A "public entity" is any state or local govemment and any department, agency, or other instnunentality of a state or local govenunent, and covers all services, programs, and activities provided or made available by public entities, including through contractual, licensing, or other arrangements. See 42 U.S.C. §§ 12131(1), 12132; 28 C.P.R.§ 35.130. Accordingly, Title II's coverage extends to the State ofRhode Island and its respective agencies, depmiments, and programs.
26. Congress directed the Attomey General to issue regulations implementing Title II of the ADA. 42 U.S.C. § 12134(a).
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27. The Title II regulations require public entities to "administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities." 28 C.P.R. § 35.130(d). "The most integrated setting" is one that "enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible." Id. pt. 35 app. B.
28. Title II's regulations further prohibit public entities from utilizing "criteria or methods of administration" that have the effect of subjecting qualified individuals with disabilities to discrimination, including unnecessary segregation, or "that have the purpose or effect of defeating or substantially impahing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities[.]" Id. § 35.130(b)(3).
29. The Supreme Court has held that Title II prohibits the unjustified segregation of individuals with disabilities. Olmstead v. L.C., 527 U.S. 581, 597-600 (1999).
30. The Supreme Couti's holding in Olmstead "reflects two evident judgments." !d. at 600. "First, institutional placement of persons who can handle and benefit from cmmnunity settings perpetuates unwananted assumptions that persons so isolated are incapable or unwmihy of participating in cmmnunity life." !d. "Second, confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural emichment." Id. at 601.
31. Under Olmstead, public entities are required to provide cmmnunity-based services, rather than segregated services, when such services (a) are appropliate, (b) are not opposed by the affected persons, and (c) can be reasonably accmmnodated, taking into account the resources available to the entity and the needs of other persons with disabilities. !d. at 607.
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B. Application of the ADA and Olmstead to Day Activity Services 32. The ADA's integration mandate applies to all of the programs, services, and
activities of a public entity, including its day activity services. 28 C.F.R. § 35.130(d) ("A public entity shall administer services, programs, and activities in the most integrated setting ....") (emphasis added).
33. Thus, under the ADA, states and localities must administer their employment and day services so as to ensure individuals with disabilities are offered those services in the most integrated settings appropriate for them, such as supported employment and integrated day settings.
34. The um1ecessary segregation of people with IIDD in sheltered workshops and facility-based day programs contravenes one of the primary purposes of the ADA: to end the isolation and segregation of individuals with disabilities.
FACTUAL ALLEGATIONS A. Defendant's Systems for Providing Employment, Vocational Rehabilitation, Day,
and Transition Services to Persons with I/DD Unnecessarily Over-rely on Segregated Employment and Day Service Settings 35. The State manages its training, vocational, Medicaid, employment, and day services for persons with I/DD, through its Executive Office of Health & Human Services ("EOHHS"). EOHHS coordinates several State agencies responsible for the delivery of services to adult individuals with I/DD, including: (a) the Department of Human Services, of which the Office ofRehabilitation Services ("ORS") is a sub-agency; and (b) the Depmiment of Behavioral Healthcare, Developmental Disabilities and Hospitals ("BHDDH"), including its Division of Developmental Disabilities. These agencies detem1ine the amount and allocation of funding for these services, including the types of employment and day services available, the licensing of
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employment and day service providers, and the levels of funding for sheltered workshops and facility-based day programs versus.integrated supported employment and integrated day programs.
36. The State, through BHDDH, detennines reimbursement rates for services and supports for individuals with IIDD, facilitates data collection with respect to the statewide day activity service system, and oversees the development and implementation of Individual Support Plans ("ISPs") and ISP meetings for service recipients to plan for and set forth the services and suppmis that individuals will access within the day activity service system. See 46-1-14 R.I. CodeR.§ 37.0.
37. The types of services that the BHDDH-licensed service providers may provide to individuals with IIDD include (a) residential support services, 46-1-14 R.I. CodeR.§§ 39.042.0; and (b) non-residential suppmis, which are called "day activity services," id. §§ 43.0-45.0.
38. "Day activity services" may include (a)"[d]ay program service;" (b) "[p]revocational training;" (c) "[s]upported employment;" or (d) "[j]ob development." Id. § 43.01. Day program services can be offered either on-site at a facility, or in a community setting. See id. § 44.01; see also id. §§ 1.14 (defining "Center-Based Day Program Service"), 1.17 (defining "Cmmnunity-Based Day Program Service").
39. The State's reimbursement model for IIDD services, has histmically provided few, if any, incentives for providers to expand or conve1i their service stmctures to include more supported employment and integrated day services. Since June 2013, BHDDH has stated a willingness to incentivize supported employment services through its cmTent rate stmcture; nevetiheless, these efforts have just begun, do not presently provide sufficient flexibility to
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providers in billing for services in cmmnunity settings, and have yet to reverse the State's significant overreliance on segregated employment and day service settings.
40. The State, through BHDDH, also has failed to suppmi adequate oppmiunities for training, professional development, or introduction to best practices in supported employment or integrated day services for its staff and the staff of day activity service providers. This failure has resulted in the lack of a professionalized workforce trained to respond to the specific needs of · individuals with I/DD who seek services in integrated daytime settings. For example, unlike the detailed training qualifications the State maintains for employment professionals in the field of mental health and substance abuse services, the State currently mandates no particular ce1iification or training for employment professionals in the field of I/DD direct services. Compare 46-1-14 R.I. CodeR.§ 45.08 with 46-1-13 R.I. CodeR.§ 9.14.
41. The State, through BHDDH, has stmctured its day activity service system to exclude individuals with the most severe disabilities from accessing supported employment services, without individualized consideration of such persons.
42. Further, the State, through its BHDDH social workers and case managers, fails to interact with suppmied employment and integrated day providers to identify and locate opportunities for individuals with I/DD. For instance, BHDDH social workers typically do not provide infonnation or individualized counseling to service recipients and their families about supported employment and integrated day service options. Instead, individuals are routinely given a publicly available BHDDH provider agency flyer that includes a list of approximately 40 state-licensed Developmental Disability Organizations ("DDOs"), the majority of which are facility-based providers. BHDDH social workers have taken new or prospective entrants to the
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system on tours of facility-based programs in their geographic area, without ever introducing such persons to integrated alternatives.
43. The State uses the Supports Intensity Scale ("SIS") as a tool for allocating the personal budgets of individuals with IIDD who receive services and supports :fi.·om BHDDH. However, the State, including BHDDH, administers the SIS assessment in a manner that serves as a barrier to individuals' access to integrated supported employment and integrated day programming..
44. ORS provides services to individuals with disabilities, including individuals with IIDD, through its Vocational Rehabilitation Program. The services provided through this program focus on initial job readiness and placement. See 39-1-112 R.I. CodeR. § 101.2(II)(B).
45. The vocational rehabilitation services provided by ORS pursuant to an Individual Plan for Employment ("IPE") are time-limited to a maximum of eighteen months. See id. § 115.14(III)(B)(1 ); see also 34 C.P.R. §§ 363.6(c)(2)(iii)-(iv).
46. The State, through ORS, has failed to assist service recipients who have been in segregated sheltered workshops and facility-based day programs, some for many years, and other individuals with IIDD who are at risk of placement in sheltered workshops and facility-based day programs, with the services and supports necessary to access integrated employment settings. Specifically, the State, through ORS, has denied numerous Rhode Islanders with IIDD who are unnecessarily segregated in sheltered workshops and facility-based day programs, and many other individuals at risk of such settings, the opportunity to access and benefit :fi.·om ORS' established resources, including: ORS' vocational assessment process; vocational rehabilitation counselors; job developers; job coaches; and other employment professionals to facilitate the transition from segregated to integrated employment settings. For example, in a 2012 State-
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commissioned survey, approximately 94% of respondents of the day activity system were not ORS clients within the past year. Just 2.8% had been ORS clients during the same period. Paul V. Sherlock Ctr., 2012 RI DD Employment and Day Activity Data Summary (on file with the Paul V. Sherlock Center). Moreover, ORS has similarly failed to assist students transitioning from school to work, as the same 2012 State-commissioned survey stated that just 14% of youth age 24 and under had an open case with or even applied for services from ORS within the past year. Id.
47. The State, including BHDDH, has failed to develop a uniform, statewide, professionally approptiate vocational assessment, discovery, and career development planning process for individuals with liDD. Consequently, many individuals with 1/DD in Rhode Island have been evaluated in segregated settings, given few opportunities to discover their career interests in integrated settings, and referred to segregated facilities, including sheltered workshops and facility-based day programs, as a matter of course.
48. The State, through BHDDH and ORS, has additionally failed to link individuals who have been in segregated sheltered workshops and facility-based day programs, some for many years, with supported erriployment and integrated day services. For instance, the State has failed to provide integrated vocational assessment, discovery, and career plruming services to individuals with 1/DD in facility-based programs who can and want to leave such programs to work and participate in the cmmnunity. A State-commissioned survey showed that, in 2011 and 2012, approximately 5% of individuals in state-licensed facility-based DDO programs reported spending any time looking for a job. !d.
49. In addition to deliveting services to adult individuals with 1/DD, the State, through the Rhode Island Department of Education ("RIDE"), BHDDH, and ORS, administer,
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oversee, and provide transition services for students with IIDD in secondary schools to prepare students to leave school and enter postsecondary employment and/or education. Transition services are "a coordinated set of activities for a young person with a disability, designed within an outcome miented process, that promotes movement from school to post-school activities including postsecondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation." R.I. Gen. Laws§ 16-24-18(e)(1); 29 U.S.C. § 705(37) (the Rehabilitation Act of 1973, as amended); see also 20 U.S.C. § 1401(34) (the Individuals with. Disabilities Education Act ("IDEA")).
50. The State, including RIDE, has failed to ensure, through its rules, policies, regulations, and guidance, that local school districts plan for and allow students with IIDD to access the services and supports- including vocational rehabilitation, transition, and supported employment services- necessary for students to make meaningful and infonned choices about postsecondary integrated employment and day services.
51. The State, including BHDDH and ORS, has failed to ensure that students with I/DD are provided with meaningful and infonned choices and preparation for work in integrated settings, and has failed to ensure that such students are provided timely infonnation and access to appropriate services and suppmis to allow them to choose to work in integrated settings. As a direct consequence of these acts and omissions by the State, students with I/DD are at serious risk of unnecessary placement in segregated sheltered workshops.
52. In February 2013, BHDDH adopted an Employment First policy, which states: [E]mployment oppmiunities in fully integrated work settings shall be the first and priority option explored in the service planning for working age adults with developmental disabilities in Rhode Island. While all options are impmiant and valued, integrated employment is more valued than non-employment, segregated
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employment, facility,based employment, or day habilitation in terms of employment outcomes for individuals with developmental disabilities. Department of Behavioral Health, Developmental Disabilities and Hospitals, "Rhode Island Employment First Policy: A Time for Action" (Feb. 2013), available at www.riddc.org/downloads/BHDDHEmploymentFirstPolicy21213.doc. The Rhode Island Employment First Policy and Five Year Implementation Plan, adopted in February 2013, states: It is expected that through implementation of this policy, individuals will be engaged primarily in paid employment. However, it is recognized that for individuals who are working on a part time basis, employment may not fully occupy their weekday hours. For these individuals, it is expected that the priority for activities during non-working daytime hours should be on supporting individuals in other typical adult activities in the community, including volunteer work, recreation, and daily living activities. Deparhnent of Behavioral Health, Developmental Disabilities and Hospitals, "Employment First Rhode Island State Policy and Five Year Implementation Plan" (Feb. 2013) (on file with BHDDH). 53. Nevertheless, the State, including BHDDH, only recently issued this Employment First Policy, after the United States infonned the State of its investigation. Prior to this policy's issuance there was no state level policy that primitized integrated employment or day services for persons with IIDD as service platming options in Rhode Island. The State's Employment First Policy has not, as implemented to date, succeeded in remedying the State's overreliance on segregated employment and day services for people with I/DD. The State's Employment First Policy does not constitute a comprehensive effectively working Olmstead plan, because, inter alia, it does not include concrete and reliable commitments to expand integrated opportunities; it lacks specific and reasonable timeframes and measurable goals for which Rhode Island will be accountable to remedy its over-reliance on segregated service settings; it correspondingly has failed to demonstrate success in actually moving such individuals to more integrated settings
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from sheltered workshops and/or facility-based day programs; and it does not have funding specifically identified for the purpose of carrying out the policy.
54. As a direct result of the actions and inactions of the State, the current training, vocational, Medicaid, employment, and day services systems for persons with IIDD are um1ecessarily over-reliant on segregated sheltered workshops and facility-based day programs to the exclusion of supported employment and integrated day programs. B. Rhode Island Unnecessarily Serves Thousands of Individuals with 1/DD in
Segregated Sheltered Workshops and Facility-Based Day Programs 55. Through its day activity service system, Rhode Island delivers services, programs, and activities to persons with IIDD. The State plans, funds, administers, licenses, manages, and oversees the day activity service system by, among other things, determining what employment and day services to provide, what rates are to be paid for services, who will provide the services, in what settings to provide them, and how to allocate funds among various services and settings. 56. In Rhode Island, approximately 2,700 people with IIDD receive employment and/or day services in segregated sheltered workshops and facility-based day programs. After entering a sheltered workshop, individuals with IIDD tend to remain in the sheltered workshop for decades, representing a pennanent placement. According to a 2012 State-conimissioned survey, nearly half (46.2%) of individuals in Rhode Island facility-based employment have received services in that setting for ten or more years, and just over one-third (34.2%) of individuals in facility-based employment have been there for fifteen or more years. Paul V. Sherlock Ctr., 2012 RI DD Employment and Day Activity Data Summary (on file with the Paul V. Sherlock Center).
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57. Rhode Island's day activity service system for people with IIDD includes sheltered workshops, facility-based day programs, group employment, individual supported employment, and integrated day services. 46-1-14 R.I. CodeR. § 43.01.
58. A sheltered workshop is a facility-based service setting that congregates individuals with IIDD who perfonn work tasks inside of the facility. Sheltered workshops are operated by service provider entities. In general, a sheltered workshop employs only individuals with IIDD or other disabilities except for service support staff. Individuals with IIDD are frequently paid far less than minimum wage for work perfonned in sheltered workshops. In sheltered workshops, individuals with IIDD have limited or no engagement with nondisabled peers, except for provider agency support staff.
59. Group or enclave employment typically consists of up to eight individuals with I/DD who work as a group in the cmmnunity and are supervised by staff from a service provider. Group employment includes "crews," such as cleaning or janitorial crews. While such individuals' work is physically located in the community, the individuals generally lack nondisabled co-workers, customers, or peers; work only with other members of the group; are typically not employees of the businesses or entities where they work; and often eam below minimum wage.
60. By contrast, suppmied employment services are the services necessary to find, place, maintain, and provide ongoing suppmi to an individual with I/DD in a competitive, integrated employment setting in the cmmnunity. A competitive, integrated employment setting is a typical job in a community-based setting where employees have the opportunity to work alongside non-disabled co-workers and eam at least minimum wage.
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61. A facility-based day program is a segregated facility-based service that congregates individuals with I/DD. Facility-based day programs, like sheltered workshops, are institutional facilities that are operated by service provider entities in which persons with I/DD have little to no contact with non-disabled persons besides paid staff. In facility-based day programs, individuals are not paid a wage for the activities that they perfonn. Facility-based day programs may be co-located with sheltered workshops, where some individuals spend part of their time perfonning organized group activities in the day program, and part of their time perfonning work tasks in the nearby sheltered workshop.
62. As part of facility-based day programs, some individuals with I/DD may be transported from the day program facility to public spaces in a group, typically in vans, with only other individuals with I/DD, other than paid staff, also providing individuals with limited or no engagement with non-disabled peers.
63. The State's sheltered workshops are typically co-located with facility-based day programs, and a significant portion of service recipients split their daytime hours between both settings. According to a 2012 State-commissioned survey, approximately 86% of individuals in sheltered work also spend one or more hours in facility-based and/or home-based non-work activities per week.
64. By contrast, integrated day services (e.g., day program services provided in a community setting) are services and suppmis that allow persons with IIDD to engage in selfdirected activities in the community at times, frequencies, and with persons of their choosing, during hours when they are not receiving employment or residential services. Integrated day services are designed to allow individuals with I/DD to interact to the fullest extent possible with non-disabled peers.
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65. Similarly, individuals with IIDD often receive services in facility-based day programs for multiple decades, and at some provider facilities individuals receive services from the same provider from the time they are young children until well into adulthood.
66. Approximately 220 persons with IIDD receive employment services in group employment throughout Rl1ode Island. Id.
67. Many individuals with I/DD receiving sheltered workshop, facility-based day, and/or group employment services are capable of working in individual supported employment and receiving integrated day services and would not be opposed to doing so if offered a meaningful and infonned choice.
68. Only approximately 385 individuals, or approximately 12% of individuals in the State service system, participate in individualized, integrated employment. Rhode Island provides some integrated altematives to segregated sheltered workshops and facility-based day programs, including integrated supported employment services and -integrated day services, though not in sufficient supply to serve all those who qualify for and are not opposed to such services.
69. Consequently, persons with I/DD across Rl1ode Island are unnecessmily forced to obtain employment services in segregated sheltered workshops or group employment or are placed at risk of segregation in sheltered workshops, even though they could be appropiiately served in integrated employment settings. Other persons with IIDD in Rl1ode Island are mmecessaiily forced to obtain day services in segregated facility-based day programs or are placed at risk of segregation in facility-based day ptograms, even though they could be appropiiately served in integrated employment and/or integrated day settings. Id.
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70. Individuals with I/DD in sheltered workshops in Rhode Island earn exceedingly low wages. According to a State-cmmnissioned survey, the average hourly wage of sheltered workshop participants in Rhode Island is approximately $2.21 per hour. Id.
71. Individuals with IIDD in facility-based day programs in Rl1ode Island are cut off from earnings altogether during the hours that they spend in facility-based day program.
72. By contrast, individuals with IIDD in Rhode Island who receive individualized supported employment services in integrated settings earn approximately $8.92 per hour, which is higher than the State's minimum wage of$8.00 per hour. Id.
73. Consequently, unnecessary segregation in sheltered workshops and facility-based day programs has negatively impacted the ability of individuals with IIDD in the State to achieve economic self-sufficiency, personal independence, and autonomy.
74. The State's data demonstrates Rhode Island's oveneliance on segregated sheltered workshops and· facility-based day programs. State data indicates that in July 2011, 83% ofRhode Islanders with IIDD in the day activity service system accessed "non-integrated day activities." Dep't of Behavioral Health, Developmental Disabilities & Hosps., Project Sustainability: Funding Initiatives Supporting Inclusion, Cmmnunity Integration and Suppmied Employment, Feb. 14, 2013, at 7 (on file with the BHDDH).
75. A 2012 State-cmmnissioned survey shows that, of3,235 respondents in the employment and day service system, approximately 80% repmied pmiicipating in facility-based day programs. Paul V. Sherlock Ctr., 2012 RI DD Employment and Day Activity Data Smmnary (on file with the Paul V. Sherlock Center).
76. By contrast, the same 2012 State-commissioned survey shows that of3,235 respondents in the employment and day activity service system for persons with IIDD,
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approximately 12% repmied that they pa1iicipated in individualized, integrated paid employment. Id.
77. The State's over-reliance on segregated settings is also evident in the number of hours that participants spend in each service setting. State documents report that: "[o]nly a small portion of all hours billed for day activities (less than 10%) are for supported employment or prevocational training." Dep't of Behavioral Health, Developmental Disabilities & Hosps., Project Sustainability: Funding Initiatives Supporting Inclusion, Cmmnunity Integration and Supported Employment, Feb. 14,2013, at 7 (on file with the BHDDH). Accordingly, Rhode Island's day activity service program participants spend the vast majority of their daytime hours in segregated settings. C. Each Year, Rhode Island Places Hundreds of Youth with 1/DD at Serious Risk of
Unnecessary Segregation in Sheltered Workshops and Facility-Based Day Programs 78. According to State data, in recent years, hundreds of Rhode Island youth with I/DD have transitioned from secondary school to Rhode Island adult day and employment service providers. Yet only approximately 5% of the youth with I/DD who transitioned from Rhode Island secondary schools between 2010 and 2012 transitioned into jobs in integrated settings. 79. Instead, the majority of youth with IIDD who leave Rhode Island secondary schools transition to segregated sheltered workshops and day programs to receive adult services. Many of these youth are able to work in integrated employment settings and are not opposed to doing so. 80. Recently-transitioned youth with IIDD represent a pmiion of the overall population served by the State's licensed DDOs, including sheltered workshop and facility-based
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day programs. In 2012, almost 8% of individuals in such programs were reported to be youth age 24 or under. Id.
81. The State's failure to promote the timely availability of sufficient integrated transition services or to link students in school districts across Rhode Island with appropriate postsecondary services and supports (like supported employment or integrated day services) has placed youth with I/DD at serious risk of entering segregated sheltered workshops and facilitybased day programs.
82. The State, including RIDE, has failed to include in State policy, and to infonn and set standards for school districts throughout Rhode Island, that integrated work placements and work-based leaming experiences are critical to mitigating the risk of unnecessary postsecondary placement in sheltered workshops and facility-based day programs.
83. The State, through its vocational rehabilitation counselors and BHDDH social workers, frequently fails to present transition-age students with IIDD with viable altematives to segregated sheltered workshops and facility-based day programs.
84. The State, including BHDDH and ORS, often fails to provide the appropriate transition services necessary to inform the employment-related recmmnendations contained in students' post-secondary ·planning documents.
85. BHDDH social workers often take youth with I/DD to visit facility-based programs, including sheltered workshops and day programs, rather than integrated employment and day programs, as part of the refenal process directly fi:om high school.
86. Students are often assessed by vocational rehabilitation counselors in segregated settings to detennine their eligibility for ORS services, fi:equently leading to pennanent placement in segregated rather than integrated employment settings.
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87. Despite Rhode Island's express requirement that transition planning begin at age 14, the State has often failed to ensure that students are given meaningful infonnation about, and ·opportunities to experience, integrated employment and day services early enough to make an infonned choice to transition to an integrated setting following their exit from school. Individuals become eligible for ORS services at age 16, and for services through BHDDH at age 18. See generally, U.S. Dep't ofEduc., Office of Special Educ. & Rehabilitative Servs., Rehab. Servs. Admin., "Fiscal Year 2012 Monitoring Report on the Rhode Island Department of Human Services, Office of Rehabilitation Services Program" (July 16, 2012), available at http://www.ors.ri.gov/PDFfiles/2012%20ri%20monitoring%20visit.pdf; Rhode Island Disability Law Ctr., Inc., "A Consumer's Guide to Rhode Island State Vocational Rehabilitation Services," available at http://www.ridlc.org/publications/Consumers_Guide_to_RI_Voc_Rehab.pdf; 46-15:4 R.I. CodeR. § 4.1; 46-1-5:2 R.I. Code R. § 2.8. Yet many students tlu·oughout Rhode Island only receive employment-related transition plmming or m·e enrolled in ORS or BHDDH services one year or less before their exit from school, if at all.
88. Even students with IIDD who receive some transition plmming services generally do not have access to services and suppmis that will allow them to make the infonned choice to pmiicipate in postsecondary competitive, integrated employment settings, such as integrated transition work placements and work-based leaming experiences such as site visits, job shadowing, soft skill and job skill development, intemships, pmi-time employment, summer employment; youth development and leadership, peer and adult mentoring, and benefits plmming.
89. The State's failure to prepare students with I/DD for integrated employment and community-based day settings results in such students' acculturation and training in segregated
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sheltered workshops and facility-based day programs, often resulting in students' pennanent placement in such settings. For instance, some Rhode Island students with I/DD perfonn inschool jobs designated for students with disabilities (instead of perfonning those same jobs in the community); others acquire work-related skills in a special education classroom without ever being presented with the choice to exercise those skills in a community job. Still other students with IIDD receive work-related transition services from facility-based adult service providers, including segregated sheltered workshops and facility-based day programs.
90. Even though individuals become eligible for Medicaid services at age 18, BHDDH does not administer services to eligible youth with IIDD until they are 21 years old. This service gap has caused many students who exit high school prior to age 21 to either sit at home without services, or to have to enroll in sheltered workshop and day programs in order to receive employment services at all.
91. The State has failed to provide integrated, transition-related adult services to many students with I/DD who are eligible for them, creating the serious risk that such students will transition to segregated settings following their exit from school. D. Individuals with 1/DD in or At Risk of Placement in Sheltered Workshops or
Facility-Based Day Services Are Qualified for and Are Not Opposed to Receiving Services in More Integrated Settings 92. Individuals who are in or at risk of placement in sheltered workshops and facilitybased day programs are largely indistinguishable from individuals with I/DD who receive supported employment and integrated day services. These individuals have similar diagnoses and support needs as individuals who work and access day services in integrated settings with the types of services and suppmis that cunently exist in Rhode Island's day activity service system.
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93. Rl10de Island service providers are capable of providing services in integrated settings and they report that, historically, they served a larger percentage of persons with I/DD in their programs in integrated settings.
94. Numerous individuals with IIDD in Rhode Island have expressed their desire to receive the supported employment and integrated day services that would allow them to work and participate in integrated settings. Many R110de Islanders with I/DD in or at risk of placement in sheltered workshops and facility-based day services would not oppose receiving supported employment and integrated day activity services if such services were available and ifthese individuals had fully-infonned choices and realistic opportunities to receive such services. E. With Reasonable Modifications to Its Existing Services, Rhode Island Can Provide
Day Activity Services in Integrated Settings 95. Providing integrated services to adults and youth in or at risk of entering sheltered workshops and facility-based day programs can be reasonably accmmnodated. The types of services needed to suppoti adults and students with IIDD in integrated employment and day settings-including individualized transition services, supported employment, and integrated day services-already exist in R11ode Island's employment and day activity service system. 96. The State provides supported employment and integrated day services to some persons with disabilities, though not in sufficient capacity to serve all those who qualify for such services. For thousands of other individuals with similar diagnoses and needs, the State's day activity service system has left them with no choice but to enter sheltered workshops and facility-based day programs to receive services. 97. Individual suppmied employment and integrated day services are a cost-effective altemative to sheltered workshops and facility-based day programs.
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COUNT I VIOLATION OF TITLE II OF AMERICANS WITH DISABILITIES ACT
(42 U.S.C. § 12131 et seq.) 103. Paragraphs 1 through 102 of this Complaint are hereby re-alleged and incorporated by reference. 104. Defendant State ofRhode Island is a public entity ·subject to Title II of the ADA,
42 u.s.c: § 12131(1).
105. The following persons have a disability covered by Title II of the ADA, 42 U.S.C. §§ 12102, 12131(2), and qualify for receiving or participating in employment, vocational rehabilitation, day activity, and/or transition-related educational services, programs, or activities provided by the State: (a) individuals with 1/DD who are eligible, or likely to be found eligible, for services or supports from BHDDH and/or ORS; and (b) students with I/DD currently or recently enrolled in a Rhode Island secondary school.
106. The State has violated and continues to violate the ADA and, accordingly, has injured numerous individuals with 1/DD, by (a) administering and delivering its employment, vocational rehabilitation, day activity, and transition services in a manner that has mmecessarily caused service recipients to be denied the opportunity to receive the benefits of the State's services in the most integrated setting appropriate to their needs, and has unnecessatily caused Rhode Island secondary school students with 1/DD to be placed at serious risk of segregation; and (b) failing to reasonably modify its administration and delivery of these services in a manner that would avoid discrimination against, and unnecessary segregation of such individuals with disabilities.
107. Defendant's actions constitute discrimination in violation ofTitle II of the ADA, 42 U.S.C. § 12132, and its implementing regulations at 28 C.F.R. pt. 35.
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108. Providing day activity services in integrated settings to persons with I/DD and ensuring that students with IIDD in Rhode Island secondary schools are not placed at serious risk of segregation can be reasonably accmmnodated.
PRAYER FOR RELIEF WHEREFORE, the United States of America prays that the Comi: A. Grant judgment in favor of the United States and declare that Defendant State of Rhode Island has violated Title II ofthe ADA, 42 U.S.C. § 12131 et seq., by
1. Failing to provide employment services, programs, or activities for persons with 1/DD in the most integrated setting appropriate to their needs; and
2. Placing Rhode Island students with IIDD at serious risk of unnecessary segregation in sheltered workshops and/or facility-based day programs;
B. Enjoin Defendant State of Rhode Island to: 1. Cease discriminating against individuals with IIDD in the State's day
activity service system; 2. Cease putting students with IIDD in Rhode Island secondary schools at
serious risk of unnecessary segregation upon their exit :limn school; 3. Provide each qualified individual with 1/DD served by BHDDH and ORS,
who does not oppose such services, with vocational rehabilitation, integrated suppmied employment and cmmnunity-based day services programs, or activities, that are consistent with his or her individual needs and that are designed to allow him or her to secure, maintain, and succeed in integrated employment settings and otherwise engage in self-directed activities in the community at times and frequencies and with persons of his or her own choosing when not receiving employment or residential services;
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Case 1:14-cv-00175-L-PAS Document 1 Filed 04/08/14 Page 29 of 30 PageID #: 29 4. Ensure that each and every student with IIDD in Rhode Island secondary
schools is provided with vocational rehabilitation, day activity services, including integrated supported employment and integrated day service programs, and transition-related educational services, programs, or activities, which are consistent with his or her individual needs and which are designed to allow him or her to secure, maintain, and succeed in integrated employment and cmmnunity-based day settings following his or her exit :from school; and
C. Order such other appropriate relief as the interests ofjustice may require.
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Dated: AprilS, 2014

Respectfully submitted,

PETER F. NERONHA United States Attorney District of Rhode Island
RICHARD B. MYRUS Assistant United States Attorney United States Attorney's Office Chief, Civil Division 50 Kennedy Plaza, 8th Floor Providence, RI 02903 Phone: (401) 709-5000 Fax: (401) 709-5001 richard.myrus@usdoj .gov

c::¥Q~~D,t.. CELYNS ELS Acting Assistant Attorney General
EVE L. HILL Deputy Assistant Attorney General
'REBECCA B. BOND Section Chief SHEILA M. FORAN Special Legal Counsel ANNE S. RAISH Deputy Chief

REGINA KLINE (Md. #0812170152) H. JUSTIN PARK Trial Attorneys Disability Rights Section Civil Rights Division United States Department of Justice 950 Pennsylvania Avenue, NW - NYA Washington, DC 20530 Phone: (202) 307-0663 Fax: (202) 305-9775 regina.kline@usdoj. gov
Counsel for Plaintif!United States ofAmerica

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UNITED STATES DISTRICT COURT DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA,

Case No. CA14-175

Plaintiff,

v.

STATE OF RHODE ISLAND,

Defendant.

CONSENT DECREE
I. INTRODUCTION
A. This Consent Decree is entered into between the United States of America ("United States"), Plaintiff, and the State of Rhode Island ("State"), Defendant (hereinafter collectively "Parties"). The Parties stipulate that this Consent Decree does not subsume or replace the Interim Settlement Agreement in United States v. State of Rhode Island and City of Providence, No.1: 13-cv-00442 (D.R.I. July 11, 2013). This Consent Decree specifically addresses the statewide day activity service system for individuals with intellectual and developmental disabilities ("IIDD"), and constitutes a complete and exclusive statement of the terms ofthis Consent Decree between the Parties with respect to its subject matter. The State shall continue to comply with the terms of the Interim Settlement Agreement, and any amendments thereto, in a manner that is consistent with and complementary to this Consent Decree; however, the Interim Settlement Agreement and Consent Decree impose separate and distinct requirements upon the State.
B. On January 14,2013, the United States Department of Justice ("United States") notified the State that it had initiated an investigation into whether the State has violated Title II of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. § 12131, et seq., as interpreted by the United States Supreme Court in Olmstead v. L.C., 527 U.S. 581 (1999), through its administration and operation of its day activity service system, including employment, vocational, and day services, 46-1-14 R.I. Code R. § 43.0, for individuals with IIDD.
C. On January 14,2013 and March 4, 2013, the United States requested documents from the State as part of its investigation into Rhode Island's day activity service system, including employment, vocational, and day services, 46-1-14 R.I. Code R. § 43.0, for individuals with IIDD. Also, as part of this investigation, the United States participated in numerous in-person meetings with the State in February and March 2013, conducted on-site interviews with providers, including sheltered workshop, supported employment and integrated day providers, as well as individuals with IIDD participating in employment programs, and met
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with numerous stakeholders and advocacy organizations. From March through May 2013, the United States communicated its findings in person and by telephone regarding two providers in the State, Training Thru Placement and the Harold A. Birch Vocational Program at Mount Pleasant High School, and sent the State written findings on June 7, 2013. To resolve those findings, the United States entered into an Interim Settlement Agreement with the State and the City of Providence, United States v. State of Rhode Island and City of Providence, No.1: 13-cv-00442 (D.R.I. July 11, 2013). The United States and the State continued to meet a number oftimes throughout the remainder of2013, following the entry of the Interim Settlement Agreement, to resolve the statewide findings.
D. In November 2013, the United States continued discussions with the State regarding the State's statewide day activity service system, including its transition, employment, vocational, and day services and its unnecessary over-reliance upon segregated sheltered workshops and facility-based day programs. On January 6, 2014, the United States sent its written findings to the State.
E: This Consent Decree resolves the United States' findings of violations of Title II of the ADA by the State with respect to the State's statewide day activity service system. The Parties expressly acknowledge and agree that compliance with this Consent Decree will remedy any and all violations of the integration mandate of Title II of the ADA and Olmstead that were identified as a result of the United States' investigation to date of the State's day activity service system.
F. This Consent Decree also is intended to ensure that the State will timely meet the requirements of the integration mandate of the ADA and the Olmstead decision as it pertains to the statewide day activity service system, which require that the State's day activity services, including employment and day services, for individuals with IIDD be provided in the most integrated setting appropriate to meet their needs.
G. Through this Consent Decree, the Parties intend that the goal of community integration will be achieved for individuals with IIDD being served in, identified for referral to, or at risk of entering sheltered workshops and facility-based day programs throughout Rhode Island.
H. The State has cooperated with the United States in reviewing and responding to the United States' findings. The Parties agree that it is in their mutual interest to avoid litigation.
II. DEFINITIONS
A. For the purposes of this Consent Decree only, the following terms have the following meanings:
1. A "career development plan" is a plan that identifies the individual's employment goals and objectives, the services and supports needed to achieve those goals, the persons, agencies, and providers assigned to assist the person attain those goals, and the obstacles to the individual working in an individualized job in an integrated employment setting at competitive wages, and seeks to identify the appropriate services and supports necessary to overcome those obstacles.
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2. "Discovery" is a time-limited process by which an employment planning team assists an individual to identify hislher interests, strengths, and abilities relating to employment, with the goal of attaining and maintaining employment in a competitive integrated employment setting, including self-employment.
3. "Evidence-based" means well-defined practices, including, but not limited to, Individual Placement and Support ("IPS") and customized employment, which have been demonstrated to be effective through research studies.
4. A "facility-based day program" is a facility-based service that congregates individuals with IIDD. Facility-based day programs are operated by service provider entities. In general, a facility-based day program provides services to only individuals with IIDD or other disabilities except for service support staff. In facility-based day programs, individuals with IIDD typically perform organized group activities like coloring, completing puzzles, watching movies, playing games, and arts and craft'S. Individuals in facility-based day programs are not paid a wage for the activities that they perform. In facility-based day programs, individuals with IIDD have limited or no engagement with nondisabled peers, except for provider agency support staff. Facility-based day programs may be co-located with sheltered workshops. As part of facility-based day programs, some individuals with IIDD may be transported from the facility to public spaces in a group, typically in vans, with only other individuals with IIDD, other than paid staff, also providing individuals with limited or no engagement with non-disabled peers.
5. "Individuals with intellectual or developmental disabilities" (IIDD) are defined, for the purposes ofthis Consent Decree, as persons who are eligible or likely to be found eligible, for publicly-funded developmental disability services through the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals ("BHDDH") as defined in Rhode Island General Laws § 40.1-21-4.3(5) or students who are eligible or likely to be found eligible for transition services and supports under the Individuals with Disabilities Education Act, and who meet the definition found at 34 C.F.R. § 300.8(c)(6).
6. An "Individual Learning Plan" is a document consisting of (1) post-secondary plans aligned to career goals; (2) documentation of the range of college and career readiness skills a student has developed; and (3) a process that enhances the relevance of school and out-of-schoollearning opportunities, and provides the student access to career development opportunities that incorporate self-exploration, career exploration, and career planning and management skill building activities.
7. "Integrated Day Services" are services and supports provided in the amouRt, duration, and intensity to allow persons with IIDD to engage in self-directed activities in the community at times, frequencies, and with persons of their choosing, during hours when they are not receiving employment or residential services.
8. "Person-centered planning" is the formal process that organizes services and supports around a self-directed, self-determined, and goal-directed future, and includes the process by which an individual, with the assistance of an employment planning team, identifies the direction ofhislher future vocational, employment related, and day activities based on
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hislher skills, interests, strengths, and abilities, regardless of whether the individual has the verbal ability to express such information.
9. "Rhode Island" or "the State" means the State of Rhode Island, including BHDDH and the Office of Rehabilitation Services ("ORS"), as administered through the Department of Human Services, the Rhode Island Department of Education ("RIDE"), and the Executive Office of Health and Human Services ("EOHHS").
10. A "sheltered workshop" is a facility-based service that congregates individuals with IIDD who perform work tasks inside of the facility. Sheltered workshops are operated by service provider entities. In general, a sheltered workshop employs only individuals with IIDD or other disabilities except for service support staff. Individuals with IIDD are frequently paid less than minimum wage for work performed. In sheltered workshops, individuals with IIDD have limited or no engagement with nondisabled peers, coworkers, and customers, except for provider agency support staff.
11. A "situational assessment" is a vocational assessment that is administered on-site in integrated employment settings, where individuals are evaluated in the performance of work activities that are typical to the setting where the assessment is administered.
12. A "Summary of Performance" is a plan developed for a student with a disability at the secondary level whose eligibility for special education services terminates because of graduation or reaching the maximum age of eligibility for special education services. The Plan must provide the student with a summary ofthe student's academic achievement and functional performance, which shall include recommendations on how to assist the student in meeting his or her postsecondary goals.
13. "Supported Employment Services" are employment services provided in the amount, duration, and intensity that allow persons with IIDD to work the maximum number of hours consistent with their abilities in a competitive integrated employment setting. Supported Employment Services include services necessary to place, maintain, and provide ongoing support to an individual with IIDD in an integrated employment setting.
14. "Transition-age youth" or "eligible youth" are youth with IIDD who attend, or in the future will attend, a Rhode Island secondary school and are between the ages of fourteen years old and twenty-one years old (14-21 years old).
15. A "trial work experience" is the opportunity to work in a real job in an integrated employment setting alongside non-disabled coworkers, customers, and/or peers, with the appropriate services and supports for a sufficient period of time to establish whether an individual's interests, skills, and abilities are well-suited for the particular job, but for no shorter than 60 days. The trial work experience shall be selected through a personcentered planning process and shall be individually tailored to each person.
16. A "vocational assessment" is an assessment administered to provide employment-related information essential to the development of, or revision of, an individual's employmentrelated planning documents, including the Individual Plan for Employment ("IPE"), Individual Support Plan ("ISP"), Individual Education Plan ("IEP") and/or Individual Learning Plan ("ILP"), where applicable. The primary purpose of all vocational
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assessments shall be to determine an individual's interests, strengths, and abilities, in order to identify a suitable match between the person and a competitive integrated employment setting.
III. SCOPE OF THE CONSENT DECREE AND TARGET POPULAnONS
A. The following individuals will be eligible for Supported Employment Services, Integrated Day Services, and/or transition services under the Consent Decree:
1. Individuals with IIDD that receive day activity services in settings where they perform sheltered workshop tasks or have received day activity services in such settings within the previous year ("Rhode Island Sheltered Workshop Target Population");
2. Individuals with IIDD that receive day activity services in facility-based day program settings or have received such services in the previous year ("Rhode Island Day Target Population");
3. Individuals with IIDD that are transition-age youth according to current Rhode Island law, currently attending a Rhode Island secondary school ("Rhode Island Youth Transition Target Population"); and
4. Individuals with IIDD that are transition-age youth who have exited or who will exit a Rhode Island secondary school during the 2013-2014, 2014-2015, or 2015-2016 school years ("Rhode Island Youth Exit Target Population").
IV. OUTCOMES
1. By January 1,2015, the State will provide all individuals in the Rhode Island Youth Exit Target Population person-centered planning resulting in a career development plan including the services and supports described in Sections V(A)(1)-(2) necessary and appropriate to introduce them to work in integrated settings, according to the youth transition process and milestones set forth in Sections VIII(4)-(10), and they will become eligible for a Supported Employment Placement, as provided in Section V, upon their exit from secondary school.
2. By October 1, 2014, and by September 1st of every succeeding year of this Consent Decree, the State will provide all individuals in the Rhode Island Youth Transition Target Population the appropriate services and supports described in Sections V(A)(1)-(2) necessary to introduce them to work in integrated settings, according to the youth transition process and milestones set forth in Sections VIII(4)-(10).
3. The State will engage in an annual person-centered planning process with all individuals in the Rhode Island Youth Transition Target Population; such person-centered planning will be coordinated with the transition planning that is mandated by State law to begin at age 14, and will result in a career development plan for each transition-age student with IIDD that consolidates the planning recommendations of school transition specialists and staff, ORS, and BHDDH representatives. The career development plan will be updated annually. The person-centered planning process will at a minimum include the standards and milestones set forth in Section VIII, including the opportunity to access integrated
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transition work placements and information about post-secondary work in integrated settings. In addition, individuals with IIDD will be offered meaningful options for postsecondary Supported Employment and Integrated Day Services beginning no later than the start of the school year in which they will turn 18. Such individuals and their families must be provided information through the person-centered planning process sufficient to make a meaningful informed choice between such services and remaining in school.
4. Effective March 1,2013, by Order of the Director ofBHDDH, the State ceased providing placement or funding, and approving ISPs or Interim Individual Support Plans ("lISPs") for new entrants to sheltered workshops, and the State will continue not to provide placement or funding for new entrants to sheltered workshop settings. The State has taken no action to cease placement or to cease funding for new entrants to facility-based day programs.
5. By January 1,2015, the State will provide career development plans, as described in Section VII, for each individual in the Rhode Island Youth Exit Target Population. By January 1,2016, the State will provide career development plans, as described in Section VII, for each individual in the Rhode Island Sheltered Workshop and Rhode Island Day Program Target Populations. However, the provision of Supported Employment Services and/or Placements will not be delayed or denied due to the lack of a career development plan.
6. By no later than the year in which an individual is scheduled to transition to a Supported Employment Placement and Integrated Day Services as set forth in Sections V-VI, and typically upon obtaining an offer of employment, for all individuals in the Rhode Island Youth Exit, Rhode Island Sheltered Workshop, and Rhode Island Day Program Target Populations, such persons shall receive benefits planning information and counseling from a qualified professional who is experienced and certified in Social Security and SSI regulations and who will review an individual's personal benefit levels and produce a written analysis ("benefits plan"), providing information to the individual and his or her family or guardian about the impact of earned income on the individual's public benefits. Individuals will also receive information about their eligibility for the State's Medicaid Buy-in Program, or the "Sherlock Plan," and assistance with enrolling in that program. Benefits counseling will be rolled out consistent with when each individual in the Target Populations is scheduled to enter supported employment. Each person's benefits plan may be adjusted thereafter, subject to review by the Monitor for this Consent Decree ("Monitor"), for six months following its completion.
7. By September 1,2014, BHDDH will issue a directive to ensure that the Supports Intensity Scale ("SIS") assessment process, set forth under Project Sustainability, is administered with the presumption that individuals with the most severe disabilities can work in integrated settings and receive the services and supports necessary to do so. BHDDH shall ensure an active role for essential participants, including family members and guardians, in the SIS administration process for individuals in the Target Populations, and will require that individuals administering the SIS assessment are knowledgeable about, and have experience working with, individuals with IIDD, and have received an appropriate level of training and certification, consistent with Section IX of this Consent Decree. BHDDH shall ensure that resource allocation decisions are made by BHDDH
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staff in a manner that is consistent with individuals' support needs. The BHDDH staff who administer the SIS assessment ("surveyors") will work in a separate, autonomous unit from the BHDDH staff who administer the resource allocations. Said resource allocations are currently and will continue to be annually reviewed by Bums & Associates or a similar consulting group. Any and all written reports, including those authored by Bums & Associates, pertaining to BHDDH's administration of the SIS tool and/or resource allocation decisions will be made available to the Monitor on an ongoing basis. The State will also provide the Monitor with documents demonstrating the level of training and certifications for surveyors.
8. The State will provide Supported Employment Placements and Integrated Day Services, as described in Sections V-VI, for individuals in the Rhode Island Sheltered Workshop and Rhode Island Youth Exit Target Populations,according to the following schedule:
a. By January 1,2015, the State will provide Supported Employment Placements to at least 50 individuals in the Rhode Island Youth Exit Target Population who left during the 2013-2014 school year.
b. By July 1,2015, the State will provide Supported Employment Placements to all remaining individuals in the Rhode Island Youth Exit Target Population who left, or will leave, school during the 2013-2014 and 2014-2015 school years.
c. By January 1,2016, the State will provide Supported Employment Placements to at least 50 individuals in the Rhode Island Sheltered Workshop Target Population.
d. By July 1,2016, the State will provide Supported Employment Placements to all individuals in the Rhode Island Youth Exit Target Population who left school during the 2015-2016 school year.
e. By January 1,2017, the State will provide Supported Employment Placements to at least an additional 50 individuals in the Rhode Island Sheltered Workshop Target Population.
f. By January 1,2018, the State will provide Supported Employment Placements to at least an additional 50 individuals in the Rhode Island Sheltered Workshop Target Population.
g. By January 1,2019, the State will provide Supported Employment Placements to at least an additional 50 individuals in the Rhode Island Sheltered Workshop Target Population.
h. By January 1, 2020, the State will provide Supported Employment Placements to at least an additional 100 individuals in the Rhode Island Sheltered Workshop Target Population.
1. By January 1, 2021, the State will provide Supported Employment Placements to at least an additional 100 individuals in the Rhode Island Sheltered Workshop Target Population.
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j. By January 1,2022, the State will provide Supported Employment Placements to at least an additional 100 individuals in the Rhode Island Sheltered Workshop Target Population.
k. By January 1,2023, the State will provide Supported Employment Placements to at least an additional 100 individuals in the Rhode Island Sheltered Workshop Target Population.
1. By January 1, 2024, the State will provide Supported Employment Placements to at least an additional 100 individuals in the Rhode Island Sheltered Workshop Target Population.
9. The State will provide Supported Employment Placements and Integrated Day Services, as described in Sections V-VI, for individuals in the Rhode Island Day Target Population, according to the following schedule:
a. By January 1,2016, the State will provide Supported Employment Placements to at least 25 individuals in the Rhode Island Day Target Population.
b. By January 1, 2017, the State will provide Supported Employment Placements to at least an additional 25 individuals in the Rhode Island Day Target Population.
c. By January 1,2018, the State will provide Supported Employment Placements to at least an additional 50 individuals in the Rhode Island Day Target Population.
d. By January 1,2019, the State will provide Supported Employment Placements to at least an additional 50 individuals in the Rhode Island Day Target Population.
e. By January 1, 2020, the State will provide Supported Employment Placements to at least an additional 75 individuals in the Rhode Island Day Target Population.
f. By January 1, 2021, the State will provide Supported Employment Placements to at least an additional 100 individuals in the Rhode Island Day Target Population.
g. By January 1, 2022, the State will provide Supported Employment Placements to at least an additional 200 individuals in the Rhode Island Day Target Population.
h. By January 1,2023, the State will provide Supported Employment Placements to at least an additional 200 individuals in the Rhode Island Day Target Population.
i. By January 1, 2024, the State will provide Supported Employment Placements to at least an additional 225 individuals in the Rhode Island Day Target Population.
10. The State will document for continuous review by the Monitor and in accord with Section XIX(7), Construction and Termination, its efforts in offering Supported Employment Placements and Integrated Day Services to individuals to fulfill its responsibilities under Sections IV(8)-(9).
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11. The individuals eligible for relief pursuant to Section IV(8) are not the same individuals eligible for relief pursuant to Section IV(9); accordingly, no individual can receive relief under both Section IV(8) and Section IV(9) pursuant to this Consent Decree.

V. SUPPORTED EMPLOYMENT SERVICES AND PLACEMENTS

A. "Supported Employment Services" include the following community services and supports that the State shall make available to satisfy the requirements of this Consent Decree:
1. Vocational and related services, such as job discovery and development, job-finding, job carving, job coaching, job training, job shadowing, co-worker and peer supports, reemployment supports, benefits counseling and transportation services; as well as those environmental modifications and environmental accessibility adaptations; behavioral supports; personal care services; case management services; assistive technology; social skills training; self exploration; career exploration; career planning and management; job customization; soft skill development; time management training; self-employment opportunities and supports; adaptive behavior and daily living skills training directly related to job placement and support necessary to allow individuals with IIDD to participate in a competitive integrated employment setting; and
2. In addition, for transition-age youth with IIDD, transitional services and supports, including: instruction; community experiences; the development of employment and other post school adult living objectives; school-based preparatory experiences; career preparation; and integrated work-based learning experiences such as site visits, job shadowing, soft skill and job skill development, internships, part-time employment, summer employment; youth development and leadership, including training in selfadvocacy, self-determination and conflict resolution skills, peer and adult mentoring, and, where appropriate, daily living skills; and connecting activities, including exposure to post-school educational and community services, transportation, benefits planning, and assistive technology.
B. Supported Employment Services shall be individualized and flexible, and shall be available as needed and desired by the individual, but shall not be mandated as a condition of working or receiving services in an integrated employment setting.
C. Supported Employment Services shall be provided in the amount, intensity, and duration necessary to place, maintain, and provide ongoing support, including ongoing professional development, to an individual in a Supported Employment Placement, as set forth below in Sections V(D)-(E).

D. "Supported Employment Placement," for the purposes of this Consent Decree, is defined as the provision of Supported Employment Services in an integrated employment setting:

1. Where the individual is compensated at or above Rhode Island's minimum wage, but not
less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities;

2. Where the individual works the maximum number of hours consistent with hislher
abilities and preferences;

"

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3. That allows individuals with disabilities to interact with individuals without disabilities in an employment setting to the fullest extent possible for the individual; and
4. That offers individuals with disabilities the same opportunity as non-disabled individuals:
a. To access community opportunities at times, frequencies, and with persons of their choosing during appropriate times when the individual is not working, such as on breaks, during lunch, and before and after the work day;
b. For promotion and/or advancement opportunities; and
c. To perform tasks or work activities that match the interests, preferences, and skills of the worker.
E. All Supported Employment Placements shall be based on an individual's capabilities, strengths, and preferences, and shall be individually tailored to each person and may include self-employment. Working from an individual's home as part of self-employment may be a Supported Employment Placement if made as an informed choice by the individual, and is subject to review by the Monitor.
F. The State, including BHDDH, ORS, and RIDE, will establish and implement a policy or policies that include the presumption that all individuals covered by this Consent Decree are capable of working in integrated employment settings.
G. Supported Employment Placements made available under this Consent Decree cannot be in sheltered workshops, group enclaves, mobile work crews, time-limited work experiences (internships), or facility-based day programs.
H. Individuals may participate in employer-sponsored training programs or provider-subsidized trial work experiences in integrated settings, of a duration no longer than 4-8 weeks, prior to placement in jobs that would qualify as a Placement under this Consent Decree. Employment compensated by any entity other than the employer (e.g., employment in which the provider pays or subsidizes the individual's wages) will not qualify as a Placement under this Consent Decree. In cases in which an individual leaves a position in which he or she has been placed under this Consent Decree and returns to the same Placement after an absence, or is placed in a different position, such secondary Placement shall qualify as re-employment support, as set forth in Section V(A)(1), but shall not qualify as an additional Placement under this Consent Decree.
I. All individuals who receive a Supported Employment Placement under this Consent Decree shall work the maximum number of hours consistent with their abilities and have access to integrated day services in sufficient amount, duration, and intensity to complement their employment and to provide them with an ISP that affords them the opportunity to participate in integrated settings at times when they are not working during a normative 40-hour work week.
J. By May 1,2016, and thereafter, all individuals in the Rhode Island Youth Exit Target Population that receive a Supported Employment Placement shall average, as determined by

"
;

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a point-in-time survey, work in an integrated employment setting for at least 20 hours per week.
K. By May 1,2018, and thereafter, all individuals in the Rhode Island Sheltered Workshop and Rhode Island Day Target Populations that receive a Supported Employment Placement shall average, as determined by a point in time survey, work in an integrated employment setting for at least 20 hours per week.
L. Any individual eligible for a Supported Employment Placement, but who makes an informed choice for placement in a facility-based work setting, group enclave, mobile work crew, time-limited work experience (internship), or facility-based day program, or other segregated setting may seek a variance allowing such placement. Variances may only be granted after an individual has:
1. Participated in at least one vocational or situational assessment, as defined in Sections II(II) and (16);
2. Completed one trial work experience, as defined in Section II(15);
3. Received the outreach, education, and support services described in Section X; and
4. Received a benefits counseling consultation, as described in Section IV(6).
M. If a variance is granted, the individual must be reassessed by a qualified professional, and the revised employment goal reevaluated, within 180 days, and annually thereafter, for the individual to have the meaningful opportunity to choose to receive Supported Employment Services in an integrated work setting. The Parties and the Monitor shall create a process that governs the variance process within 30 days of entering this Consent Decree.
N. Individuals who seek a variance from this Consent Decree, but who are unable to participate in a trial work experience, pursuant to Section V(L), due to a documented medical condition that poses an immediate and serious threat to their health or safety, or the health or safety of others, should they participate in a trial work experience, may submit documentation of such a condition to the Monitor to seek exemption from Section V(L)(2). Exemptions from trial work experiences will be subject to the Monitor's approval.
O. The State will ensure that individuals currently in sheltered workshops who receive a variance pursuant to Section V(M) will continue to receive employment services.
VI. INTEGRATED DAY SERVICES AND PLACEMENTS
A. "Integrated Day Services" include the appropriate services and supports necessary to allow individuals with IIDD to participate in and gain membership in mainstream communitybased recreational, social, educational, cultural, and athletic activities, including community volunteer activities and training activities, as well as other non-facility based activities of a person's choosing that are provided in integrated settings during the day with the appropriate services and supports.
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B. Integrated Day Services will be provided to all individuals in the Rhode Island Sheltered Workshop, Rhode Island Youth Exit, and Rhode Island Day Target Populations who receive a Supported Employment Placement, for the remainder of all time set forth in an individual's ISP in a 40-hour work week in which such individuals are not in school or supported employment. Integrated day settings must:
1. Allow individuals with disabilities the opportunity to interact with individuals without disabilities in a community setting to the fullest extent possible for the individual; and
2. Offer individuals with disabilities the same opportunity as non-disabled individuals:
a. To engage in non-work activities that match the interests, preferences, and goals of the participant; and
b. To do so at times, frequencies, and with persons of their choosing during the day, when an individual is not working or receiving residential care or educational services.
3. Integrated Day Services shall be individualized, flexible, purposeful, and productive daytime activities; shall be individually tailored to a person's interests, abilities, and goals; and shall afford individuals the services and supports necessary to interact with non-disabled individuals to the fullest extent possible during the day.
4. Integrated Day Services must be individually selected and designed by the service recipient through person-centered planning and include the services and supports necessary to allow individuals to participate in an array of group and non-group, structured and unstructured, activities and to facilitate meaningful choice by individuals with IIDD between group and non-group activities and structured and unstructured activities.
5. Integrated Day Services shall not be services provided as part of a sheltered workshop, day services, group home, or residential service provider's on-site program.
6. For working-age adults with IIDD, Integrated Day Services must complement, supplement, and promote integrated employment outcomes by aiding the development of social capital, including broad personal and professional networks, and individuals' active participation and membership in integrated settings. Integrated Day Services for working-age adults with IIDD must include an adequate mix of leisure, employmentrelated, and daily life activities that are comparable to those activities engaged in by working-age non-disabled peers, and will include the availability of paid and natural supports.
7. Retirement-age adults with IIDD who are eligible for Integrated Day Services will have access to supported retirement activities, including a mix of leisure, meaningful seniorrelated activities, and daily life activities that are comparable to those activities engaged in by retirement-age non-disabled peers, and will include the availability of paid and natural supports.
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8. Individuals in the Rhode Island Day Program Target Population may select an Integrated Day-Only Placement in lieu of a Supported Employment Placement. An "Integrated DayOnly Placement," for the purposes of this Consent Decree, is the provision of Integrated Day Services in an integrated non-work setting to a person who has made the informed choice not to participate in an integrated employment setting, where the placement is individually tailored to a person's interests, abilities, and goals pertaining to productive and meaningful day-time activities in the community, and where integrated day services allow an individual to interact with non-disabled individuals in integrated day settings for the maximum number of hours possible for the individual during the day, as set forth in an individual's ISP. Individuals in the Rhode Island Day Program Target Population may select an Integrated Day-Only Placement only after being fully informed of their eligibility for a Supported Employment Placement and if they have:
a. Received information about and the opportunity to participate, should they desire to, in: (1) at least one vocational or situational assessment, as defined in Sections II(ll) and (16); and (2) one trial work experience, as defined in Section II(15);
b. Received the outreach, education, and support services described in Section X; and
c. Received a benefits counseling consultation, as described in Section IV(6).
9. If an individual chooses an Integrated Day-Only Placement, the individual must be reassessed by a qualified professional, and the revised employment goal reevaluated, within 180 days, and annually thereafter, for the individual to have the meaningful opportunity to choose to receive Supported Employment Services in an integrated work setting.
10. For individuals in the Rhode Island Day Target Population who do not select to receive a Supported Employment Placement, they must be offered integrated day services in an Integrated Day-Only Placement for all time set forth in an individual's ISP in a 40-hour workweek.
VII. CAREER DEVELOPMENT PLANNING
1. By January 1,2015, the State shall adopt and implement policies and procedures for developing career development plans for each individual in the Rhode Island Sheltered Workshop, Rhode Island Day, and Rhode Island Youth Exit Target Populations. The policies will include a presumption that all individuals covered by this Consent Decree are capable of working in an integrated employment setting and that a rapid search process for employment should be implemented for individuals eligible for Supported Employment Services under this Consent Decree. The policies will also include the presumption that all individuals covered by this Consent Decree will be ensured an active and leading role in the career development planning process. The policies also will include a provision that no readiness criteria shall be used in pre-eligibility or eligibility determinations to assess an individual's ability to work in an integrated setting. All individuals covered by this Consent Decree will be presumed ready for employment.
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2. The State shall adopt evidence-based vocational assessments and vocational eligibility criteria that are person-centered and appropriate for individuals with IIDD; based on the presumption that with the appropriate services and supports individuals with IIDD can work; and designed to reveal information about an individual's skills, interests, strengths and abilities, regardless of whether the individual has the verbal ability to express such information.
3. For the purposes of this Consent Decree, no vocational or situational assessments, including those conducted by BHDDH, ORS, and RIDE, or any vendors or contractors of the State, shall be conducted in segregated work settings, including in sheltered workshops or in any setting that does not meet the definitions and standards set forth in Sections V(D)-(E).
4. The State shall ensure that all assessments:
a. Are conducted by appropriate and trained staff;
b. Maintain fidelity to an asset-based assessment model (like MAPS, PATHS, or YAPS);
c. Are available for all individuals eligible for relief under this Consent Decree to be assessed in several different integrated employment settings, should they desire to be assessed in more than one community employment setting; and
d. Are conducted with the appropriate accommodations, services, and supports necessary for individuals eligible for relief under this Consent Decree to be assessed performing work activities in integrated employment settings.
5. A career development plan shall be formulated and/or revised at least annually in conjunction with the ISP or IEP process through an asset-based, person-centered planning process including discovery, vocational assessment, and situational assessment conducted with the goal of maximizing the number of hours spent working, consistent with an individual's abilities, in settings that meet the definitions and standards set forth in Sections V-VI. The career development plan shall:
a. Set forth the individual's skills, interests, strengths, and abilities;
b. Be integrated into the individual's IPE, ISP, IEP, and ILP and Summary of Performance ("SOP"), where applicable; and
c. Identify the nature and scope of services needed by the individual to remove obstacles to obtaining and keeping an individualized job in an integrated employment setting and participating in Integrated Day Services meeting the definitions and standards set forth in Sections V-VI.
6. Translation and interpretation services, including sign language interpretation, shall be accessible and available to all individuals in the Target Populations and their families who require such services during all career and transition planning meetings and during
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the entire assessment, career planning, and placement process, including during the administration of the SIS assessment. The State will ensure that individuals in the Target Populations who are deaf and eligible for a Supported Employment or Integrated DayOnly Placement receive the necessary interpretation services to allow them to work or fully participate in integrated activities in their Placements under this Consent Decree. Further, all individuals covered by this Consent Decree will have access to the services and supports necessary to make informed decisions pertaining to this Consent Decree.
7. If, after discovery, and a vocational or situational assessment, an individual expresses that a particular work setting does not match his/her interests, strengths, or abilities, the person-centered planning process shall resume, the reasons that the individual did not prefer the work placement shall be documented, and all planning shall proceed with goals that have been adjusted based on the information revealed through the discovery and assessment process.
8. The State shall implement a rapid job search process for each individual eligible for a Supported Employment Placement under this Consent Decree.
9. At minimum, the State shall ensure that the rapid job search process:
a. Begins within 10 days of the completion of an individual's vocational assessment;
b. Includes an individualized job search; and
c. Includes job development and job carving, as needed.
VIII. TRANSITION PLANNING FOR YOUTH
1. RIDE shall adopt an Employment First Policy, making work in integrated employment settings the first and priority service option for youth seeking transition work placements and for transition-age youth's postsecondary vocational planning objectives. RIDE's Employment First Policy will set forth values for the State's transition planning process that reflect the State's expectations for supporting youth in transition to integrated employment settings through a systemic and collaborative framework.
2. By July 1,2014, the State's respective agencies, including RIDE, BHDDH, and ORS, shall amend and modify their existing interagency agreement to include the promotion and implementation of a school-to-work transition planning process that includes specific timelines and benchmarks for all transition-age youth (14-21 years of age) with IIDD, as set forth in Section VIII(4), and providing for students' access to the services and supports set forth in Sections V(A)(I)-(2). The interagency agreement also will designate, inter alia, ORS as responsible for the trial work experience requirements of Section VIII(6) of this Consent Decree and RIDE as responsible for ensuring that the trial work experience requirement of Section VIII(6) is embedded and incorporated into the existing IEP planning process.
3. The State, including RIDE, BHDDH, and ORS, shall promote the involvement, availability, and use of career planning teams in each school district. Career planning teams shall at a minimum include a qualified vocational rehabilitation counselor,
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qualified school transition specialist, qualified State representative, where applicable, and the eligible youth with IIDD. Family and/or guardian participation in all planning meetings should be required. The eligible youth shall be ensured an active and leading role in all ofhislher planning meetings.
4. The transition planning process for students in the Rhode Island Youth Transition Target Population shall begin by age 14, as required by state law, shall include a career planning team, and shall include access to ORS and Medicaid Waiver services, if the individual is eligible for such services. The transition planning process shall be designed to ensure that each youth and his/her family has been informed about, and been given opportunities to experience, Supported Employment Services and trial work experiences. The transition planning process, as set forth by interagency agreement in Section XIII, shall be inclusive of specific and relevant planning milestones for all students in the Rhode Island Youth Transition Target Population. At minimum, these milestones shall include:
a. Assignment, by age 14, to an employment planning team, as defined in this Section;
b. No later than during the first year of entry to a Rhode Island secondary school, and with the assistance of the career planning team during the annual IEP planning process, the formulation of the employment-related recommendations of the IEP to discover and record students' personal interests and goals for postsecondary employment and/or postsecondary education. Such goals will be re-evaluated and adjusted according to a student's preferences during each subsequent year of a student's secondary school participation;
c. No later than the year in which a student turns 16 years of age and, during the annual IEP planning process with the assistance of the career planning team, a comprehensive introduction to or enrollment in State services, if an individual is eligible or will be eligible, and also with the assistance of the employment planning team, the formulation of the employment-related recommendations of the IPE and ISP, where applicable;
d. No later than the year in which a student turns 18 years of age, during the annual IEP planning process, a meeting with the career planning team to facilitate possible postsecondary employment placements, and to ensure that an eligible youth has been introduced to, numerous and specific options to receive Supported Employment Services in a community-based long-term placement in an integrated employment setting meeting the definitions and standards set forth in Sections V(D)-(E), and that the eligible youth has (or will have) experienced the opportunity to be placed in such a setting, and to begin working there, prior to the end of his or her participation at a Rhode Island secondary school; and
e. No later than during the year prior to exit from secondary school, all individuals in the Rhode Island Youth Transition Target Population shall receive benefits planning information, according to the standards set forth in Section IV(6).
5. All youth in transition shall have a meaningful opportunity to experience one or more vocational and/or situational assessments in an integrated employment setting prior to
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exit from a Rhode Island secondary school, pursuant to the standards set forth in Sections 1I(11) and (16).
6. All youth in transition shall have a meaningful opportunity prior to exit from a Rhode Island secondary school to experience at least two trial work experiences, where each trial work experience is approximately 60 days in duration, in an individualized, integrated employment setting meeting the definitions and standards set forth in Sections V(D)-(E) with supervision and appropriate services and supports. Such trial work experiences may be exempt from the requirement of Section V(D)(1), and may include full-time, part-time, or seasonal work on a paid or unpaid basis, including internships, summer work experiences, or volunteer/community service experiences. Such trial work experiences cannot be positions of employment that are controlled by an employer that is a provider or school for the purpose of employing individuals with disabilities; instead, they must be provided in typical work settings meeting the definitions and standards set forth in Sections V(D)(2)-(4) and V(E).
7. A person-centered career development plan shall be developed by the employment planning team for each youth in transition, to inform the employment-related goals and recommendations of the youth's ISP, IEP, IPE, ILP, and SOP, where applicable, and to provide ongoing coordination of the employment-related recommendations of those plans.
8. The State, including BHDDH, ORS, and RIDE, shall prohibit vocational assessments of transition-age youth in segregated work settings, and shall issue a directive that no youth in transition will be assessed in segregated settings or in settings that do not meet the definitions and standards set forth in Sections V(D)-(E).
9. The State, including BHDDH, ORS, and RIDE, shall ensure that the appropriate services and supports are available to transition-age youth who choose to work in the community before their 21st birthday rather than remaining in school. To this end, BHDDH will update its policies and administrative rules to facilitate individuals who are eligible to access State services, including Supported Employment Services, by age 18. ORS will update its policies and administrative rules to facilitate individuals who are eligible to access vocational rehabilitation services beginning at age 16. RIDE will issue a statewide directive that local school districts comply with State law to begin the transition planning process at age 14.
10. The State, including RIDE, shall take affirmative steps to ensure that all youth in transition, as defined in Section 11(14), are not excluded from the benefits and opportunities of transition academies, and other post-secondary planning, education, and employment resources in a student's assigned school district following their exit from school. Also, RIDE will take affirmative steps to link the parents and families of transition-age youth with IIDD, as defined in Section 1I(14), with information about supported employment and integrated day services and parent information networks and groups during the school year that the transition-age youth is age 14.
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IX. TRAINING
1. By September 1, 2014, the State will establish competencies, and will develop and implement a competency-based and value-based training program for:
a. Sheltered workshop and facility-based day program staff;
b. All members of career planning teams as defined under Section VIII;
c. Youth service professionals; and
d. State agency staff, including for BHDDH, RIDE, and ORS staff.
2. The competency-based and value-based training program, as set forth in Section IX(I), will pertain to the development of vocational assessment/profiles, career development plans, and transition plans; job development, job coaching, employment support, benefits counseling, and Supported Employment and Integrated Day Services and Placements; intake and vocational rehabilitation services; and service coordination. The State will ensure that all persons involved in the discovery and assessment process, the preparation and implementation of career development plans, and the provision of Supported Employment and Integrated Day Services and Placements for members of the Target Populations have completed the necessary training, have attained and retain the required competencies, and are otherwise qualified (as specified in Section X) to perform their respective responsibilities with respect to employment and day services. To do so, the State will rely upon a range of resources which may include State and local accredited training programs, and nationally-recognized and accredited training programs.
3. The State will ensure that all persons involved in the discovery and assessment process, the preparation and implementation of career development plans, and the provision of Supported Employment and Integrated Day Services and Placements for members of the Target Populations receive training specific to providing services and supports to individuals with IIDD.
4. The Monitor will be required to approve the competency-based and value-based training program prior to its implementation, and will be available to provide guidance and suggestions in the formulation of the program.
X. OUTREACH, EDUCATION, AND SUPPORT
1. By September 1, 2014, the State will develop an outreach, in-reach, and education program that explains the benefits of supported employment, that addresses concerns of families and perceived obstacles to participating in supported employment programs, and that is designed to encourage individuals with IIDD in Rhode Island day activity service programs, including in sheltered workshops and facility-based day programs, and their families to seek Supported Employment Services and to understand the objectives of the State's Employment First Policy, receive benefits planning consultation, and participate in other related initiatives. The Monitor will be required to approve the outreach, in-
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reach, and education program prior to its implementation, and will be available to provide technical assistance in the formulation of the program. As part of its outreach, in-reach, and education program, the State will ensure that:
a. Individuals are educated about the ways in which Integrated Day Services can complement employment in integrated settings, and will develop opportunities for individuals and families to learn about the benefits of Integrated Day Services;
b. Individuals in the Target Populations are provided the opportunity to visit and observe integrated employment and day settings where individuals with IIDD receive Supported Employment and Integrated Day Services; and
c. The outreach, in-reach, and education program is available to individuals with I1DD and their families by no later than September 1,2014, however, the State will ensure that ongoing efforts are made during the length of this Consent Decree to sustain the outreach, in-reach, and education program.
2. The State will support personal networks and use family to family and peer to peer programs to link families and individuals with IIDD who obtain competitive integrated employment with families and individuals with IIDD at sheltered workshops and facilitybased day programs, in order to explain the benefits and opportunities of supported employment and integrated day services.
3. By no later than May 1,2014, the State will create an Employment First Task Force that will include, but will not be limited to, representatives of the technical assistance entities discussed in Section XII, the Community Provider Network of Rhode Island, the Paul V. Sherlock Center on Disabilities at Rhode Island College, the Rhode Island Disability Law Center, the Rhode Island Developmental Disabilities Council, the Rhode Island Parent Information Network, the Rhode Island Business Leadership Network, individuals with IIDD, and parent and family representatives. The Employment First Task Force will:
a. Meet with the Monitor on a quarterly basis to identify and discuss barriers to successful implementation of this Consent Decree, best practices, and corrective actions to ensure that individuals in the Target Populations can successfully transition to integrated employment and day settings;
b. Meet with relevant State officials, including the Directors ofDHS, BHDDH, RIDE, and ORS, on a quarterly basis to identify and discuss barriers to successful implementation of this Consent Decree, best practices, and corrective actions to ensure that individuals in the Target Populations can successfully transition to integrated employment and day settings;
c. Produce policy recommendations, research, and publicly disseminated information, based on the experience of Task Force Members in working with individuals with IIDD, pertaining to successfully assisting individuals in the Target Populations to transition to integrated work and day settings; and
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d. Have an active role in providing in-reach, outreach, education, transition, and linkage activities to individuals in facility-based sheltered workshops, day programs, and secondary schools.
XI. PROVIDER CAPACITY
1. The State, including BHDDH and ORS, will ensure that it supports and maintains a sufficient capacity to deliver Supported Employment and Integrated Day Services to individuals in the Rhode Island Sheltered Workshop, Rhode Island Day Program, and Rhode Island Youth Exit Target Populations, including qualified supported employment providers and integrated day providers, consistent with the terms of this Consent Decree.
2. The State, including BHDDH and ORS, will ensure that the supported employment providers and/or integrated day providers have a sufficient array of trained staff, adequate staff supervision, appropriate policies and procedures, a quality improvement program, and the capacity to deliver Supported Employment and Integrated Day Services consistent with the terms of this Consent Decree.
3. By September 1,2014, the State, including BHDDH and ORS, will establish, implement, and enforce pre-qualification requirements for all Supported Employment and Integrated Day Services providers that supply services to individuals in the Rhode Island Sheltered Workshop, Rhode Island Day Program, and Rhode Island Youth Exit Target Populations, consistent with the terms of this Consent Decree.
4. Effective upon signing this Consent Decree, the State will be responsible for creating incentives to encourage the transition of individuals from sheltered workshops, facilitybased day program settings, and Rhode Island secondary schools to integrated employment and integrated day settings that meet the definitions and standards of Sections V(D)-(E). The State will implement these incentives through public-private partnerships with persons with IIDD, family members, employers, employment providers, community organizations, and additionally by other means that are approved by the Monitor.
5. The State will provide monitoring, oversight, and technical assistance to ensure supported employment providers use evidence-based employment practices, have adequate staffing, organizational support and supervision, and use effective business models to meet the goals and outcomes of this Consent Decree. The State will develop and publicize its oversight process and provide mechanisms for individuals with IIDD, their families, service providers, and advocates to file complaints which will be timely addressed by the State.
6. The State will require the supported employment provider(s) used to transition individuals with IIDD from Rhode Island sheltered workshop and facility-based day service providers into Supported Employment Placements to:
a. Identify and promote Supported Employment Placements in state and federal agencies and in private industry on a statewide basis; and
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b. Develop relationships with public and private employers based on the benefits to businesses of hiring people with disabilities.
7. By July 1,2015, the State will establish public and private sector initiatives to support the integrated employment of individuals in the Target Populations.
8. By July 1,2015, the State will develop procedures to require provider staff to assist in the transition of individuals from Rhode Island sheltered workshop settings and facilitybased day settings to Supported Employment Services and Placements. The procedures will provide incentives and support to qualified providers of sheltered workshop services upon the effective date of this Consent Decree to begin to convert their employment programs to Supported Employment Services so that the providers' services are converted primarily to Supported Employment Services once the terms and conditions of this Consent Decree are met, at the expiration of this Consent Decree.
9. By October 1,2014, the State will establish a Sheltered Workshop Conversion Institute. The Parties have jointly selected the Paul V. Sherlock Center on Disabilities at Rhode Island College to administer the Sheltered Workshop Conversion Institute. The Sheltered Workshop Conversion Institute will be designed to assist qualified providers of sheltered workshop services to convert their employment programs to include Supported Employment Services. The Sheltered Workshop Conversion Institute will provide individual analysis, technical assistance, and support to each qualified provider of sheltered workshop services, and will work together with the technical assistance entities discussed in Section XII, to support individual providers in a process of conversion and transformation of service options. The Sheltered Workshop Conversion Institute shall operate based on authority and under guidelines that are mutually agreed upon by the Parties and the Monitor by no later than October 1,2014. .
10. By October 1,2014, the State, including BHDDH and ORS, will establish and begin distributing a Sheltered Workshop Conversion Trust Fund in the amount of $800,000, to provide upfront start-up costs to providers that have agreed to convert their services from primarily sheltered employment to primarily Supported Employment Services. The Sheltered Workshop Conversion Trust Fund will be administered by the Director ofDHS ("Sheltered Workshop Trust Fund Administrator") or herlhis designee, the Associate Director of ORS, and the funds appropriated shall only be used by qualified sheltered workshop providers for the initial costs associated with converting from a primarily facility-based service model to an integrated service model. Among the qualifications to become eligible for start-up funds from the Sheltered Workshop Conversion Trust Fund, a provider must:
a. Receive ongoing technical ass,istance and guidance from the Sheltered Workshop Conversion Institute, set forth in Section XI(9); and
b. Submit a detailed Conversion Plan to the Sheltered Workshop Trust Fund administrator, including budgetary projections, and multi-year projections for the number of service recipients to be served by the provider in the sheltered workshop, in segregated group enclaves, and in integrated employment settings, and the number of service recipients per year transitioned to integrated employment settings meeting
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the standards set forth in Sections V(D)(I)-(4) of this Consent Decree. To be approved, at minimum, a Conversion Plan must specify the critical steps that the provider will take to ensure that its services will be converted to meet the standards for integration set forth in this Consent Decree.
11. If any service gaps or obstacles are identified through the process set forth in Section XV, the Monitor may recommend the necessary actions to remedy these gaps and address these obstacles, including increasing the number of trained and qualified vocational rehabilitation counselors, transition specialists, job developers, job coaches, benefits counselors, job placement specialists, case managers, youth service professionals, and other community employment professionals, in order to allow for successful transition of individuals with IIDD in Rhode Island sheltered workshops, facility-based day programs, and individuals exiting Rhode Island secondary schools to integrated employment and integrated day settings and to ensure the full implementation of the goals and outcomes of this Consent Decree.
XII. STATE AND OTHER AGENCY ACTIONS
1. By July 1,2014, the State, including BHDDH, ORS, and RIDE, will identify and pursue a contract with a technical assistance provider, or access the services of an existing technical assistance provider, to provide leadership, training, and technical assistance to employment providers and to the State staff involved in assessing, planning, and' providing Supported Employment Services, in order to support the goals and outcomes of this Consent Decree.
2. The technical assistance provider set forth in Section XII(1) will assist and support employment providers to transition individuals, programs, staff, and resources from Rhode Island sheltered workshops and facility-based day programs to Supported Employment Services meeting the definition and standards set forth in Sections 11(13), V, and VI of this Consent Decree; will assist and support the development ofnew providers of Supported Employment Services; and will work collaboratively with the Sheltered Workshop Conversion Institute set forth in Section XI.
3. By July 1,2014, the State, including BHDDH, ORS, and RIDE, will identify and pursue a contract with a technical assistance provider, or access the services of an existing technical assistance provider, to provide leadership, training, and technical assistance to day services providers and to the State and provider staff as well as all caseworkers involved in assessing, planning, and providing Integrated Day Services and Integrated Day-Only Placements, in order to support the goals and outco~es of this Consent Decree. If a separate entity other the entity set forth in Section XII(1) is retained to perform this function, the technical assistance provider shall work collaboratively and in concert with the technical assistance provider set forth in Section XII(I), to provide information about the manner in which Integrated Day Services can complement and strengthen individuals' employment goals and to develop concrete recommendations for converting facility-based day services to a meaningful and purposeful service model for employment and integrated day services.
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XIII.

4. The technical assistance provider(s), set forth in Sections XIl(1) and (3), cannot be a sheltered workshop provider, facility-based day program provider, supported employment provider, or integrated day provider in Rhode Island.
5. The technical assistance provider(s) set forth in Sections XII(1) and (3) will assist and support service providers to transition individuals, programs, staff, and resources from the facility-based sheltered workshop and day programs to Supported Employment and Integrated Day Services, meeting the definition and standards set forth in Sections 11(7), 11(13), V, and VI of this Consent Decree.
INTERAGENCY COLLABORATION

XIV.

1. By October 1, 2014, the State will develop and implement one or more interagency agreements or memoranda of understanding between BHDDH, ORS, and RIDE designed to ensure the full implementation of this Consent Decree that addresses:
a. Allocation of responsibility, funding commitments, and authority for conducting and ensuring the quality of all efforts to meet requirements of this Consent Decree, including career planning, transition planning, outreach, in-reach, and education, training and professional development, Supported Employment and Integrated Day Services, and data collection, sharing, and reporting;
b. Supported employment outcomes through coordination and collaboration between BHDDH, ORS, and RIDE;
c. The compatibility of ORS and RIDE services with services funded through BHDDH by clarifying and streamlining interagency procedures and allowing for the blending and braiding of funding; and service gaps resulting from the transition from one funding stream to another funding stream (e.g., ORS funding to BHDDH funding or special education funding to ORS funding), enabling individuals with IIDD to maintain uninterrupted integrated employment without unnecessary delays in services;
d. Individual tailoring of the vocational rehabilitation assessment and job placement activities to serve people with the most significant disabilities, and other day activity service provider facilities, who are eligible for ORS funding; and
e. Coordinated outreach and in-reach efforts to individuals in the Target Populations conducted by vocational rehabilitation counselors and BHDDH representatives.
FUNDING

1. The State shall ensure that all individuals in the Rhode Island Sheltered Workshop, Rhode Island Day, and Rhode Island Youth Exit Target Populations with a career development plan have an ongoing allocation from available fundinglbudgets that is dedicated to supports for gaining, maintaining, or improving employment outcomes and for integrated day services.
2. The State will reallocate resources expended on Rhode Island sheltered workshop programs and segregated day programs to fund supported employment and/or integrated

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day services as individuals in the Target Populations transition from sheltered workshops to supported employment and/or integrated day only placements, in order to have funding "follow the person."
3. The State shall timely fund the services and supports necessary to comply with this Consent Decree for the eligible members of the Rhode Island Sheltered Workshop, Rhode Island Day, Rhode Island Youth Transition, and Rhode Island Youth Exit Target Populations according to the standards and timelines set forth in this Consent Decree.
4. By January 1,2015, the State shall develop and implement performance-based contracts for Supported Employment Services to individuals in the Target Populations, linking funding to the provider's achievement of numerical targets and implementation timelines.
5. The State will ensure that its reimbursement model for day activity services is sufficiently flexible to allow providers to be reimbursed for costs (e.g. transportation to the job site, employer negotiation, counseling clients by telephone) that are: (1) directly related to providing Supported Employment Services to individuals in the Target Populations, and (2) provided when service provider staff is not face-to-face with a client.
6. The State shall timely fund, and provide an ongoing allocation from available funding/budgets, the transportation services-including travel training services and supports-necessary for individuals in the Target Populations to obtain and maintain Supported Employment and Integrated Day-Only Placements under this Consent Decree.
xv. QUALITY IMPROVEMENT
1. By November 1,2014, the State will develop and implement a statewide quality improvement initiative to ensure that individual, integrated Supported Employment Services and Supported Employment Placements, and Integrated Day Services and Integrated Day-Only Placements as defined and described in Sections V-VI, are developed in accordance with this Consent Decree; to evaluate the quality and quantity of Supported Employment and Integrated Day Services provided to persons with IIDD under this Consent Decree; and to ensure that individuals in the Rhode Island Sheltered Workshop, Rhode Island Day, and Rhode Island Youth Exit Target Populations who receive Supported Employment Placements and Integrated Day Services under this Consent Decree receive services and supports that are adequate and sufficient to achieve integration, increased independence, and increased economic self-sufficiency.
2. By November 1,2014, the State will establish detailed program standards for transition planning and services, career development planning, benefits planning, Supported Employment Services, Integrated Day Services, and Supported Employment and Integrated Day-Only Placements, that at least incorporate the definitions, standards, and processes set forth in Sections V, VI, VII, and VIII.
3. Through its quality improvement initiative, the State will regularly conduct on-site reviews of day activity service programs, including of integrated community-based employment and day programs, to evaluate the services provided to individuals with IIDD against the program standards described above.
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4. The State will regularly publish reports from its reviews describing its findings and recommendations, identifying any program deficiencies, and requiring a plan of correction, where appropriate. If a plan of correction is required, details of the plan's requirements will be included in the report.
5. The State will conduct appropriate follow-up reviews to determine if plans of correction have been implemented and to ensure that any identified deficiencies have been corrected in a timely manner. The State will issue reports pertaining to any follow-up reviews.
XVI. DATA COLLECTION AND REPORTING
1. Upon execution of this Consent Decree, the State shall moriitor and collect data.
a. The State will report on a monthly basis from October 1, 2014 through October 1, 2015, and quarterly thereafter, the progress of implementation of this Consent Decree.
b. Between the date of execution of this Consent Decree and October 1,2014: (1) the Monitor and the State will jointly develop reporting protocols and processes for reporting; and (2) upon the request of the Monitor, the State will provide the Monitor with access to data and reports, as set forth in Section XVI(2), reflecting progress under this Consent Decree.
2. Pursuant to Section XVI(1), the State shall collect data and report to the Monitor and to the United States on the following unduplicated data for individuals with IIDD in the Target Populations:
a. The number of career development plans in place for members of the Target Populations;
b. The number and reason for any readmissions to any Rhode Island sheltered workshop program;
c. The number and reason for any readmissions to any Rhode Island facility-based day program;
d. The number of individuals moving from Rhode Island sheltered workshop programs to another sheltered workshop setting, facility-based day services setting, group enclave, mobile work crew, time-limited work experience (internship), or other segregated setting, the reasons for such moves, and the number of variances granted;
e. The number, hours worked or served, wages earned, age, and tenure of all individuals in the Rhode Island Sheltered Workshop, Rhode Island Youth Exit, and Rhode Island Day Program Target Populations;
f. The number of individuals referred to and receiving Supported Employment Services as defined in Sections V(A)-(C) and Supported Employment Placements as defined in Sections V(D)-(E), and from which setting (e.g. a sheltered workshop or facilitybased day program setting or school) they have been referred;
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g. The number of individuals participating in Integrated Day-Only Placements as defined in Section VI(B)(8), and from which setting they came;
h. The number of hours worked per week, hourly wages paid, and tenure of all members of the Target Populations in an integrated employment setting, as set forth in Section V;
1. The number of hours spent per week, and tenure of all individuals in the Target Populations receiving Integrated Day Services or in Integrated Day-Only Placements, including the name of that service setting, the provider of Integrated Day Services, and the specific activity(ies) that the individual is engaged in (i.e., art classes, health club, etc.);
j. The number and reason(s) for lost jobs and/or terminations from employment along with plans for re-employment;
k. The number of youth in the Rhode Island Youth Transition Target Population who have vocational objectives;
1. The number of youth in the Rhode Island Youth Transition Target Population who are exiting or graduating, or otherwise expected to exit or graduate each year, their career planning goals, and where they transition to following their exit;
m. The number of qualified and trained individuals who develop assessments and transition plans for youth with IIDD across Rhode Island, and who participate on employment teams;
n. The number and client capacity of supported employment providers providing services to the Target Population;
o. The number and client capacity of integrated day providers providing services to the Target Population;
p. The number of qualified and trained individuals for each category of supported employment professionals, including job coaches, job developers, employment specialists, and benefits counselors providing services to the Target Population;
q. The number of qualified and trained vocational counselors who assess and assist persons with IIDD for Supported Employment Services across Rhode Island; and
r. The number of in-reach, out-reach, and education programs and efforts offered to the Target Population(s).
3. The State shall take the following steps related to Data Collection and Monitoring:
a. The State will regularly collect, aggregate, and analyze data described above, will identify problems or barriers to placement in or retaining jobs in individual, integrated employment settings, and will recommend to the Directors of DHS, BHDDH, RIDE, and ORS remedial actions to resolve the problems or barriers. The State will review this information on a monthly basis upon execution ofthis Consent
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Decree through October 1, 2015 and quarterly thereafter and develop and implement effective measures to overcome the problems and barriers identified; and
b. The State, on a quarterly basis, will analyze service data, monitor services and service gaps, report on any service gaps, and identify and address any obstacles to the implementation of the goals and outcomes of this Consent Decree.
XVII. MONITORING AND ENFORCEMENT
1. The Parties have jointly selected Charles Moseley as the Monitor. The State will contract with the Monitor to provide monitoring services pursuant to this Consent Decree, subject to applicable purchasing laws, and the State will fulfill all obligations under that contract. In the event that the Monitor resigns or the Parties agree to replace the Monitor, the Parties will select a replacement. If the Parties are unable to agree on a replacement within 30 days from the date the Parties receive a notice of resignation from the Monitor, or from the date the Parties agree to replace the Monitor, they shall each submit the names of up to three candidates to the Court and the Court shall select the replacement from the names submitted.
2. The Monitor shall conduct the factual investigation and verification of data and documentation necessary to determine whether the Parties are in compliance with this Consent Decree, on a regular cycle, to be agreed upon by the Parties by no later than May 1,2014, and continuing during the pendency of the Consent Decree. The Monitor may hire staff and consultants, in consultation with and subject to reasonable objections by the Parties, including but not limited to the economic efficiency of the Monitor or other budgetary requirements, to assist in hislher compliance investigations. The Monitor and any hired staff or consultants are neither agents nor business associates of the State, or the United States Department of Justice.
3. The Monitor shall provide a written report to the Parties regarding the State's compliance with the terms of this Consent Decree every 90 days from April 1, 2014 through April 1, 2015, and every 180 days thereafter. The first report shall be issued two months from the effective date of this Consent Decree. At the request and with the consent of the Parties, the Monitor may hold an informational and review meeting after the filing of each written report. The Monitor shall provide the Parties a draft of hislher report at least 7 days before issuing the report. The Parties shall have the opportunity to review and comment on the proposed report. The Parties may agree to allow the Monitor an additional 5 days to finalize a report after he/she receives comments from the Parties.
4. In order to determine compliance with this Consent Decree, the Monitor and any hired staff or consultants shall have full access to the people, places, documents and materials that are necessary to assess the State's compliance with this Consent Decree, to the extent they are within the State's custody or control. This shall include, but not be limited to, access to the data and records maintained by the State pursuant to Section XVI. The Monitor and any hired staff or consultants may also interview individuals receiving services under this Consent Decree with the consent of the individual or hislher authorized representative. The Monitor's access to people, places, documents and
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materials shall continue until the Consent Decree is terminated. Any individually identifying health or education information that the Monitor and any hired staff or consultants receive or maintain shall be kept strictly confidential.
5. The Monitor shall also have access to any and all:
a. Data collected by the State;
b. Information necessary to determine that placements, pursuant to the terms ofthis Consent Decree, meet the definition and standards set forth in Sections V-VI;
c. Information necessary to ensure that the Consent Decree outcomes set forth in Section IV are met; and
d. Information necessary to evaluate the quality and quantity of Supported Employment Services provided to persons with IIDD under this Consent Decree.
6. The Monitor, and any hired staff or consultants, may:
a. Have ex parte communications at any time with the Court, the Parties, including counsel for the Parties, and employees, agents, contractors and all others working for or on behalf of the State or the United States to implement the terms of this Consent Decree;
b. Request meetings with either or both Parties. The purpose of these meetings shall include, among other things, prioritizing areas for the Monitor to review, scheduling visits, discussing areas of concern, and discussing areas in which technical assistance may be appropriate;
c. Speak with stakeholders with such stakeholders' consent, on a confidential basis or otherwise, at the Monitor's discretion;
d. Speak with anyone else the Monitor and any staff/consultants deem necessary for completing the compliance evaluations and reports required by this Consent Decree. However, the State has no obligation to require any individual who is not a State employee or contractor to speak with the Monitor;
e. Offer guidance and suggestions to the State regarding any issue related to compliance with this Consent Decree;
f. Attempt to resolve any dispute arising out of a Party's position with regard to the construction or implementation of this Consent Decree; and
g. Testify in this case regarding any matter relating to the implementation, enforcement, or dissolution of the Consent Decree, including the Monitor's observations, findings and recommendations in this matter. The Monitor may not voluntarily testify as an expert witness against the State in any other administrative or civil proceeding of
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whatever nature brought before any federal or state court or other administrative or judicial tribunal.
7. The Monitor and any hired staff or consultants shall not be liable for any claim, lawsuit, or demand arising out of its duties under this Consent Decree. This paragraph does not apply to any proceeding before this Court for enforcement of payment of contracts or subcontracts for reviewing compliance with this Consent Decree.
8. The Monitor and any hired staff or consultants shall not be subject to formal discovery, including, but not limited to, depositions, requests for documents, requests for admissions, interrogatories, or other disclosures. The Parties are not entitled to access the Monitor's records or communications, or those of hislher staff and consultants, although the Monitor may provide copies of records or communications at the Monitor's discretion.
9. Reimbursement and Payment Provisions
a. The cost of the Monitor, including the cost of any consultants and staff to the Monitor, shall be incurred by the State. The allocation ofthe cost of the Monitor, including the cost of any consultants and staff to the Monitor, shall be determined by the State, based upon utilization of the Monitor's services. All reasonable expenses incurred by the Monitor in the course of the performance of hislher duties as set forth in the Consent Decree shall be reimbursed by the State. If a dispute arises regarding reasonableness of fees or costs, the Monitor shall provide an accounting justifying the fees or costs.
b. The approved budget of the Monitor shall not exceed $300,000 in any State Fiscal Year during the pendency of this Consent Decree, inclusive of any costs and expenses for hired staff and consultants, without the approval of the State or the Court.
c. Within 10 business days ofhislher appointment, the Monitor shall submit to the Parties for approval a proposed budget for the first six months of operations. Before the conclusion of the first six months, the Monitor will submit a proposed budget for the following year and then submit proposed budgets annually thereafter.
d. The Parties shall raise with the Monitor any objections they may have to the draft of the proposed budget within ten days of its receipt. The Parties and the Monitor shall work to resolve any objections within ten days of an objection being raised. If the objection cannot be resolved, a Party may thereafter file the objection with the Court.
e. At any time, the Monitor may submit to the Parties for approval a proposed revision to the approved budget, along with any explanation of the reason for the proposed revision. Budget revisions will be effective upon approval by the Parties.
10. The Monitor, including any hired staff or consultants, shall not enter into any contract with the State while serving as the Monitor. If the Monitor resigns from or does not continue in hislher position as Monitor, he/she may not enter into any contract with the
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State on a matter related to the Consent Decree during the pendency of the Consent Decree without the written consent ofthe United States.
11. The Monitor, and any hired staff or consultants, shall refrain from any public oral or written statements to the media, including statements "on background," regarding this Consent Decree, its implementation, or the State's compliance.
XVIII. GENERAL PROVISIONS
1. This Consent Decree does not resolve any claims other than those alleged by the United States Department of Justice, Civil Rights Division, under the integration mandate of Title II of the ADA, as interpreted by the U.S. Supreme Court in Olmstead v. L.C., 527 U.S. 581 (1999), in the State's administration and operation of its day activity service system, including sheltered workshops and facility-based day programs, for people with IIDD. No other agency of the U.S. government, group, or individual is bound by or waives or resolves any claims herein. Nor are any other claims affected by this Consent Decree.
2. The signatures below of officials and attorneys representing the United States and the State signify that these Parties have given their final approval to this Consent Decree. Each Party to this Consent Decree represents and warrants that the person who has signed this Consent Decree on behalf of his or her entity or client is duly authorized to enter into this Consent Decree and to bind that Party to the terms and conditions of this Consent Decree.
3. This Consent Decree is binding upon the Parties, by and through their officials, agents, employees, and successors for the term of this Consent Decree. If the State contracts with an outside provider for any of the services provided in this Consent Decree, the Consent Decree shall be binding on all contracted parties,including agents and assigns. The State shall ensure that all contracted parties and agents take all actions necessary for the State to comply with the provisions of this Consent Decree.
4. No person or entity is intended to be a third party beneficiary ofthe provisions of this Consent Decree for purposes of any civil, criminal, or administrative action, and, accordingly, no person or entity may assert any claim or right as a beneficiary or protected class under this Consent Decree in any civil, criminal, or administrative action. No person or entity may assert any claim or right as a beneficiary or protected class member under this Consent Decree if they do not reside in the State of Rhode Island and, therefore, do not maintain eligibility for the State's day activity service system.
5. This Consent Decree and any documents incorporated by reference constitute the entire integrated agreement of the Parties. No prior or contemporaneous communications, oral or written, or prior drafts shall be relevant or admissible for purposes of determining the meaning of any provisions herein in any litigation or any other proceeding.
6. This Consent Decree may be executed in counterparts, each of which shall be deemed an original, and the counterparts shall together constitute one and the same Consent Decree, notwithstanding that each Party is not a signatory to the original or the same counterpart.
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All references to signature or execution of the Consent Decree shall be calculated from the date on which the last Party executed the Consent Decree.
7. The Parties represent and acknowledge that this Consent Decree is the result of extensive, thorough and good faith negotiations. The Parties further represent and acknowledge that the terms of this Consent Decree have been voluntarily accepted, after consultation with counsel, for the purpose of making a full and final compromise and settlement of any and all claims or allegations set forth by the United States Department of Justice as a result of its investigation and findings made about Rhode Island's statewide day activity service system, including sheltered workshops and facility-based day programs.
8. The United States will bear the cost of its own fees and expenses incurred in connection with this Consent Decree.
9. This Consent Decree shall be interpreted in accordance with federal law and the laws of the State of Rhode Island. The venue for all legal actions concerning this Consent Decree shall be in the United States District Court for the District of Rhode Island.
10. The Court has jurisdiction over this action pursuant to 28 U.S.C. § 1331; 28 U.S.C. § 1345; and 42 U.S.C. §§ 12131-12132. Venue is proper in this district pursuant to 28 U.S.C. § 1391(b).
XIX. CONSTRUCTION AND TERMINATION
1. The Parties agree to jointly file this Consent Decree with the United States District Court for the District of Rhode Island.
2. The implementation of this Consent Decree shall begin immediately upon the Effective Date, which shall be the date on which this Consent Decree is approved and entered as an order of the Court. The Parties anticipate that Rhode Island will have complied with all provisions of the Consent Decree by the end of State Fiscal Year 2024, unless this Consent Decree is otherwise terminated, cancelled, or extended. Substantial compliance is achieved where the State has implemented all of the provisions of the Consent Decree for all individuals in the Target Populations. Any violations of the Consent Decree that are minor and occasional and are not systemic shall not be deemed noncompliance. The Court shall retain jurisdiction of this action for all purposes until the end of State Fiscal Year 2024, unless:
a. The Parties jointly ask the Court to terminate the Consent Decree before the end of State Fiscal Year 2024, provided Rhode Island has complied with this Consent Decree and maintained compliance for one year; or
b. The United States disputes that Rhode Island is in compliance with the Consent Decree at the end of State Fiscal Year 2024. The United States shall inform the Court and Rhode Island by January 1, 2024, that it disputes compliance, and the Court may schedule further proceedings as appropriate. In any such proceedings, the burden shall be on the State to demonstrate substantial compliance.
3. Any Consent Decree deadline may be extended by mutual agreement of the United States
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and the State. Within 30 days after the Consent Decree is signed, the Defendant, through the Office of the Governor, shall select and appoint a Consent Decree Coordinator to oversee compliance with this Consent Decree and to serve as a point of contact for the Monitor, and shall provide notice to the Monitor and to the other Parties of the Consent Decree Coordinator's name, title, address, telephone number, and e-mail address. The individual serving as the Consent Decree Coordinator shall remain except upon cause or by mutual decision of the Parties. The Consent Decree Coordinator may be the same person as the State's Interim Settlement Agreement Coordinator in the matter of United States v. State of Rhode Island and City of Providence, No.1: 13-cv-00442 (D.R.I. July 11,2013).
4. Throughout the pendency of this Consent Decree, the United States and the State will coordinate and discuss areas of disagreement and attempt to resolve outstanding differences. In the event of any dispute over the language or construction of this Consent Decree or its requirements, the Parties agree to meet and confer in an effort to achieve a mutually agreeable resolution prior to initiating any court proceeding.
5. With the exception of conditions or practices that pose an immediate and serious threat to the life, health, or safety of individuals receiving services under this Consent Decree, if the United States believes the State has failed to fulfill any obligation under this Consent Decree, the United States shall, prior to initiating any court proceeding, notify the State in writing of any alleged non-compliance with the Consent Decree and request that the State take action to correct such alleged non-compliance. With the exception of conditions or practices that pose an immediate and serious threat to the life, health, or safety of individuals receiving services under this Consent Decree, the State shall have 15 days from the date of such written notice to respond to the United States in writing by denying that noncompliance has occurred, or by accepting (without necessarily admitting) the allegation of noncompliance and proposing steps that the State will take, and by when, to cure the noncompliance. Ifthe State fails to respond within 15 days, denies that noncompliance has occurred, or provides a proposal for curative action that is on its face insufficient, the United States may seek an appropriate judicial remedy.
6. If the State responds by proposing a curative action by a specified date that is not on its face insufficient, the United States may accept the State's proposal or offer a counterproposal for a different curative action or deadline. If the Parties reach an agreement that varies from the provisions of this Consent Decree, the new agreement shall be in writing, signed and filed with the Court. If the Parties fail to reach agreement on a plan for curative action, the United States may seek an appropriate judicial remedy. Any modification of this Consent Decree must be consented to by the Parties, and shall be executed in writing by the Parties, and the Parties will file the agreed upon modification jointly with the Court. The Parties shall promptly notify each other of any judicial or administrative challenge to this Consent Decree or any portion thereof, and shall defend against any challenge to the Consent Decree.
7. If the United States, having satisfied the requirements of Sections XIX(5)-(6) above, initiates a court proceeding based on the State's failure to meet the Outcomes specified in Section IV, then the State will have a defense in the proceeding if it can demonstrate both
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that: (l) it is performing its obligations under Sections V ("Supported Employment Services and Placements"), VI ("Integrated Day Services and Placements"), VII ("Career Development Planning"), VIII ("Transition Planning for Youth"), IX ("Training"), X ("Outreach, Education, and Support"), XI ("Provider Capacity"), XII ("State and Other Agency Actions"), XIII ("Interagency Collaboration"), XIV ("Funding"), XV ("Quality Improvement"), and XVI ("Data Collection and Reporting"); and (2) it was impossible to meet the relevant Outcom~ or Outcomes in Section IV because factors beyond the State's control impeded the effect of the services and supports that the State provided under Sections V-XVI.
8. Failure by any Party to enforce this entire Consent Decree or any provision thereof with respect to any deadline or any other provision herein shall not be construed as a waiver.
9. The State shall maintain sufficient records to document that the requirements of this Consent Decree are being properly implemented and shall make such records available to the Monitor or the United States for inspection and copying upon request. The Monitor or the United States may require additional written reports from the State with regard to the State's compliance with the terms ofthis Consent Decree. The State will cooperate and comply with those requests.
10. The State will work collaboratively with the United States to provide full access for the United States and the Monitor to the people, places, and documents that are necessary to assess the State's compliance with and/or implementation of this Consent Decree, subject to applicable federal and state law.
11. The Parties agree that, as of the date the Court approves and enters this Consent Decree as an order of the Court, for purposes of the Parties' preservation obligations pursuant to Federal Rule of Civil Procedure 26, litigation is not "reasonably foreseeable" concerning the matters described in the Findings Letter issued to the State pertaining to the statewide day activity service system, including sheltered workshops and facility-based day programs. To the extent that either Party previously implemented a litigation hold to preserve documents, electronically stored information, or things related to the matters described in the Findings Letter issued to the State on January 6, 2014, the Party is no longer required to maintain such a litigation hold. Nothing in this paragraph relieves the United States or the State of any other obligations imposed by this Consent Decree.
12. "Notice" under this Consent Decree shall be provided by overnight courier to the following or their successors:
Chief of the Disability Rights Section United States Department of Justice Civil Rights Division 1425 New York Avenue NW Washington, DC 20005
Office of the Secretary, Executive Office of Health & Human Services Louis Pasteur Building
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57 Howard Avenue Cranston, RI 02920
Office of the Commissioner, Rhode Island Department of Education 255 Westminster Street Providence, RI 02903

~ SO ORDERED THIS

day of

~

,2014.

~41.~
Senior U.S. District Judge

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Case 1:14-cv-00175-L-PAS Document 5 Filed 04/09/14 Page 35 of 36 PageID #: 116 Case 1:14-cv-00175-L-PAS Document 3-2 Filed 04/08/14 Page 35 of 36 PagelD #: 72
EVEL.HILL Deputy Assistant Attorney General Civil Rights Division REBECCA B. BOND Section Chief SHEILA M. FORAN Special Legal Counsel ANNE S. RAISH Deputy Chief Disability Rights Section Civil Rights Division REGINA KLINE
H. JUSTIN PARK Trial Attorneys Disability Rights Section Civil Rights Division U.S. Department of Justice
35 , '

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FOR THE STATE OF RHODE ISLAND: HONORABLE LINCOLN D. C Governor for the State of Rhode sland
Dire or Depa ent of Behavioral Healthcare, Developmental Disabilities and Hospitals
Director Rhode Island Department of Human Services
~-------------Rhode Island Commissionerof Education
36

 
 Case 1:14-cv-00175-JJM-PAS Document 35 Filed 05/18/16 Page 1 of 8 PageID #: 2106

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

)

UNITED STATES OF AMERICA,

)

Plaintiff,

)

)

v.

)

)

STATE OF RHODE ISLAND,

)

________D_ef_en_da_n_t. ___________

)
)

C.A. No. 14-175-M-PAS

ORDER
After a review ofall ofthe material submitted to the Court and after conducting status conferences and evidentiary hearings, the Court has concluded that the State of Rhode Island must take the following actions to ensure full compliance with the Consent Decree (ECF No. 5) in this matter.
It is hereby ORDERED that the State will: 1.) Appropriate the additional money contained in the Governor's budget for fiscal year 2017 in order to fund compliance with the Consent Decree. 2.) Create a live database that will allow for efficient and effective tracking of each member ofeach target population outlined in the Consent Decree and all related and required services and outcomes, including dates for assessment and the start of services related to Individual Plans for Employment ("IPEs"), Individual Support Plans ("ISPs"), Individual Education Plans ("IEPs") and/or Individual Learning Plans ("ILPs"), where applicable. For those individuals who receive IEPs, the database will track dates of each IEP meeting and whether the Department of Behavioral

Case 1:14-cv-00175-JJM-PAS Document 35 Filed 05/18/16 Page 2 of 8 PageID #: 2107
Healthcare, Developmental Disabilities & Hospitals ("BHDDH") or the Office of Rehabilitation Services ("ORS") attended the meeting. The live database will also track, by individual: a) the date on which each Career Development Plan ("CDP") was finalized; b) each date on which a CDP was updated to demonstrate whether the CDP is being revised at least annually, as required by the Consent Decree; and c) the date(s) of benefits counseling and distribution of a written benefits plan for all individuals scheduled to transition to a Supported Employment Placement or Integrated Day Services, as well as for all members of the Rhode Island Youth Exit, Rhode Island Sheltered Workshop, and Rhode Island Day Program Target Populations who have received offers of employment. For Youth Exit and Transition Target Population members, the live database will also track the transition process, including the following dates: a) first contact with BHDDH; b) initial assessment; c) approval of services; d) Supports Intensity Scale ("SIS") assessment; e) tier assignment (and which tier was assigned); and J) date of start of services. The State must report to the United States and the Court Monitor on progress relating to the database on or before July 30, 2016.
3.) By July 29, 2016, provide the United States and the Court Monitor with either access to the database or a list of database entries from which the United States and the Court Monitor will select files at random for verification. The United States and the Court Monitor will each provide a selection of entries to the State on or before August 5, 2016. By August 12, 2016, the State will produce for verification
2

Case 1:14-cv-00175-JJM-PAS Document 35 Filed 05/18/16 Page 3 of 8 PageID #: 2108
the Career Development and benefits plans associated with the files selected by the United States and the Court Monitor.
4.) From this date forward, comply with every deadline in the Consent Decree, with compliance measured, in part, by regular reports of supported employment placements filed with the Court by the Court Monitor.
5.) The State shall maintain sufficient records to document that the requirements of this Order are being properly implemented and shall file evidence of compliance with the Court through the ECF system in accordance with the following dates:
a. By July 1, 2016, finalize a project management plan for Consent Decree activities, developed and agreed to by BHDDH, ORS and RIDE, with enumerated goals, tasks, deadlines, interim deadlines, and names of project leads.
b. By July 1, 2016, finalize a transition timeline, developed and agreed to by BHDDH, ORS and RIDE, that identifies each agency's responsibility for engagement with individuals transitioning from the youth to adult service systems, including associated timelines for initial engagement, assessment, and start of services.
c. By July 1, 2016, finalize a communication plan. The communication plan will include a method of communicating to individuals and families the status of any pending BHDDH IDD services eligibility request, deadlines for any required actions by the individual, and expected dates for initial
3

Case 1:14-cv-00175-JJM-PAS Document 35 Filed 05/18/16 Page 4 of 8 PageID #: 2109

assessment; approval of services; SIS assessment; tier assignment; and start

of services.

d. As part of its communication plan, the State will outline its efforts to

gather information from the community, including but not limited to: 1)

specific dates and audiences for future community meetings; 2) proposed dates

for two meetings with the Employment First Task Force attended by the

,,

Deputy Secretary of the Rhode Island Executive Office of Health and Human

Services in the next six months; 3) updates to agency websites that provide

individuals and families with practical information on services and deadlines

to support seamless transitions; and 4) a specific Consent Decree update to be

shared through the BHDDH newsletter by July 29, 2016.

e. By July 1, 2016, add to BHDDH Policy No. SIS·4 "Service Tier

Policy/Assigning Resource Allocation," a provision requiring that all decisions

involving SIS tier assignments and changes will be made by BHDDH staff in

a manner that is consistent with individuals' support needs, separate and

apart from resource allocation considerations.

f. By July 29, 2016, file with the Court agendas or meeting minutes that

demonstrate training of all SIS Interviewers and Assessors on the above listed

change to BHDDH Policy No. SIS·4.

g. By July 1, 2016, finalize a plan for ensuring consistent attendance by

individuals employed by BHDDH or ORS at IEP meetings for transition age

individuals.

4

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h. By July 29, 2016, BHDDH, ORS and RIDE must implement ongoing training on the use of career development plans and provide regular supervision to ensure all relevant agency staff are using the plans as contemplated by and required in the Consent Decree.
i. By July 29, 2016, RIDE must train all census clerks to accurately report the number of career development plans in place.
J. By July 29, 2016, hire a Program Developer and Employment Specialist.
k. By August 1, 2016, implement a new reimbursement model for services that is sufficiently flexible to allow providers to be reimbursed for services rendered, including, but not limited to career exploration discovery services, vocational situational assessments, work trials, development of job seeker profiles, job search and placement, job training and support, support coordination, and transportation services.
l. By August 1, 2016, implement a new service package design that includes service authorizations for Supported Employment Services.
m. By August 1, 2016, implement performance-based contracts to provide Supported Employment Services to individuals in the Target Populations that link funding to graduated levels of providers' achievement of quality numerical targets and implementation timelines, with evidence that all remaining providers have signed such a contract by December 31, 2016.
5

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n. By August 1, 2016, appropriately increase salaries, benefits, training, and supervision for Direct Support Professionals and Job Coaches.
o. By December 31, 2016, file with the Court examples of weekly activity plans used by each Integrated Day Services provider that has received increased funding for services required by the Consent Decree, demonstrating adherence to the definitions and standards set forth in Sections V·VI of the Consent Decree. 6.) By May 30, 2016, compensate the Court Monitor for all monies owed as of the date of this Order under the relevant employment contract. Continue to compensate the Court Monitor in the amount and on the schedule outlined in the relevant employment contract throughout the entire term of the contract or this Consent Decree, whichever comes later. 7.) By May 30, 2016, compensate the Consent Decree Coordinator for all monies owed as of the date of this Order under the relevant employment contract. Continue to compensate the Consent Decree Coordinator in the amount and on the schedule outlined in the relevant employment contract throughout the entire term of the contract or this Consent Decree, whichever comes later. 8.) In the event of any violation of this Order, including any violation of a deadline imposed by this Order, upon motion by the United States or upon notice by the Court Monitor, the Court will forthwith conduct a show cause hearing as to why the State should not be held in contempt and why the following sanctions should not be imposed:
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a. The State to contribute to a Consent Decree Compliance Fund $5,000 per day for each provision violated until the violations are remedied and the State is in compliance.
b. The State to make additional payments of $100 per day for each member of the target populations whose employment or integrated day services are delayed or interrupted as a result of violation of this Order.
c. The Court Monitor to track compliance with any Order of this Court arising from the show cause hearing, and to notify the Court, State, and the United States ofany noncompliance, and calculate the appropriate amount due to the Consent Decree Compliance Fund.
d. The State to pay the amount due into the Fund within 14 days of the Court Monitor's notification. Total monies paid as a result of an Order of this Court will not exceed $1,000,000 per year.
e. The Consent Decree Compliance fund will be used to fund Consent Decree activities that directly benefit target population members. The Court Monitor is charged with making recommendations to the Court, in consultation with the State and the United States, as to how the fund will be used. Disbursement form the Fund will be subject to a Court order after hearing from the parties. 9.) In the event that the State believes that any term in this Order is ambiguous or any mandate ill defined, it shall immediately consult with the United States and Court Monitor in order to seek clarification and consensus on the term or
7

Case 1:14-cv-00175-JJM-PAS Document 35 Filed 05/18/16 Page 8 of 8 PageID #: 2113 mandate. In the event that the State continues to believe that any term is not sufficiently defined or any mandate not clear, the State shall immediately seek a hearing with the Court.
John J. McConnell, Jr. United States District Judge May 18, 2016
8

 
 Case 1:14-cv-00175-JJM-PAS Document 7 Filed 09/17/15 Page 1 of 66 PageID #: 119
Report of the Court Monitor Progress on the Consent Decree United States v. State of Rhode Island
United States District Court District of Rhode Island Civil Action No. CA14-175
Period of Review: April9, 2014 -April10, 2015 Respectfully Submitted Charles Moseley EdD
U.S. District Court Monitor Issued August 17, 2015

Case 1:14-cv-00175-JJM-PAS Document 7 Filed 09/17/15 Page 2 of 66 PageID #: 120

Table of Contents

I. Executive Summary

3

II. Introduction

A Background

8

B. Key Terms, Target Populations and Provisions

8

C. Assessing Progress

8

IV. Findings: Review of Progress on the Operational Provisions

11

A Outcomes

12

B. Supported Employment Services and Placements

12

C. Career Developmental Planning

17

D. Transition Planning for Youth

25

E. Training

37

F. Outreach, Education and Support

42

G. Provider Capacity

44

H. State and Other Agency Actions

47

I. Interagency Collaboration

50

J. Funding

51

K. Quality Improvement

57

L. Data Collection and Reporting

61

V. Attachments

65

2

Case 1:14-cv-00175-JJM-PAS Document 7 Filed 09/17/15 Page 3 of 66 PageID #: 121
I. Executive Summary
The filing of the Consent Decree on April 9, 2014launched the State of Rhode Island on a major initiative designed to change the nature and operation of day and employment services furnished to individuals with intellectual and developmental disabilities (IDD) who receive publicly financed supports. Under the terms and conditions of the Consent Decree, the State made a sustained commitment to transform its service system to provide individuals with IDD the training and support they need to: (a) become employed in competitive, integrated jobs working alongside people without disabilities and paid a minimum wage or higher; and (b) fully participate in community activities of their own choosing with friends, families and other members of society. Through this agreement over the next 10 years, the State will provide the option of integrated day and employment services to approximately 3,250 individuals with IDD. Supported employment placements, or competitive, integrated employment, will be provided by the State to approximately 2,000 individuals, including at least 700 people currently in sheltered workshops, at least 950 persons currently in facility-based non-work programs, and approximately 300-350 students leaving high school. Additionally, transition services will be provided to approximately 1,250 youth between the ages of 14 and 21.
This report documents the progress that has taken place during the first year of Consent Decree implementation with a particular focus on the provisions specifically related to two target populations, the RI Youth Exit Target population and the RI Youth Transition Target Population. The report also covers activities related to key infrastructure development including the establishment of the Sheltered Workshop Conversion Institute, the Conversion Trust Fund, Quality Improvement and other programs. Progress on several of the benchmarks related to activities of the RI Sheltered Workshop Target Population and the RI Day Target Population are deferred to subsequent reports.
The agreement requires the three State agencies responsible for providing the majority of services to children and adults with IDD, the department of Behavioral Health Developmental Disabilities and Hospitals (BHDDH), the Rhode Island Department of Education (RIDE) and the Office of Rehabilitative Services (ORS) to reach key performance milestones within the first year and on an ongoing basis thereafter. During the pendency of the agreement the State must revise or replace existing policy, regulatory, funding, and operational barriers with new rules, practices and outcome based services designed to ensure full access to integrated employment and community resources.
The Office of the Governor strongly supports the accomplishment of the goals and outcomes of the Consent Decree. The State's new administration has reinvigorated efforts among state agencies to accomplish the changes necessary to meet the terms of the Consent Decree. Key administration officials, department heads and staff across state government agencies are working to bring about needed changes.
This review reveals that the State has made significant progress in meeting the many performance benchmarks identified by the Consent Decree that were to be achieved during
3

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this period. Additional actions need to be taken by BHDDH, ORS and RIDE to fully operationalize the changes that have been made and to build the foundation for the next stages of system change and program development.
The State has made progress in the following areas:
• Leadership, oversight and management. o The State's mid-year elections resulted in the inauguration of a new Governor and a renewed commitment by the State to carry out the terms of the Consent Decree, bringing about cultural change for people with IDD receiving publicly financed support and establishing a new floor by which the system would be measured. o The new administration hired new state agency leadership, including the Secretary of the Executive Office of Health and Human Services, the Director of BHDDH and the Associate Director for the Division of Developmental Disabilities. o Within the first 90 days of her appointment the new BHDDH director initiated a comprehensive examination of the state's efforts to meet the terms of the Consent Decree. o The administration shifted Consent Decree related budgets and relocated the staff coordinating the State's compliance efforts from the Office of Administration to BHDDH. o The State established the Office of the Consent Decree (OCD) with a full-time Coordinator and Deputy Coordinator to organize and facilitate state agency activities related to both the Consent Decree and the Interim Settlement Agreement. o During the first two months of the new administration, BHDDH cleared a backlog of eligibility determinations for over 120 people that had extended for the previous two years.
• Resources were secured for infrastructure change and development, including:
o Additional $2 million in state funding for services for people with IDD. o Fully funding the Sheltered Workshop Conversion Institute and the Sheltered
Workshop Conversion Trust Fund, consistent with Consent Decree requirements under Section XI. o Significantly increasing overall funding for IDD services.
• ORS expanded its resources to implement the Consent Decree adding an Assistant
Administrator for Supported Employment (SE) services and four new Master's Level Vocational Rehabilitation Counselors, one of whom is bilingual.
• Employment First policies were developed and implemented across the State and within BHDDH, ORS and RIDE, identifying employment as a primary goal and focus of service delivery and including the presumption that all members of the Target
4

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Populations are able to work in integrated employment settings at competitive wages and benefits.
• BHDDH ceased funding of new entrants to existing workshop programs during the past year. The Consent Decree does not require the closing of sheltered workshop programs.
• A Variance Policy was developed and approved by the Monitor for adults with IDD seeking alternatives to integrated employment.
• Youth Transition o The three state agencies developed and implemented a Transition Timeline identifying mutual responsibilities and anticipated performance outcomes to be achieved for each person with IDD between the ages of 14 and 21 years during their transition from school to adult services.
o RIDE and ORS expanded outreach to the Transition-Age Youth populations providing individuals with vocational assessments, career development plans and integrated work experiences. Additional training opportunities were made available to staff, families and stakeholders.
• The State developed and received provisional approval from the Monitor for an Outreach, In-Reach, and Education Program. The draft program is currently being implemented.
• The State received approval from the Monitor for the Values-Based CompetencyBased Training Program which is now being implemented.
• The Employment First Task Force, required by Section X(3) of the Decree, was formed and is operational. Membership includes representatives from stakeholder organizations, the Sherlock Center, the Community Provider Network of Rhode Island, the Developmental Disabilities Council, Rhode Island Parent Information Network, individuals with IDD, families and others. The Task Force meets with the monitor and with State officials.
• Person Centered Career Development Planning. The implementation of personcentered planning and person centered career development plans is well underway with the Transition Youth Populations supported by RIDE and ORS.
• All three state agencies are providing training and support to strengthen the ability of direct service staff to provide person-centered services.
• BHDDH, RIDE and ORS are collaborating on the provision of transition services, training and the delivery of supports to members of the Target Populations.
5

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• The State made progress on securing contracts with technical assistance providers to deliver needed staff training and direct assistance to the State and to provider agencies on effective strategies for bring about the changes that must be made.
• The State made progress on finalizing an interagency Memorandum of Understanding that meets the requirements of the Consent Decree.
Additional work needs to be completed to fully operationalize the changes that have been made and build the foundation for the next stages of system development:
• The State has made progress on rapidly increasing the number of Youth Exit Target Population members who achieve supported employment placements pursuant to Section IV(S) of the Consent Decree, but additional members of that population will need to be placed.
• BHDDH is working with provider agencies and stakeholders to revise the processes by which the Support Intensity Scale (SIS) is administered, individual service determinations are made, support related funds are allocated, and appeals are processed to increase individual and family input and responsiveness.
• The current DD services funding methodology is being reviewed to address concerns that individuals' funding levels are not sufficient to enable provider agencies to meet placement targets.
• State agencies are collaborating on efforts to construct an effective strategy for meeting the needs of individuals with IDD for benefits planning services.
• BHDDH is redesigning its existing person centered career development planning process to strengthen outcome-based planning and improve consumer participation. A draft process has received input from providers and the Monitor, and is awaiting implementation.
Progress needs to be accomplished in the following areas:
• Quality Improvement. BHDDH, RIDE and ORS are conducting quality improvement activities within each of their agencies. Additional work needs to be completed to ensure the statewide Quality Improvement initiative includes clear program standards and policies for conducting on-site reviews, performance reporting, remediation and follow-up.
• Funding. As noted above, additional state funding for IDD services was included in the Governor's budget and approved by the Legislature. BHDDH needs to continue current efforts to review the methodology for the allocation of service funding to ensure provider agencies are able to accomplish the supported employment and day service outcomes required by the Consent Decree.
6

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• Data Collection and Reporting. The Consent Decree requires that data be regularly
gathered and reported by the State on approximately 44 key individual and system performance outcomes. BHDDH, ORS and RIDE are each collecting some of the information that is required but systems are not in place to gather, analyze and report this data across BHDDH, ORS and RIDE. The State is actively addressing this benchmark, but urgent action is needed if the State is to be able to effectively document and claim credit for the changes that are being made and the outcomes that are being accomplished. This report identifies key benchmarks for each operational provision of the Consent Decree and the status of the State's efforts to address the various outcomes. Each section concludes with a statement of recommended actions the State should take to meet Consent Decree requirements.
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II. Introduction
A. Background
The Consent Decree between the United States of America and the State of Rhode Island resolves the United States' findings of violations by the State of Rhode Island of Title II of the Americans with Disabilities Act of 1990 (ADA), 42 U.S.C. § 12131, et seq., as interpreted by the United States Supreme Court in Olmstead v. L.C., 527 U.S. 581 (1999), through its administration and operation of its day activity service system, including employment, vocational, and day services, 46-1-14 R.I. CodeR.§ 43.0, for individuals with intellectual and developmental disabilities (IDD).
B. Key Terms, Target Populations and Provisions
Definitions (CD Section II). The Consent Decree pertains to the State's delivery of employment services and supports to members of the four Target Groups (see below). Key operational terms, service types and activities are defined to ensure consistency in language, meaning and understanding among the many individuals and groups who have a part in carrying out the Consent Decree's objectives and anticipated outcomes.
Target Populations (CD Section III). Under the terms of the Consent Decree the following individuals are eligible for Supported Employment Services, Integrated Day Services, and/or transition services:
1. Rhode Island Sheltered Workshop Target Population. Individuals with IDD who receive day activity services in settings where they perform sheltered workshop tasks or have received day activity services in such settings during the year before the Consent Decree went into effect.
2. Rhode Island Day Target Population. Individuals with IDD who receive day activity services in facility-based day program settings or have received such services during the year before the Consent Decree went into effect.
3. Rhode Island Youth Transition Target Population. Individuals with IDD who are transition-age youth according to current Rhode Island law, currently attending a Rhode Island secondary school.
4. Rhode Island Youth Exit Target Population. Individuals with IDD who are transition-age youth who have exited or who will exit a Rhode Island secondary school during the 2013-2014, 2014-2015, or 2015-2016 school years.
C. Assessing Progress
Focus and Methodology. This report describes the State's efforts to meet the terms and conditions of the Consent Decree during the first 12 months of implementation and
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includes reference to key actions and activities, such as BHDDH's request for additional funding, that were initiated during the first year and completed in the early months of the following year.
During the past year the Monitor's work focused on developing an understanding of Rhode Island's developmental disabilities service delivery system and the role played by the Consent Decree in changing the funding, structure and operation of employment services to bring the State into compliance with the ADA. Emphasis was placed on ensuring that: (a) members of the target populations received the services and supports that were required to be furnished to them under the terms of the agreement, and (b) the State was making changes in policies and procedures as consistent with the provisions of the Consent Decree.
The review process involved six (6) on-site visits to the State and regular weekly or biweekly contact with the RI State Consent Decree Coordinator and DOJ. Numerous scheduled and unscheduled telephonic meetings were held with the directors and key staff of BHDDH, RIDE and ORS, staff from the RI Developmental Disabilities Council, the director of the Sherlock Center at Rhode Island College and other advocates. One meeting was held specifically with Advocates in Action, the State self-advocacy organization. Discussions focused on state strategies for system change, the identification and removal of regulatory and programmatic barriers and the provision of updates on current events and activities of relevance to the Consent Decree. The Monitor additionally reviewed case files of a sample of approximately 35 individuals receiving support, met with families and advocates, observed services being provided and engaged in detailed discussions of needed actions and activities with state agency personnel from BHDDH, RIDE and ORS. The Monitor's report reviews and evaluates the many objectives that need to be (and have been) accomplished by the State with respect to the services and supports offered to target population members within the broader context of state systems change.
Early goals of this Monitor were to develop an understanding and familiarity with key components of Rhode Island's publicly funded system of employment supports and day services for people with IDD with respect to five key areas:
1. Leadership, vision and values. The extent to which the goals and aspirations of the Consent Decree were reflected in the language and actions of key department and school leaders.
2. Policy alignment. The extent to which the structure and functioning of the State's service delivery system for people with IDD, as operated and overseen by BHDDH, RIDE, and ORS, support the state's efforts to change consistent with the Consent Decree.
3. Funding and financing flexibility. The extent to which funding from available resources and budgets is sufficient to ensure individuals in the identified target populations receive the services and supports necessary to comply with the standards and timelines identified in the Consent Decree.
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4. Interagency collaboration. The Consent Decree covers activities across three State departments. The extent to which the three State departments work together to enable members of the Target Populations to receive continuous and uninterrupted services as adults moving from segregated, sheltered settings to supported employment and as youth transitioning from school to adult services.
5. Outcome and performance data. The extent to which the State has systems in place within and across departments to document and report individual outcomes, track system performance and effectively demonstrate progress in implementing the Consent Decree over time.
Data for this report was gathered through a number of different sources, methods and strategies including:
• Interviews of the directors and key staff of BHDDH, RIDE, and ORS.
• Discussions of the requirements of the Consent Decree and the challenges of
systems change with provider agency directors who are members of the Community Provider Network of Rhode Island.
• Interviews with the director and key staff of the Rhode Island College Sherlock
Center and with representatives of the Rhode Island Developmental Disabilities Council.
• Visits to a sample of seven (7) developmental disabilities services provider
organizations across the state, visits with people with IDD receiving support and interviews of program directors and key staff.
• Participation in meetings coordinated by the State agencies to improve and expand
access to benefits counseling services, redesign career development planning tools, improve outcome and service related data, and address other key areas identified by the Consent Decree.
• Interviews and meetings with stakeholders on the content and pace of change in state agencies.
• Meetings with the leadership of provider agencies to learn about and understand
the barriers and challenges they face in implementing the Consent Decree.
• Participation in meetings of the Employment First Task Force discussing barriers to
Consent Decree implementation and effective strategies for moving forward with systems change.
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• Review and analysis of state data, records and documentation of services and supports furnished to members of the Target Groups conducted by a subject matter expert in collaboration with the Monitor and key state agency officials.
• Discussions with Burns and Associates on the use of the Supports Intensity Scale (SIS) for needs assessment and individual resource allocations. Review of related documentation and the use of claims data.
Based on information and data gathered through the review process, three areas are prioritized for additional focus in the months ahead: (a) tracking and analyzing Consent Decree outcome and performance data (as identified by Section XVI of the Consent Decree) within each department; (b) evaluating the delivery of required services and supports; and (c) assessing leadership and the development of effective and inclusive strategies for changing the State's IDD system in line with the provisions ofthe Consent Decree. These areas are highlighted in the findings section.
The Monitor independently validated much of the information and data provided by the State. Additional steps will be taken during the upcoming review period to verify data reported on individual Target Population members as well as summary data furnished by the State on services and supports provided and outcomes achieved.
III. Findings: Review of Progress on Consent Decree Provisions
This section describes progress on achieving key benchmarks identified in the operational provisions of the Consent Decree and includes a summary of the status of the State's activities to date, additional information that the State may need to provide and the steps the State must take to make progress under the Agreement. The term "operational provisions" refers to those provisions of the Consent Decree that require specific changes to be made in State policy, regulation and practice that affect the delivery of services and supports to the identified Target Populations. Generally these provisions are located in Sections IV through XVI.
This review focuses on key activities accomplished during the first year of implementation, addressing some areas in detail and deferring consideration of others to future reports. Particular emphasis is placed on activities and outcomes related to two target populations; the Rhode Island Youth Transition Target Population and the Rhode Island Youth Exit Population. The review of progress being made by the State with respect to the Sheltered Workshop Target Population and the Day Program Target Population is deferred to subsequent reports.
As noted in the Executive Summary, during the first year of implementation the State spent considerable time and effort developing the plans and strategies to implement the requirements of the Consent Decree and establish mechanisms for adequately funding needed services, tracking individual outcomes and ensuring system performance and quality. Accordingly, this review finds that considerable progress was made on achieving
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the outcomes of some of the operational provisions while less headway was made on others. It is important to note that this finding does not mean that the State is ignoring or downplaying the importance of selected Consent Decree provisions, but rather that the process of systems change takes place in a non-linear fashion, with some areas needing to be addressed before others in order to remove programmatic barriers, secure necessary resources or develop new approaches. An outline of Consent Decree provisions that are covered by this report or deferred for subsequent reviews is included at Attachment 1.
A. Outcomes (CD Section IV)
The Outcomes section summarizes key performance benchmarks, systems change requirements and procedural obligations the State must address to demonstrate progress on achieving the terms and conditions of the Consent Decree. Virtually all of these requirements are included and described in more detail in subsequent sections of the Agreement. To improve readability and avoid redundancy, information on the State's progress in meeting the various benchmarks identified in the Outcomes section is reported within the relevant topical section consistent with the arrangement of the various provisions of the Consent Decree. For example, all information regarding the State's progress on meeting supported employment placement requirements is located in Section Cof this report, Supported Employment Services and Placements.
B. Supported Employment Services and Placements (CD Sections IV and
V)
Provisions within this section of the Consent Decree define and describe the nature and composition of Supported Employment Services furnished to individuals with IDD by the State and the attributes of a qualifying Supported Employment Placement. Performance expectations, including the presumption that all individuals in the four target groups are capable of integrated employment, are provided as well as specific operational benchmarks setting the parameters of the services and supports to be offered. This section additionally details a variance process for individuals in the target populations who choose not to seek employment in integrated settings.
Progress
Benchmark 1 Integrated Employment §IV(2). By October 1, 2014, and by September 1st of every succeeding year of this Consent Decree, the State will provide all individuals in the Rhode Island Youth Transition Target Population the appropriate services and supports described in Sections V(A) (1)-(2) necessary to introduce them to work in integrated settings, in accordance with the youth transition process and milestones set forth in Sections VIII(4)-(10). Integrated employment services will be identified in the individual's annual person centered plan and career development plan as set forth in Section VIII.
Status:
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RIDE identified 526 youth with IDD in the Transition Target Population who are enrolled in Rhode Island LEAs. The department, in collaboration with the Regional Transition Centers (RTC) and ORS, provided training and resources to the LEAs to improve the provision of services and supports as described in Sections V (A) (1)(2). In addition, these services were incorporated into RIDE's Career Development Plan (CDP) template to guide and document the provision of school-based preparatory experiences and community-based work trials.
ORS has provided services to 109 Transition Youth in the 2013-14 and 2014-15 exit populations. A 2013 Cooperative Agreement between RIDE and ORS ensures the presence of ORS Masters-level vocational rehabilitation counselors in each high school in the State of Rhode Island. This agreement enables ORS to attend IEP and CDP meetings and partner with schools in the provision of vocational assessments and work experiences prior to graduation. As a result, upon graduation, the student has an established relationship with an ORS VR Counselor and an Individualized Plan for Employment (IPE) that creates blueprint for services to reach an integrated, competitive, community-based employment outcome. RIDE has identified to the LEAs the specific youth with IDD who should be in consultation with ORS regarding career development planning. ORS is identifying eligible youth with IDD on their caseloads who are due to exit school during the current school year. Once identified, ORS works with the LEA to convene meetings with the youth, family, BHDDH and ORS to ensure access to integrated work experiences and adult provider involvement prior to graduation.
BHDDH has taken steps to increase the ability of Developmental Disabilities Division (DDD) caseworkers to attend IEP/CDP planning meetings for the Youth Exit and Youth Transition populations (see below). A memo was sent to all Developmental Disability Provider Organizations (DDOs) notifying them that Transition Age Youth cannot take part in any vocational assessments in segregated settings. BHDDH revised policies and practices to comply with the Consent Decree and updated its external website to reflect these policy changes. The BHDDH director, in written testimony to the Rhode Island House Finance Committee, identified programmatic and financial barriers that are impeding the ability of the department to meet the State's Consent Decree mandates.
Summary. RIDE identified the youth in transition and is engaged in career development planning in collaboration with ORS. RIDE has worked closely with the LEAs to provide needed training and support to special education teachers and staff. ORS has identified the youth in transition receiving ORS supports in the 2013-14, and 2014-15 exit populations. BHDDH did not furnish information on the numbers of Transition Age Youth that DDD has been involved with during the past year. The department is working to increase the involvement of DDD caseworkers with local schools, improve staff training and strengthen collaboration with the LEAs, RIDE and ORS. BHDDH's recently approved budget includes additional funding for transition activities.
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Benchmark 2 - Supported Employment Placements IV(8) (a-b) - The State will provide Supported Employment Placements and Integrated Day Services as detailed in Sections VVI of the Consent Decree for individuals in the Rhode Island Youth Exit and the Rhode Island Sheltered Workshop Target Populations according to the schedule in this section.
(a) By January 1, 2015, the State will provide Supported Employment Placements to at least 50 individuals in the Rhode Island Youth Exit Target Population who left school during the 2013-2014 school year.
(b) By July 1, 2015, the State will provide Supported Employment Placements to all remaining individuals in the Rhode Island Youth Exit Target Population who left, or will leave, school during the 2013-2014 and 2014-2015 school years.
Status:
RIDE provided the Monitor, ORS, and BHDDH information on the total number of students who have a qualifying condition of intellectual disabilities enumerated by the June 2014 RI Special Education Census in September 2014.
Based on the June, 2014 RI Special Education Census, approximately 183 students were identified as comprising the Rhode Island Youth Exit Target Population.
2013-2014 • 54 students who qualify as youth with IDD exited between September 1, 2013- August 31,2014 • 16 school districts had fewer than 10 students exit with IDD between September 1, 2013- August 31,2014 • Providence was the only district with more than 10 students who exited with IDD. Providence had 21 students with IDD exit September 1, 2013- August 31, 2014
All individuals who were placed in supported employment were compensated at $9.00 per hour, the state minimum wage. Documentation indicates that the provider agencies, ORS and BHDDH continue to move individuals who are not working toward integrated, competitive employment. ORS submitted information in a report dated July 1, 2015 showing that between April30, 2015 and July 1, 2015, the State nearly doubled the number of the 2013-2014 Youth Exit target population members who are in competitive, integrated employment, bringing the current total to 21. It is important to note that there may be more than 54 individuals in this target population and that additional members of this population may be identified in the future.
BHDDH reports that it continues to provide individuals with support services needed to obtain or maintain employment in integrated work settings. Necessary
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resources are provided to support individuals in their search for employment. BHDDH social caseworkers assist individuals with IDD in locating service providers with the capacity to serve new applicants in their programs.
Summary. The State has made strong efforts to improve the ability and capacity of the education and adult service systems to move Target Group members toward supported employment placements through increased training and coordination between departments. Staff training and effective coordination is essential, but efforts need to be more strongly focused on increasing the number of persons receiving supported employment placements, consistent with the Consent Decree targets. A key step toward achieving this goal lies in the documentation of the numbers of individuals receiving supports in each of the various categories of service leading to the actual job placement (see below).
Benchmark 3- Presumption of Employability §V(E). Provisions require BHDDH, ORS and RIDE to establish and implement policies regarding employment for people with disabilities policies that presume that all individuals covered by the Consent Decree are capable of working in integrated employment settings.
Status:
Former Rhode Island Governor, Lincoln Chaffee, signed an Employment First Executive Order on October 22,2014. This policy requires BHDDH, ORS and RIDE to include in each department's policies and practices the presumption that all individuals with IDD can work in integrated employment setting, making a competitive wage and receiving benefits. These expectations, including the focus on employment as the primary objective are included in the policies, practices and regulations of each state agency.
All Transition Youth who are exiting school are eligible for Supported Employment Services. It is BHDDH's position, policy and philosophy that every individual is capable of working in a position that affords them the same opportunities as their non-disabled counterparts. This policy has been disseminated through the Transition to Adult Services brochures. The Employment First Policy, which can be found on BHDDH's external website, addresses segregated setting and work environments.
Summary. BHDDH, ORS and RIDE have included the presumption that all individuals with IDD are capable of becoming employed in integrated settings in their policies and procedures. To assess progress on this provision additional information on the numbers and percentages of target group members who have been evaluated and determined to be "unemployable" or otherwise not able to receive vocational or employment services should be reported to the Monitor..
Benchmark 4- Establishment of a Variance Process §V(L), (M), & (N). A variance process must be established by the State to accommodate individuals who, after receiving
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information, services and work experiences, make an informed choice not to work in integrated settings. All variances are re-assessed after 180 days and annually thereafter to ensure individuals have the opportunity to make an informed and meaningful choice to receive supported employment in an integrated setting and are subject to review and approval by the Monitor.
Status: The variance process was developed and provisionally approved by the Monitor in October 2014, and currently is operational for members of the target populations. Final approval of the policy and related forms occurred in June 2015. Variances may only be granted after an individual has:
a. Participated in at least one vocational or situational assessment, as defined in Section II of the Consent Decree;
b. Completed one trial work experience, as defined in Section II;
c. Received the outreach, education, and support services described in Section X; and
d. Received a benefits counseling consultation, as described in Sections IV(6).
No variances have been requested or granted to date. However, staff from BHDDH and provider agencies have provided examples of target population members who indicate that they are not interested in competitive employment at this time. This suggests that information on the variance application process has not been made available or is not well understood by people with disabilities, providers, families, and others who may be interested in taking advantage of this provision.
Summary. The State's variance process includes the required activities and provisions. It has been approved by the Monitor and is in the early stages of implementation. The Monitor will review all variance requests.
Achieving Progress on Meeting the Terms ofthe Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree
1. BHDDH and ORS are requested to provide to the Monitor information on their efforts to ensure individuals with IDD, their families and service providers are aware of and understand the variance process.
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C. Career Development Planning (CD Section VII)

Person Centered Career Development Plan Deadlines and Outcomes Summary

Date

Target Population(s)

101112014 Youth Transition

.Requirement Receives all SE services V(A)(1)-(2) and

Reference IV(2)(3)

Vlll(4)-(10)

• Receives Person Centered Planning I

Career Development Planning beginning

11112015 Youth Exit

. at age 14, updated annually Receives Person Centered Planning I

IV(1), (5)

Career Development Planning and

services V(A)(1)-(2)

11112015 11112016

Sheltered Workshop, Day Program, Youth Exit Sheltered Workshop, Day Program

State adopts and implements COP policies covering each individual State provides COP for each individual

Vlll(1) IV(5)

Progress
Benchmark 1- Person Centered Career Planning Outcomes §IV(1), (3).
Rhode Island Youth Exit Target Population. By January 1, 2015, the State will provide all individuals in the Rhode Island Youth Exit Target Population person-centered planning (PCP) resulting in a career development plan (CDP). The CDP must include the services and supports described in Sections V(A)(1)-(2) as necessary and appropriate to introduce them to work in integrated settings consistent with the youth transition process and milestones set forth in Sections VIII(4)-(10). Youth Exit Target Population members will become eligible for a Supported Employment Placement, as provided in Section V, upon their exit from secondary school.
Status:
Youth Exit Population Current Census: 183
• 2013-14: 54 students who qualified as youth with IDD exited Sept. 1, 2013Aug. 31, 2014.
• 2014-15: 53 students who qualify as youth with I/DD will reach age 21 between September 1, 2014-Aug.31, 2015.
• 2015-16: 76 current students who qualify as youth with I/DD who will reach age 21 between September 1, 2015 and August 1, 2016.

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RIDE developed a Person Centered Planning approach for LEAs that organizes services and supports around a self-determined, self-directed future for individuals with IDD based on the person's skills, preferences, strengths and abilities. RIDE, in collaboration with ORS, the Rhode Island Parent Information Network (RIPIN) and BHDDH provided LEAs with brochures, fact sheets, and general information at IEP meetings, transition parent events, conferences, etc. RIDE provides information regarding Employment First, introduction to state services and knowledge of postsecondary services and supports begin at the age of 14 as indicated in the RI Transition Timeline.
Person Centered Planning (MAPS, Path, Discovery) Participation:
• RI Youth Exit Target Population 2014-2015: 24 students participated in a person centered planning process
• RI Youth Exit Target Population 2015-2016: 38 students participated in a person centered planning process.
• Sixty additional students who were not considered to be part of the "RI Youth Transition Target Population" or the "RI Youth Exit Target Population" were identified as being likely to be found eligible for developmental disability services through BHDDH. These students also participated in a person centered planning process.
BHDDH/DDD finalized a Person Centered Plan/Career Development Plan that was to be used by providers beginning July 1, 2015. Initial training on the new format was offered to provider organizations and the draft form was field tested by four provider agencies. The Monitor reviewed the plan format and recommended that revisions be made to make it outcome based, identifying specific objectives to be accomplished and more person-centered, reflecting the perspectives of the individual receiving support. As a result of the feedback received BHDDH opted to delay implementation until July 31, 2015 in order to make changes to ensure the development of a format that, "actually provides needed information." BHDDH continues to work with ORSon the development of a unified CDP format for the two agencies.
During the current 2014-15 school year BHDDH social casework supervisors attended a total of 54 Career Development Planning j IEP meetings at the LEAs for students who will be exiting school within the next year. The department is challenged by the current lack of internal capacity to meet the demand and the need for more effective communication/planning with the LEAs.
ORS' Individualized Plan for Employment (IPE) for both transitioning youth and adults with disabilities is based on principles of person-centered planning and informed choice. The IPE articulates a specific employment goal that is developed
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with the individual through vocational guidance and counseling and reflects the person's unique strengths, resources, priorities, concerns, abilities, capabilities, and interests. The IPE includes the services needed for the person to move toward his or her employment goal and is expected to be reviewed at least on an annual basis by the VR Counselor and individual (and others as appropriate). The IPE is described as a fluid document that can be amended with the agreement of the individual and the VR Counselor to best meet the person's needs. The goals, objectives, and services identified in the IPE for a student with a disability who is receiving special education services is coordinated with the student's individual education plan (IEP). In order to ensure in-school youth have an opportunity for informed choice, ORS, via a Memorandum of Understanding with RIDE, has a VR Counselor at every high school to consult with school personnel, provide guidance & career counseling, accept referrals, and offer assessment services and summer work opportunities. ORS has built on its relationships with RIDE and the LEAs to assist school personnel in implementing the State's obligations under the Consent Decree with respect to developing and updating Career Development Plans and collaborating on assessments and work experiences.
Summary. RIDE is tracking this population and providing needed training and supports to staff on person centered planning. ORS is using person centered planning instruments and has provided needed training to staff on the process. BHDDH has not completed its revision of its person-centered planning process and continued efforts need to be placed in this area.
RIDE provided data on the numbers of individuals receiving a person centered plan, ORS provided IPEs for the 54 identified members of the 2013-2014 Youth Exit target population. BHDDH did not furnish data on person centered planning or the number of CDPs. ORS reports that it has the capacity to provide data on the numbers of individuals in the Youth Exit Population with career development plans once they apply for ORS services. ORS participated in 110 CDP meetings at schools over this past school year and completed 109 IPEs for individuals with IDD in the 2013-14 and 2014-15 Youth Exit Populations. BHDDH provided print-outs of client files for the identified members of the 2013-14 Youth Exit Target population.
Rhode Island Youth Transition Target Population. The State will engage in an annual person-centered planning process with all individuals in the Rhode Island Youth Transition Target Population that will: (a) begin at age 14, (b) be updated annually, (c) address standards and milestones set forth in Section VIII, including the opportunity to access integrated transition work placements and information about post-secondary work in integrated settings, (d) provide information needed by individuals with IDD and their families to make an informed choice regarding remaining at school and adult services, and (e) result in a career development plan that consolidates the planning recommendations of school transition specialists and staff, ORS, and BHDDH representatives.
Status:
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Youth Transition Target Population Current Census: In 2014-15 there are 526 youth that qualify as persons with IDD ages 14-21 enrolled in Rhode Island LEAs.

See Benchmarks 2 and 3 in this section below.

Benchmark 2 - Career Development Planning Outcomes §IV(2), (5)

Youth Transition Target Population. The career development plan will: (a) be updated

annually, and (b) offer meaningful options for post-secondary Supported Employment and

Integrated Day Services beginning no later than the start of the school year in which they

will turn 18.

·

Youth Exit Target Population. By January 1, 2015, the State will provide career development plans, as described in Section VII, for each individual in the Rhode Island Youth Exit Target Population.

Status:

•\ RI Youth Exit Target Population 2014-2015: Currently, 46 students have career ', development plans. Several students were reported as having exited school or moved prior to the implementation of their career development plans.

• RI Youth Exit Target Population 2015-2016: 53 students currently have a career
development plan.

RIDE has identified 81 students who are not considered part of the RI Youth Transition Target Population or RI Youth Exit Target Population but may be likely to be found eligible for developmental disability services through BHDDH who currently have a career development plan. These students have developmental but not intellectual disabilities and should be considered as potential members of one of the target populations.

RIDE continues to inform LEA's of the requirement to annually update career development plans in collaboration with a student's IEP, ILP (Individual Learning Plan - a RI Secondary School Regulatory requirement), and IPE; and to incorporate plans in each student's Summary of Performance as appropriate. The department noted that additional training may be needed by the LEAs to align IEPs and CDPs in the upcoming year. As indicated in the RI Transition Timeline, RIDE will collaborate with ORS and BHDDH in providing students and families with information on the options for post-secondary supported employment and integrated day services for the youth with IDD. Three trainings on the CDP template were offered to LEAs introducing the document in detail. Training on CDPs continues to be provided to the LEAs through RIDE and the Regional Transition Centers. Currently, RIDE is conducting a survey with the LEAs to collect data on components of the CDP. Available data are identified within the benchmarks in this report.

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ORS participated in 110 Career Development Plan meetings at schools during the past school year and has provided an array of services to the 54 individuals in the RI Youth Exit Target Population including the development of IPEs. The agency has been working on the development of a Career Development Plan format with BHDDH and has been using the individual program plan to accomplish career development planning activities in the meantime.
BHDDH social casework supervisors attend the CDP meeting for individuals in their last year of school but do not have the capacity to attend CDP meetings for all Transition Age Youth during the four to seven years that they participate in special education. BHDDH has asked RIPIN to attend transition meetings of individuals beginning at age 14 years. The department also requested the parent network to provide the LEAs with brochures explaining BHDDH eligibility policies and services for distribution to IEP planning teams during meetings that BHDDH is unable to attend. BHDDH indicates that staff are available to meet with families and teams at different times and places if scheduling conflicts exist and have offered to go to families' homes.
Summary. RIDE is tracking and reporting data on the Youth Exit Population and the Youth Transition Target Population with career development plans. ORS is providing services to these individuals and is offering related training to practitioners. BHDDH has not finalized its process for career development planning but plans to implement its new format by September 2015. BHDDH did not provide data on Target Population members with CDPs.
Benchmark 3- Career Development Planning §VII(1)- The State must adopt and implement policies and procedures for developing career development plans for each individual in the Rhode Island Sheltered Workshop, Rhode Island Day, and Rhode Island Youth Exit Target Populations by January 1, 2015. The policies must presume that all Target Group members: (a) are capable of working in integrated employment settings, (b) have an active and leading role in the career development planning process, and (c) are determined eligible for employment without meeting any pre-established readiness criteria. See also Sections V-VI Section VII(7).
Status:
As noted in Benchmark 1 above, RIDE developed a person centered planning approach for LEAs that organizes services and supports around a self-determined, self-directed future for individuals with IDD based on each person's skills, preferences, strengths and abilities. Person centered planning trainings emphasized the importance of using this approach as the foundation for the CDP. RIDE reports that teachers currently are providing person centered planning with career development planning elements that are consistent with the Consent Decree. Three trainings on the CDP template were offered to LEAs introducing the document in detail.
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ORS is training all rehabilitation counselors with transition responsibilities on the career development plan format and process that was introduced to special education teachers. IPEs and IEPs with CDPs are in place for members of the Youth Exit Target Population.
Summary. Policies and procedures for the development and implementation of CDPs are in place for RIDE and ORS. BHDDH is redesigning its current format to improve person centeredness, individual involvement and integration with the person-centered planning process. As noted above, the new format is to be implemented by September 2015.
Benchmark 4- Benefits Planning §IV(6). All individuals in the RI Youth Exit, Sheltered Workshop, and Day Program Target Populations will receive benefits planning information and counseling from qualified professionals who are experienced and certified in Social Security and SSI regulations. A written analysis or "benefits plan" will be provided furnishing information to the individual, family or guardian regarding the impact of earned income on the individual's public benefits. Individuals also will receive information about their eligibility for the State's Medicaid Buy-in Program, or the "Sherlock Plan," and assistance with enrolling in that program. Benefits planning and information will be · provided no later than the year in which the person is scheduled to transition to a supported employment placement in accordance with the schedule in Section IV(S)(a) and (b).
Status:
ORS reports that of the 54 members of the Youth Exit Population exiting school during the 2013-14 school years and receiving ORS services, 19 individuals (35%) had received benefits counseling by June 8, 2015.
ORS entered into a contract with the Sherlock Center to build the State's capacity over a three-year period to furnish benefits counseling coordination. Additional deliverables are to increase the number of Social Security-approved benefits counselors, expand training locally to better meet the needs for services, and bring together state agencies and others with common goals and responsibilities. ORS, on behalf of the State, will be coordinating with the Regional Vocational Assessment Centers to conduct four regional benefits counseling orientations for students, families and educators in order to increase knowledge and understanding within the IDD community about benefits information. Two sessions have been completed.
RIDE in collaboration with ORS and the Regional Transition Centers offered two Benefits Planning Orientations for members of the Youth Exit Population (February 11, 2015 &AprilS, 2015) that were conducted by a qualified benefits counselor.
BHDDH has not, to date, provided benefits counseling to individuals in the Target Groups. Department staff have participated in discussions concerning benefits
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planning, but no concrete strategy has been developed to pay for benefits counseling. BHDDH has worked with the benefits counselors to better understand benefit resources that may be available to target group members and the issues involved in developing a benefits plan. DDD social caseworkers have received training on the Sherlock Plan. Caseworkers can provide basic information and answer general questions regarding the Sherlock Plan but are not able to furnish actual benefits planning at this time. The social services division is assisting individuals who are working apply for the Sherlock Plan.
BHDDH and ORS participate in the Sherlock Workgroup led by the Executive Office of Health and Human Services (EOHHS) that is addressing ways to expand access and information regarding the Sherlock Plan. These meetings have moved beyond discussions of the Sherlock Plan to include a larger conversation about benefits counseling. The discussion has resulted in a renewed focus among the participating departments on understanding and addressing the impact of income on the state and federal benefits received by people with disabilities. BHDDH has been attending these meetings for over a year. The Sherlock Workgroup met at least once a month to come up with a guide to provide information for working individuals with a developmental disability. BHDDH along with EOHHS made presentations to the stakeholders on the Sherlock Plan.
Summarv. Information is available from ORS on the provision of Benefits Planning for the 54 members of the Youth Exit Population exiting school during the 2013-14 school years but data is not available for the subsequent Youth Exit Target populations or for the Youth Transition Target population. ORS and BHDDH recognize the need for skilled personnel to provide required services in this area and are meeting with other state agencies and the Sherlock Center to address funding and resource availability. Progress on achieving this benchmark has been slow, however. BHDDH and ORS have agreed on an approach for expanding benefits planning to address the Consent Decree Target Populations. The State needs to develop and implement a plan for locating the resources and funding necessary to increase the number of qualified benefits counselors available to assist members of the Targeted Groups.
Benchmark 5 -Vocational Assessments and Eligibility Criteria §VII(2)-(7). All vocational assessments and vocational eligibility criteria will be person-centered, appropriately designed for individuals with IDD and based on the presumption that with the correct services and supports all individuals with IDD can work. The State shall ensure that all assessments conducted by BHDDH, ORS, and RIDE, as well as any vendors or contractors of the State are:
• Conducted in integrated settings that meet the definitions and standards set forth in Sections V(D)-(E).
• Conducted by appropriate and trained staff.
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• Consistent with and maintain fidelity to an asset-based assessment model (i.e. MAPS or PATHS).
• Able to be conducted in more than one community setting if requested by individuals eligible for support.
• Are conducted with the appropriate accommodations, services, and supports necessary for each targeted class member.
Status:
RIDE, in collaboration with the RTC's, developed the RI Transition Assessment Matrix to provide guidance for choosing the most age appropriate assessment in a person-centered format. The matrix is updated as new evidenced-based tools become available. The matrix was updated in October 2014 to include the most recent evidenced based assessments for youth with the most significant disabilities. A copy of the matrix was submitted to the State Consent Decree Coordinator in October 2014. Certified secondary special educators are qualified to conduct transition assessments. Many LEAs are having staff attend job coaching and job development trainings to obtain additional credentialing, although it is not required of school personnel under state educator licensure. The trainings emphasize the importance of using person centered planning, transition assessment and vocational evaluations for students.
RIDE ensures translation and interpretation services are provided to all individuals with communication or language disabilities through its authority under the IDEA. RIDE reports that no enforcement complaints were filed with the department under Sec. 300.29 in 2014-15. Sec. 300.29 Native language. BHDDH has a "Master Price Agreement" for sign language and foreign language interpreters that enables state and "quasi-state" agencies to purchase needed services and supports when required.
ORS reports that assessments and/or work experiences may be agreed to by the individual and authorized by ORS prior to the development of the IPE. All assessments are intended to help the individual and the VR Counselor identify a career and employment goal based on informed choice, information derived from assessments and/or prior work experiences and interests. The IPE identifes a specific employment goal that is developed through vocational guidance and counseling with the individual and is consistent with his/her unique strengths, resources, priorities, concerns, abilities, capabilities, interests. The IPE additionally specifies the services needed for the person to move toward his or her employment goal. Since the Consent Decree was signed, ORS has collaborated with RIDE, RTC's, and LEA's in assisting school personnel implement the obligations of the state to develop and update CDPs for transition age youth and work together on the
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provision of assessments and work experiences. DDOs interested in expanding the scope of their services to include supported employment were encouraged to attend training offered through the Center for Excellence prior to applying to be a Community Rehabilitation Provider (CRP) or vendor. ORS, in collaboration with Institute on Community Inclusion at the University of Massachusetts/Boston, Dr. Judith Drew, and other VR content experts, have provided a series on Best Practices in Community Employment including vocational assessments to community providers.
BHDDH prioritized working with ORS on vocational assessments. Under ORS's policies and regulations all assessments must be conducted in non-segregated community settings. BHDDH does not currently fund vocational assessments but refers individuals to ORS for this service. ORS similarly reported increased efforts to refer individuals to BHDDH.
Summary. RIDE, ORS and BHDDH have policies and practices regarding vocational assessments and vocational eligibility criteria that require assessments and evaluations to be performed in integrated employment and community settings.
Achieving Progress on Meeting the Terms of the Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree:
1. BHDDH is requested to provide the Monitor with a copy of the new CDP format and plan for implementation by September 30, 2015.
2. ORS is requested to provide the Monitor within 60 days with data on (a) the total number of transition age youth currently receiving ORS services, and (b) the numbers of individuals in the 2014-15 Youth Exit Target population and the Youth Transition Target population who have received benefits planning services during the past year.
3. BHDDH and ORS are requested to develop a plan for ensuring a sufficient number of certified benefits counselors are available to assist members of the four Targeted Groups as required by the Consent Decree -within 90 days.
D. Transition Planning for Youth {Section VIII)
The Consent Decree requires the development and implementation of a comprehensive process for transitioning youth with IDD between 14 and 21 years of age with specific performance benchmarks regarding state policy and systems change, implementation requirements and service delivery.
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Progress
Benchmark 1- RIDE Employment First Policy §VII1(1). RIDE shall adopt an Employment First Policy, making work in integrated employment settings the first and priority service option for youth seeking transition work placements and for transition-age youth's postsecondary vocational planning objectives. RIDE's Employment First Policy will set forth values for the State's transition planning process that reflect the State's expectations for supporting youth in transition to integrated employment settings through a systemic and collaborative framework.
Status:
On September 24, 2014, Education Commissioner Deborah A Gist approved the Rhode Island Department of Elementary & Secondary Schools Employment First Policy. This policy specifies that work in integrated employment settings is the first and priority service option for youth seeking transition work placements and for transition-age youth's postsecondary vocational planning objectives. The policy reflects the State's expectations regarding the provision of supports to youth in transition and the achievement of integrated employment through systemic collaboration with the adult service system. This is the first known Employment First Policy for a State Education Agency in the country. The RIDE Employment First Policy was submitted to the State Coordinator in October 2014.
RIDE, in collaboration with BHDDH and ORS, has issued clear Employment First policies. BHDDH has published its employment first policy. ORS' operational policies are consistent with employment first concepts. An interagency agreement between RIDE and ORS addressing the provision of services and supports to transition-age youth was signed on October 1, 2013.
Summary. RIDE, ORS and BHDDH have developed and instituted the required policies and practices.
Benchmark 2- Interagency Agreement §VIII(2). By July 1, 2014, the State's respective agencies, including RIDE, BHDDH, and ORS, shall amend and modify their existing interagency agreement to include the following provisions:
• The joint promotion and implementation of a school-to-work transition planning process that includes specific timelines and benchmarks for all transition-age youth (14-21 years of age) with IDD, as set forth in Section VIII(4), and ensures students' access to the services and supports set forth in Sections V(A)(1)-(2).
• The designation of ORS as responsible for the trial work experience requirements of Section VIII(6) of the Consent Decree and RIDE as responsible for ensuring that the trial work experience requirement of Section VIII(6) is embedded and incorporated
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into the existing IEP planning process.
Status:
RIDE, ORS and BHDDH identified transition benchmarks in the draft MOU submitted in October 2014. The RI Transition Timeline was incorporated into the draft MOU to include specific state agency responsibilities and performance objectives pertaining to services for youth ages 14 to 21 years as set forth in Section VIII(4). The document identifies the activities RIDE, ORS and BHDDH will engage in and the services that will be provided to ensure students' access to the services and supports set forth in Sections V(A)(1)-(2) (See Benchmark 3 below). The Timeline incorporates the trial work experience requirement in the existing CDP and IEP process as a responsibility of RIDE and the LEAs. The Transition timeline states that students with IDD will have at least two work experiences prior to leaving high school supported through the resources of the LEA, RIDE, ORS and BHDDH. RIDE is providing the LEAs with additional training in the development of work experiences.
Summary. The formal Memorandum of Understanding is being revised to better align with the terms and conditions of the Consent Decree. The above transition related requirements are addressed in the original draft MOU and currently are being implemented by RIDE, ORS and BHDDH. The State should review the final MOU to ensure all relevant transition related requirements are addressed.
Benchmark 3- Transition Process §VII1(4). The transition planning process for students in the Rhode Island Youth Transition Target Population shall begin by age 14 and will include a career planning team and access to ORS and Medicaid Waiver services as appropriate. The transition planning process must be designed to ensure that each youth and his/her family has been informed about, and been given opportunities to experience, Supported Employment Services and trial work experiences and identify milestones including, but not limited to the following:
• Assignment by age 14 to an employment (career) planning team.
• No later than during the first year of entry to a Rhode Island secondary school, the
formulation and annual reassessment of employment related recommendations of the IEP reflecting students' personal interests and goals for postsecondary employment and/or postsecondary education.
• No later than the year in which a student turns 16 years of age during the annual
IEP/ISP planning process the development of employment-related recommendations and a comprehensive introduction to or enrollment in State services, if an individual is eligible or will be eligible.
• No later than the year in which a student turns 18 years of age, during the annual
IEP planning process, a meeting with the career planning team to facilitate post-
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secondary employment and ensure that eligible youth: (a) have been introduced to numerous and specific options to receive integrated supported employment services in community-based long-term placements, (b) have (or will have) experienced the opportunity to be placed and work in such a setting prior to the end of his or her participation at a Rhode Island secondary school.
• No later than during the year prior to exit from secondary school, all individuals in the Rhode Island Youth Transition Target Population shall receive benefits planning information, according to the standards set forth in Section IV(6).
Status:
In July 2014, RIDE, in collaboration with ORS and BHDDH, initiated the development of the RI Transition Timeline. The Transition Timeline outlines a school to work transition planning process, setting timelines and benchmarks for all transition-age youth with IDD (14-21 years of age) in compliance with Consent Decree Section VIII (2). The initial draft was submitted to the State Coordinator in October 2014. The Timeline sets forth actions that RIDE/LEA, ORS, and BHDDH will take to prepare youth for future competitive employment and to involve families in that process. RIDE, ORS, BHDDH and the State Consent Decree Coordinator have been in agreement that the Transition Timeline be implemented as a "living document," being modified as procedures and policies change occur over time. RIDE also developed and disseminated "Tools for Implementing the Transition Timeline" to provide educators examples and resources to operationalize RIDE/LEA actions in the Timeline (see http: //www.ritap.org/transition/transition-networks#drop).
BHDDH/DDD social casework supervisors and the eligibility unit supervisor are attending school planning meetings for transition age youth who may be eligible for DD services. During the 2014-15 school year, a total of 50 meetings were attended; about half by staff from the DDD eligibility unit and the other half were attended by staff from the social caseworker units. BHDDH also works with transition age youth who are in DCYF custody and/or in out of district school placements. BHDDH eligibility unit supervisor works closely with DCYF to discuss youth who will be transitioning into the adult DD system. BHDDH also attends school meetings for youth who are in out of district placements, but who still live at home. BHDDH social caseworkers attend a variety of transition planning meetings for these youth who have very significant needs. The social caseworkers attend meetings at The Groden Center School, Bradley School, Bradley Hospital, Butler Hospital and out of state residential treatment centers where these youth live and attend school. Over 15 students who were classified as out-of-district placements entered the adult DD system during the 2014-15 school year.
ORS counselors ensure the provision of services and supports identified in the Transition Timeline, for students 18 to 21 years of age. They are responsible for opening new cases, attending all Career Plan Team meetings and developing an IPE that incorporates elements from the Career Planning Team. The ORS counselor
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reviews transition services and assesses need for further community supports. ORS cites funding and resource issues as barriers to the provision of competent, quality Benefits Counselors for in-school youth and their families.
Summary. The Transition Timeline developed and approved by RIDE, ORS and BHDDH addresses the key areas identified by this provision of the Consent Decree. BHDDH reports that the lack of staff challenges its ability to have a presence at all transition meetings. The department is taking steps to address this issue by providing printed information on eligibility and the process of transitioning to adult DDD services. BHDDH reports that staff have been made available to answer questions when department representatives are unable to attend face to face meetings, but acknowledges that continued work needs to be done in this area to comport with Consent Decree requirements. Additional information will be gathered by the Monitor during the subsequent weeks to assess to the extent to which the identified steps and responsibilities identified by the Transition Timeline are being carried out as intended.
Benchmark 4- Person-Centered Career Development Plan §VII1(3), (7). A personcentered career development plan shall be prepared by appropriately staffed career planning teams for each youth in transition to inform the development of employment related goals and recommendations.
Status:
See above, V. Findings (C) Career Development Planning, Benchmarks 5 regarding the actions taken by RIDE, ORS and BHDDH to address this provision.
Benchmark 5- Vocational Assessments §VIII(S), (8). All youth in transition shall have an opportunity to experience one or more vocational/situational assessments in integrated employment settings. BHDDH, ORS, and RIDE, shall prohibit vocational assessments of transition-age youth in segregated work settings.
Status:
See above Section C. Career Development Planning, Benchmark 5, Vocational Assessments and Eligibility Criteria.
Summary. RIDE informed LEAs that its Employment First Policy prohibits the provision of vocational assessments of transition-age youth in segregated work settings (ie. sheltered workshops). ORS's policies and regulations state that all assessments must be conducted in non-segregated community settings. BHDDH affirms and supports this practice, and does not currently fund vocational assessments. RIDE, ORS and BHDDH staff appear to have been informed of and trained on the requirements of the Consent Decree regarding this provision.
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Benchmark 6- Trial Work Experiences §VII1(6). Before exiting secondary school all transitioning youth shall have an opportunity to experience at least two trial work experiences, each of approximately 60 days in duration, in an individualized, integrated employment setting meeting the definitions and standards set forth in Sections V(D)-(E).
Status:
RIDE. Based on the CDP data collection survey the following data on trial work experiences to date is as follows:
• RI Youth Exit Target Population 2014-2015- 39 students have completed one or more trial work experiences; 4 have anticipated participation dates and one student is reported as employed.
• RI Youth Exit Target Population 2015-2016- 35students have completed one or more trial work experiences; 16 have anticipated dates for trial work experiences.
• In addition, there are 32 students who currently have completed one or more trial work experiences who are not considered part of the RI Youth Transition Target Population or RI Youth Exit Target Population but may be likely to be found eligible for developmental disability services through BHDDH; 40 have anticipated participation dates for trial work experiences.
Summary. RIDE identified the numbers of individuals who completed trial work experiences in the transition populations. ORS needs to provide similar data within 60 days.
Benchmark 7- Services to Transition Age Youth §VII1(9). BHDDH, ORS, and RIDE shall ensure that the appropriate services and supports are available to transition-age youth who choose to work in the community before their 21st birthday rather than remaining in school. BHDDH will update its policies and administrative rules to enable eligible individuals to access State services by age 18. ORS will update its policies and administrative rules to enable eligible individuals to access vocational rehabilitation services at age 16. RIDE will issue a statewide directive to local school districts to begin the transition planning process at age 14.
Status:
To assist in meeting the requirements of Section IV of the Consent Decree (Outcomes) pertaining to services and service outcomes for the transition age youth target populations, RIDE identified the total number of students with a qualifying condition of intellectual disability through the June 2014 RI Special Education census and shared this information with the Court Monitor, ORS, and BHDDH. RIDE
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additionally provided school districts with a list of those students in the census with IDD diagnoses, noting that secondary teams should be aware of the supports and services required to be provided to those students under Section V of the Consent Decree Supported Employment Services and Placements. RIDE provided a sample letter for optional use for LEAs to assist in communicating with parents of the students in the targeted populations regarding the meaning of Employment First and planning needed for successful employment outcomes. ORS and BHDDH provided contact numbers on the letter.
RIDE. The RI State Transition Council leads efforts to organize and operate a collaborative system of services to enable students and young adults with disabilities to become self-sufficient members of their community. Members of this council assist in the development, guidance and implementation of Rhode Island's State Transition Plan developed annually at the National Capacity Building Institute. To facilitate the implementation of the Consent Decree throughout the State's educational system, the State Transition Council aligned particular requirements of the Decree with goals and tasks identified within the Rhode Island State Transition Plan. (See State Plan 2014-2015). The Transition Council is chaired by RIDE and composed of state agencies, parents, students, LEA representatives, adult agency providers and advocates and provides an effective forum for distributing information and providing technical assistance.
RI special education regulations are consistent with the Consent Decree requirement that the transition planning process for a child with a disability begins at age 14, or younger if determined by the IEP team. The RI Transition Timeline identifies services and supports available to transition-age youth by RIDE/LEA, ORS and BHDDH.
RIDE's recent survey regarding the implementation of the Consent Decree revealed the following data:
1. Has your district undergone any systems change related to the implementation ofthe Consent Decree? Ninety to one-hundred percent of LEAs reported an increase in: • School-based preparatory experiences and community based vocational experiences; • Curriculum and programmatic changes with an increased focus on work readiness skills, financial literacy, and person centered planning; • Newly established coursework (i.e., career interest class and internship for all students); • Regularly scheduled district meetings and trainings focused on youth with IDD; • Re-structured summer programming; and • The development and use of improved data collection tools.
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• One district reported changing its part-time job coach to full time status, as well as the purchase of a van to support the limited public transportation availability within this rural district.
2. What new community vocational opportunities are available for the target population? • Eighty-five percent of the districts report an expansion of community based vocational experiences ranging from Career Exploration to Community Based Work Trial Experiences; • Two districts reportedly have initiated and been working in collaboration with ORS in the development of two Project Search sites; and • Several districts report an increasing participation with adult service vendors to provide expanded community vocational services.
3. What benefit have you seen for the target population since the implementation ofthe Consent Decree? • The majority of districts reported that the Consent Decree has thus far resulted in an increased expectation for youth with IDD with person centered planning becoming more systematic and inclusive of student/parent voice; • Increased focus on competitive employment rather than community involvement; • Curriculum and staffing re-design; increased parental awareness and excitement; and increased LEA comfort level in working with adult service providers.
4. What barriers or challenges have you encountered? The majority of districts report that access to reliable and timely transportation is challenging; economy/job market challenges; completing graduation requirements while increasing community based vocational experiences; parent participation and shared belief that their son/daughter is capable of competitive employment; lack of BHDDH capacity/involvement; time constraints (academic needs and vocational needs); and time/training for staff to do job development.
ORS has provided extensive transition services to transition age youth with disabilities. The Assistant Administrator for Transition coordinates a monthly meeting of the 24 ORS rehabilitation counselors with transition responsibilities and their supervisors to discuss services, new initiatives and policy to enable counselors to provide consistent vocational rehabilitation services to all Rhode Island high schools. ORS, in collaboration with school districts, supports several pilot projects with this population:
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• Miriam Hospital Project Search: Providing services to 8 students in the target populations. Two students have been hired by the Miriam Hospital. The others are participating in job development.
• Blue Cross Project Search: ORS has led the expansion process to open our
second Project Search Site next year in collaboration with the Cranston School Department. Eight students are projected to begin in September 2015
• Memorial Hospital Project Search: Preliminary conversations for a third Project Search site serving Students with IDD in the Pawtucket school system to start Sept 2015 or 2016 with 8 students.
• Summer Employment Alliance/Cumberland: ORS has entered into a Service agreement with Cumberland High School and Northern Collaborative to offer a paid integrated summer work experience for students with IDD in their extended school year program. Cumberland staff will provide job coaching, ORS will provide funding for wages and Northern will provide the technical assistance to insure integrated community base placements based on the interests/aptitudes of the participant. Students will work for 4 weeks at summer positions. 8 students
• Pilgrim Employment Pilot: ORS has partnered with Pilgrim High School and
West Bay Collaborative in order to provide 100 hour individualized paid internships in the community along with weekly work readiness training for 10 students with disabilities in their junior or senior year of high school.
• Central Falls Tri-employment Program: ORS has partnered with Central Falls High School and Goodwill Industries to provide 100 hours of individualized\ paid internships in the community along with weekly work readiness training for 10 students with disabilities in their junior or senior year of high school.
• North West Pilot: ORS partnered with Northern Rhode Island Collaborative to provide supported employment services to students in this rural community. The pilot project enables services to be provided in the students' home community. Services include vocational evaluations, situational assessment, summer work and job development and placement. 15 students participated
• Planning for the Future: DLT/ORS Pilot project to collaboratively utilize each agencies funding to provide two years of services to students at North Kingstown High school. ORS funding during the first year of summer work with DLT providing work readiness during the second year of services for six students.
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Summer Work Experiences. ORS sponsored a summer work experience for 335 students with special needs, collaborating with 11 service agencies to develop integrated work sites in the community and funding for students (to work in individual jobs at minimum wage) to work for 80 hours over a four-week period. Four of the agencies work specifically with students with IDD.
Career Development Plans. ORS counselors participated in over 110 Career Development Plan Meetings for IDD students during 2014-15 (see above).
BHDDH has updated policies and practices to comply with the Consent Decree requirements concerning Transition Age Youth, and has updated its website to reflect these policy changes and distributed Transition to Adult Services brochures affirming the policy that individuals are eligible for adult services at age 18. BHDDH has completed the following additional activities:
• The construction of a web portal to track/collect information on transition age
youth providing the status of an individual's application for services and needed forms and reports will be completed by July 31.
• The development and distribution of brochures for RIDE, LEAs, and relevant stakeholders on the DD Division's eligibility process and transition to adult services.
• Identification of a point of contact within DDD for all LEA's and created a
transition-age-youth e-mail.
• Established working relationships with RIPIN to expand social caseworkers'
outreach and assistance to transition age youth. And, in collaboration with the DDD eligibility unit, improve the accessibility and user-friendliness of informational materials and forms.
• Reached agreement with RIPIN to begin attending transition meetings for youth
as young as 14 years old. Over the summer 2015, the DDD administrator, social casework supervisors and RIPIN workers will meet to discuss full implementation.
• BHDDH social caseworker supervisors and the eligibility supervisor attended the Regional Transition Council's Transition Advisory Council (TAC) meetings to present/update on DDD changes, hold case-conferences with the LEAs on specific students and share information.
• BHDDH is a member of the State's Transition Council and attended the past two
Transition Institutes in North Carolina where the statewide transition plan for the upcoming school year was developed.
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• BHDDH is a consistent panelist on the Family Employment Awareness Trainings discussing the services, systems change and answering questions.
• BHDDH attended and provided information at the Annual Transition Parenting Conference in November.
• BHDDH presented to Special Education Directors at RIDE's Transition Institute addressing DDD's commitments under the consent decree, and plans for the future.
• BHDDH presented to the Teachers of Life Skills Network, including special education teachers, transition counselors/caseworkers, special education directors, addressing DDD's commitments under the consent decree and plans for the future.
Summary. RIDE and ORS have made significant outreach to the Transition-Age Youth populations, providing direct opportunities to individuals and significant amounts of training and support to staff and stakeholders. BHDDH clearly articulates its role and responsibilities for assisting youth transition from school to employment and adult services in the Transition Timeline. The department has updated its policies, increased training and restructured responsibilities of case workers to expand information available to children and families on BHDDH eligibility and services, and increase its presence at transition meetings. These steps have enabled BHDDH to address many of the Consent Decree requirements. Additional work needs to be accomplished over the following 180 days to ensure information is available and provided at each individual's transition meeting as required by the Consent Decree.
Benchmark 8- Transition Education and Training VIII(10). The State, including RIDE, shall take affirmative steps to ensure that all youth in transition are not excluded from the benefits and opportunities of transition academies, and other post-secondary planning, education, and employment resources in a student's assigned school district following their exit from school. RIDE will take affirmative steps to link the parents and families of transition-age youth with IDD with information about supported employment and integrated day services and parent information networks and groups during the school year that the transition-age youth is age 14.
Status:
Information regarding transition academies or other post-secondary planning opportunities is made available to all school districts through the Regional Transition Centers (RTC), ORS and RIPIN. RIDE has a contract with RIPIN to produce transition deliverables focusing on parent outreach, advocacy, information and training specifically to the families of transition-age youth. RIDE, the RTCs and RIPIN work in collaboration to provide training, technical assistance and
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information sharing to parents regarding the pathway to adult services. RIDE and RIPIN host an annual Transition Parent 101 Conference; College Forum; as well as local and regional events to support families of transition-age youth.
ORS participated in the RI Transition Institute held March 12-13, 201S at Roger Williams University to build transition capacity within the Rhode Island Schools. ORS sent 1S counselors as school team members. ORS additionally participated at the Mid-Year Check and Connect Cadre Meeting held by RIDE and the RTCs to follow up to the RI Transition Institute. ORS presented on Project Search and problem solved with the 77 district participants on ORS information dissemination and services.
ORS shared information on ORS services and supports to individuals with disabilities and families at the following events:
• College Forum for parents and students focusing on preparing for life after high school and post-secondary education March 7, 201S. ORS assisted with planning and sent a supervisor to assist with the 48 participants
• Dare to Dream Conference for self advocates. ORS participated in the planning and sent three counselors to assist the with the 900 attendees
• DeafAwareness Expo. Participated in the Expo and led a financial aid forum.
• TLS Network. ORS presented on the ORS perspective and services available to 100 Life Skills teachers over 3 RIDE coordinated sessions.
• Family Awareness Training. ORS presented at four sessions to approximately SO parents.
• Transition Academies. ORS funding is used for integrated community work experiences (20 weeks) and Job Readiness to prepare students for the workforce. SO students with various disabilities participated throughout the programs at Providence, West Bay, East Bay and the Northern Collaboratives.
• Transition 101 for Parents. ORS participated in the conference held by the RTC in collaboration with RIPIN and provided an overview of the Transition process for parents. ORS manned a booth to disseminate ORS information and answer parents' questions and also lead a breakout session explaining ORS services. 1SO parents.
• RIPIN Conference. ORS sponsored and attended a benefits orientation at RIPIN by a Social Security Approved Benefits Counselors on 2/11/1S. 1S parents and agency representatives attended. ORS sponsored a benefits
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counselor at Northern RI transition night. 18 parents and students met for mini sessions with the certified benefits specialist.
Summary. RIDE, ORS and BHDDH are making significant efforts to ensure that all youth in transition are not excluded from the benefits and opportunities of transition academies, and other post-secondary planning, education, and employment resources in a student's assigned school district following their exit from school. Parents and families are receiving access to information and support to strengthen their ability to support their family members with IDD during the transition process, consistent with the provisions of the Consent Decree.
Achieving Progress on Meeting the Terms of the Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree:
1. BHDDH, ORS and RIDE, are requested to assist the Monitor by providing information and data on the extent to which the provisions of the Transition Timeline are being followed. The Monitor will issue specific queries to each state agency with response timelines over the course of the following six months.
2. ORS is requested to provide the Monitor with the numbers of transition age youth with IDD who are currently receiving ORS services -within 30 days.
E. Training (CD Section IX)
By September 1, 2014, the State will establish competencies, and will develop and implement a competency-based and value-based training program for: (a) sheltered workshop and facility-based day program staff; (b) all members of career planning teams as defined under Section VIII; (c) youth service professionals; and (d) BHDDH, RIDE, and ORS staff.
Progress
Benchmark 1- Training Program Focus §IX(1), (2) & (4). The competency-based and value-based training program will be provided to ensure all staff have completed the necessary training, attained the required competencies, and are otherwise qualified (as specified in Section X) to perform their respective responsibilities with respect to employment and day services. Training pertains to:
• The development of: vocational assessment/profiles, career development plans, and transition plans, job development, job coaching, employment support, benefits counseling, supported employment and integrated day services and placements, intake and vocational rehabilitation services, and service coordination.
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• All persons involved in the discovery and assessment process, the preparation and implementation of career development plans and the provision of supported employment and integrated day services and placements for members of the Target Populations.
Status:
ORS, BHDDH, and the State Consent Decree Coordinator agreed that agency providers must be able to demonstrate competency in job development and job coaching using ACRE-approved, evidence-based training for Supported Employment. The competency-based value-based training program developed by the State reflected these competencies and received provisional approval from the Monitor on November 20,2014 and final approval on June 19,2015.
In addition to the competency and values based training curriculum that was developed, ORS ensures that the Supported Employment vendors the agency approves have demonstrated competency in providing vocational evaluations (including discovery and assessment), and are accountable for service delivery via
timely, quality and accurate reports. The ORS Supported Employment QA Task
Force has responsibility for reviewing the credentials of CRPs that provide ORS services to individuals with IDD with VR criteria specific to employment and assessment, consistent with the Consent Decree and the ISA.
BHDDH and RIDE are working closely with the Sherlock Center to furnish comprehensive evidence-based training to school personnel and adult services practitioners. BHDDH is receiving technical assistance from the Sherlock Center to help with competency and value based trainings for job development, job coaching and employment supports. Sherlock Center staff are working to build capacity within the IDD system as they work with providers to revitalize and restructure their organizations through the Conversion Institute.
RIDE continues to encourage LEAs to take advantage of Job Development and Job Coaching certification courses/trainings from state approved vendors including the Sherlock Center. Working in collaboration with RIDE and the Association of Administrators of Special Education, the Sherlock Center designed an initiative based on three predictors: family expectations about work, student selfdetermination, and experience in actual work settings. School districts were recruited to participate in the training. Training highlights include:
• Twenty-two (22) school districts and three (3) non-public special education schools committed to participate. Four (4) districts and/or non-public special education schools have committed to join in September.
• Five (5) sessions of the two-day Family Employment Awareness Training (FEAT) were conducted. There were 87 participants. Twenty (20) additional
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participants were involved in an initial pilot session. Feedback has been excellent. Six (6) sessions are being scheduled for 2015-2016.
• One-hundred and twelve (112) teachers participated in two days of selfdetermination training. Most of these teachers have done initial instruction in the Self Determination Learning Model of Instruction (SDLMI) and collected baseline information using the Self Determination Inventory- Teacher Version
(SDI)
• Sixteen (16) district self-determination coaches have met five times- refining
and developing materials for next year, learning fidelity, developing examples, etc
• Thirty-eight (3 8) district staff participated in one and a half days of training re:
the structural components of school based discovery and career development. Ten (10) sessions are scheduled for next year, each session will focus on developing one of the structural components.
• Some school personnel participated in the generic ACRE accredited Employment Specialist 40 hour training during the Spring 2015. A school-focused section of this training is scheduled for the Fall 2015. Two mini certificates (12 hours) in Job Coaching are also scheduled for the Fall.
Summary. BHDDH, RIDE and ORS have collaborated with the Sherlock Center in the development of a competency based and value based training program addressing the specific provisions of the Consent Decree. The training program was reviewed and given provisional approval by the Monitor and is being implemented. BHDDH, ORS and RIDE have provided a significant number of training opportunities to staff and technical assistance to provider agencies. Additional steps need to be taken to provide documentation that staff involved in the delivery of services and supports, as identified by Section IX (2) and (3) of the Consent Decree, are being trained to established competency levels. RIDE reports that non-public special education schools are participating in the training that is being provided. The Monitor requests that additional information is provided on the nature of these schools (see below).
Benchmark 2- Staff Training §IX(3). The State will ensure that all persons involved in discovery, assessment, career development planning and the provision of integrated employment and day series will receive specific training.
Status:
Following the signing of the Consent Decree onApril9, 2014 RIDE took immediate steps to disseminate information on the background and content of the Consent Decree and its implications for the education of students with IDD. Presentations were held on May 23, 2014 for the RI Special Education Directors and June 6, 2014
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for the Transition Life Skills Network (TLS). RIDE acknowledged school districts' needs for training and technical assistance in person centered planning, career development planning, school- based vocational experiences, and integrated community work trials in order to comply with Consent Decree requirement Section IV (Outcomes). During the summer of 2014, RIDE, in collaboration with the Regional Transition Centers, ORS and the Court Monitor, began drafting the Career Development Plan (CDP) format, which was finalized and approved in September 2014. The RI Transition Assessment Matrix was updated (submitted to State Coordinator in October, 2014) to include reference citations for informational tools that are useful with students with IDD complying with Section VII (2) of the Consent Decree pertaining to evidence-based and person-centered vocational assessments. In June, RIDE distributed an electronic survey to the 34 special education directors to gather data on the specific technical assistance needs for districts regarding the Consent Decree and the logistical support necessary to make information delivery more effective. Respondents identified six areas of technical assistance need, ranked below by the percentage of individuals selecting each area as a top priority:
• Career Development Planning- 78%
• Documenting vocational development - 74%
• Asset based Person Centered Planning (Discovery)- 63%
• Job Coaching 56%
• Asset based Person Centered Planning (MAPs)- 56%
• Department of Labor Wage and Hour regulations related to students & youth52%
Throughout early 2015, the Regional Transition Centers prioritized and delivered regional and district level technical assistance related to the Consent Decree.
RIDE and the LEAs utilize existing regional committees to disseminate the information, professional development and technical assistance needed to support the implementation of the Consent Decree requirements. Originally established to assist the LEAs in meeting IDEA secondary transition requirements, four Regional Transition Centers (RTCs) supported by RIDE offer direct, regional and statewide consultation to LEAs, students, parents and adult service providers on a variety of transition areas. RTC coordinators organize and facilitate local Transition Advisory Committees (TAC) consisting of educators, administrators, RIPIN liaisons, ORS representatives, vocational rehabilitation counselors, and BHDDH supervisors within the region. These committees provide a forum for districts to be informed of current information, best practices, resources and professional networking opportunities. The Teachers of Life Skills (TLS) Network, which is primarily
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composed of teachers who support youth with intellectual and developmental disabilities, continues to be an effective means to deliver supports to educators and students related to Consent Decree obligations. The TLS Network provided a full day of training on implementation of the Consent Decree to 16 of 34 school districts at the beginning of the 2014-2015 school year on September 26, 2014. The attendees received information regarding the RI Employment First Policy and RIDE's Employment First Policy. Additional trainings focused on "Using Discovery to Improve Transition Employment Outcomes" and on "Infusing Self Advocacy and Self Determination into the Core Curriculum and the IEP." Additional training on the Making Action Plans (MAPS) process was provided by the TLS Network during the summer 2014.
Person-Centered Career Development Planning. RIDE developed a Person Centered Planning approach for LEAs that organizes services and supports around a selfdetermined, self-directed future for individuals with IDD based on the person's skills, preferences, strengths and abilities. Training was provided by content experts who were engaged to provide professional development to LEAs on MAPS, Discovery, and PATH starting in the summer of 2014.
RIDE shared the Career Development Plan (CDP) format with all school districts as well as the full TLS membership. Sixty educators representing 29 districts, plus over 40 private and charter school educators attended technical assistance sessions about CDP implementation on October gth, and 28th 2014 and again on November 3rd 2014. The sessions introduced the document section by section, defined the language and described its purpose as a process document for students with IDD transitioning from school to employment. The CDP provides the format for documenting the services and supports described in Consent Decree Sections V (1)-(2) (i.e., soft skill development, career exploration, self-determination, community experiences and integrated work trials, etc.). Forty educators representing 22 districts and over 30 private and charter school educators participated in "Documenting Community Based Experiences" trainings on 11/18, 12/2, and 12/14, 2014. These trainings were developed to compliment the CDP by training educators in ways to quantify the vocational expectations and development plans for youth with IDD. On April2 7, 2015 school educators received additional training and materials on the Consent Decree, including technical assistance with implementing the Transition Timeline and connecting youth to adult services through ORS and BHDDH.
RIDE in collaboration with the RTCs developed a sharing website offering forms, methods, and practices relating to the Career Development Plan implementation and documentation. The RTCs received TLS and Consent Decree updates at their monthly TAC meetings and in individual districts throughout 2014-2015. This allowed for information to be provided to all special education transition professionals within the districts, including not only educators of the Youth Target populations but also those who work with other youth. In the spring of 2015, BHDDH assigned social workers from the DD Unit to become TAC members to increase opportunities for collaboration between educators and BHDDH. Twenty-two educators representing
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16 districts participated in "Exemplary CDPs and 2014-2015 Planning," the last full TLS session of this reporting period, on April12, 2015. On June 1, 2015 RIDE initiated a survey to collect information from LEAs regarding the "RI Youth Exit Target Population" progress on the implementation of Career Development Plans and status of meeting Consent Decree Section IV Outcomes. Survey data collection to date is reflected in the specific benchmarks throughout this report.
ORS provided a combination of training sessions and individualized technical assistance to all DRS-approved IDD service providers. Focused technical assistance was provided to seven DRS-approved DD providers. The director of Salve Regina University Rehabilitation Counseling program, and the ORS Assistant Administrator for Supported Employment are working to reinforce Employment First principles, explore business model options to maximize fee for service funding through ORS, and identify needs and barriers that must be addressed to increase capacity for quality integrated, community-based employment services.
Summary. RIDE, ORS and BHDDH are providing or ensuring the provision of a significant number of training opportunities. The approved competency based values based training program identifies the competencies that are required. Some of these competencies may be determined by provider agencies while others may be left to the State to assess.
Achieving Progress on Meeting the Terms of the Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree:
1. It is requested that BHDDH, RIDE and ORS provide the Monitor with a brief description of the mechanisms used to ensure that provider or vendor agency staff have reached established competency levels. Requested by September 30, 2015.
2. RIDE is requested to provide information to the Monitor on the number of nonpublic special education schools serving young adults with IDD and the services provided.
F. Outreach, Education and Support (CD Section X)
By September 1, 2014, the State will develop an outreach, in-reach, and education program that: (a) explains the benefits of supported employment, (b) addresses concerns of families and perceived obstacles to participating in supported employment programs, and (c) encourages individuals with IDD in day activity service programs, sheltered workshops and facility-based day programs, and their families to seek Supported Employment Services. The program additionally will explain the objectives of the State's Employment First Policy, benefits planning and other related initiatives.
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Progress
Benchmark 1- Program Development §X(1), (2). Develop the Outreach-In reach and Education Program as described in this section and receive the approval of the Monitor.
Status: A draft program description of the plan developed in collaboration with BHDDH, RIDE, ORS, the Employment First Task Force and the Sherlock Center was has received provisional approval by the Monitor and is being implemented. The final version of the program must be submitted to the Monitor for approval by September 15, 2015.
Benchmark 2- Employment First Task Force §X(3). By May 1, 2014, the State will create an Employment First Task Force that will include, but will not be limited to, representatives of the technical assistance entities discussed in Section XII, the Community Provider Network of Rhode Island, the Paul V. Sherlock Center on Disabilities at Rhode Island College, the Rhode Island Disability Law Center, the Rhode Island Developmental Disabilities Council, the Rhode Island Parent Information Network, the Rhode Island Business Leadership Network, individuals with I/DD, and parent and family representatives.
The Task Force will meet with the meet with the Monitor and State officials on a quarterly basis to discuss the successful implementation of the Consent Decree and produce policy recommendations, research and information pertaining and have a role in providing inreach, outreach, education, transition and linkage activities.
Status:
The Employment First Task Force (EFTF) was established and is meeting on a regular basis. BHDDH has consistently had a presence on the Employment First Task Force and participates on the pre-qualifications and training joint workgroup. The newly appointed BHDDH Director, Maria Montanaro, attended an Employment First Task Force Meeting during her first day as director, and key administrative staff have attended Task Force meetings in the past. RIDE had been participating in the Employment First Task Force meetings on a regular basis and has not been informed of recent meetings or the upcoming schedule. ORS reported that it is not a member of the Employment First Task Force and has not been informed of recent meetings or upcoming schedule.
The Employment First Task Force was created by the State in accordance with Consent Decree requirements and, in response to stakeholder requests, operates as an independent entity. While the Monitor has attended a few meetings, meeting minutes and schedules for future meetings are not routinely received. Recent conversations between the Monitor and the Task Force chairperson are addressing this issue.
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Task Force members are meeting with state officials to discuss barriers to the successful implementation of the Consent Decree as well as best practices. The Task Force was instrumental in developing the value-based, competency-based training program and the In-Reach, Outreach, and Education program and has made other policy recommendations. The Task Force has encountered barriers that have impeded its ability to carry out its responsibilities, and reportedly regular attendance has declined. The group has met and revised its agenda to focus on one issue at a time rather than attempting to address the entire Consent Decree. Currently, the group is working on Transition Age Youth. RIDE noted that it was unaware of this focus. Although the group has encountered challenges in carrying out its mission, its chairperson reported that key members believe it can play a valuable role in assisting the State to meet its Consent Decree obligations.
Summary. The Employment First Task Force has provided constructive input to the State on meeting the terms of the Consent Decree in the area of Training. Members of the Committee report that the most effective approach for carrying out their roles and responsibilities is to focus on one systems change issue at a time. Current focus is on Transition Age Youth. Meeting attendance has declined over the past several months. The Consent Decree requires that the EFTF meet with the Monitor and relevant State officials on a quarterly basis but not necessarily within the context of the EFTF's regular meetings. RIDE and ORS reported that they have not received regular announcements of meetings or requests to attend. The Chairperson is addressing this issue.
Achieving Progress on Meeting the Terms of the Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree:
1. The final version of the In-Reach, Outreach, and Education program must be submitted to the Monitor for approval by September 15,2015.
2. The Monitor needs to meet with the Task Force on a quarterly basis. This meeting can be in conjunction with the Task Force's regular meetings or alternative arrangements can be made. It is recommended that the Employment First Task Force chairperson establish a schedule for meeting with the Monitor and State agency representatives well in advance to ensure participation.as required by the Consent Decree.
G. Provider Capacity (Section XI)
The State, including BHDDH and ORS, will ensure that it supports and maintains a sufficient capacity to deliver Supported Employment and Integrated Day Services to individuals in the Rhode Island Sheltered Workshop, Rhode Island Day Program, and Rhode Island Youth Exit Target Populations, including qualified supported employment providers and
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integrated day providers, consistent with the terms of this Consent Decree.
Progress
Benchmark 1 - Developing Provider Capacity §XI (1-8). Accomplishment of key deliverables and policy changes regarding staff qualifications [XI(1-2)]; prequalification requirements [XI(3)]; incentives [XI(4)]; monitoring, oversight and technical assistance [XI(S)]; promotion of supported employment at state and federal levels through public and private initiatives [XI(6-7)]; and provider incentives to convert to supported employment [XI(8)].
Status:
BHDDH has launched a number of initiatives and activities to strengthen the ability of provider agencies to meet the goals and outcomes identified by the Consent Decree, launching initiatives addressing system redesign, rate redesign, responding to departmental funding requests, provision of technical assistance to provider agencies and departmental reorganization that are described in the sections listed above.
The Community Provider Network of Rhode Island (CPNRI) has been working with the newly appointed BHDDH Director and key staff to provide input on the revision, development and implementation of State policies and practices necessary to meet the Consent Decree's requirements. Providers report that as a group they support the focus on improving employment outcomes among individuals receiving support and the changes that the Consent Decree brings to Rhode Island's IDD system. CPNRI identified a number of barriers providers believe are preventing the system from moving forward and offered recommendations on needed changes in resource allocation, regulatory relief and outcome-based service delivery.
Summary. BHDDH has started the process of developing infrastructure within the IDD service delivery system to support and sustain the capacity of provider agencies to implement the broad scope of system change activities identified in Sections X1(1)-(8). The review and evaluation of the State's progress in this area will be presented during the forthcoming Consent Decree Report.
Benchmark 2- Establish a Sheltered Workshop Conversion Institute §XI(9)
Status: A contract was established by BHDDH acting on behalf of the State with the Sherlock Center at Rhode Island College to administer the Conversion Institute on October 1, 2014. The Sherlock Center, in collaboration with the providers and stakeholders, developed a plan to assist qualified providers of sheltered workshop services to convert their employment programs to include Supported Employment Services. The Sheltered Workshop Conversion Institute will provide individual analysis, technical assistance, and support to each qualified provider of sheltered
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workshop services, and will work together with the technical assistance entities discussed in Section XII to support individual providers in a process of conversion and transformation of service options. The Sheltered Workshop Conversion Institute will operate in accordance with the authority and guidelines that were mutually agreed upon by the Parties and the Monitor.
The roll out and funding of the Conversion Institute was delayed but several accomplishments have been made as the process of setting up the institute has moved forward. Information on the Conversion Institute has been shared with the providers and a community meeting was held at Rhode Island College to discuss other states' strategies for funding the conversion of sheltered workshops to integrated employment activities. Discussions were meant to inform the providers and other stakeholders, and to answer questions about the work the state is engaged in.
The second phase was to determine the areas of need and was accomplished through the Sherlock Center's survey of provider agencies. Ten focus groups with leadership and other key staff (in some instances, families) of the "sheltered workshops" were held- approximately 40 hours in total. Major themes from these focus groups were discussed with the "Developmental Disability System Redesign Group," the leadership of the Community Provider Network of RI (CPNRI) and others. These themes formed the conceptual basis of the proposal to redesign the BHDDH DD rate structure. The themes also will be used as the basis for (a) the application for Trust Fund dollars and (b) the development of a five-year plan by each of the sheltered workshops. Focus group participants identified a wide range of key themes and content areas that agencies would need to address in their plans to convert services to integrated person-centered alternatives. This information will be used along with data gathered through the Sherlock Employment Surveys of provider agencies to inform the process of system change and the design and delivery of technical assistance.
Additional phases of Conversion Institute implementation involve developing a process for soliciting, accepting and reviewing applications for support from the provider agencies (Phase 3), providing technical assistance and training to service providers (Phase 4), and developing a format for gathering data on process and outcomes at regular intervals throughout the year, consistent with Section XVI of the Consent Decree. Nine provider agencies have indicated that they will be applying for support.
Summary. The basic structure, financing, and operational principles of the Conversion Institute were agreed upon by the Parties in October 2014. The Sherlock Center has held public forums, focus groups, trainings, and other related activities as the Conversion Institute for the past 9 months since the agreement in October 2014. The Conversion Institute has been established and is proceeding with its plan for implementation.
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Benchmark 3- By October 1, 2014 establish and begin distributing a Sheltered Workshop Conversion Trust Fund in the amount of $800,000 to provide upfront start up funding for providers to convert their sheltered services to supported employment services §XI(10). Establish an application process for providers and parameters regarding distribution of funding, outcomes to be accomplished, services to be provided, oversight and evaluation.
Status: The Legislature approved the Governor's request for $800,000 to establish the Sheltered Workshop Conversion Trust Fund. The Trust Fund will provide resources to enable nine sheltered workshop provider agencies to defray some of the initial costs incurred during the conversion of their sheltered programs to integrated day and employment supports. Plans call for the State and the Conversion Institute to distribute applications for provider agencies to request Trust Fund dollars in September, 2015. A Review Committee will approve requests for funding by September 30, 2015. The Sherlock Center reports that they have designated two part time staff, both with extensive experience with the provider agencies, to act as coaches to assist provider agencies in developing applications and five year plans based on a standard template.
Summary. After initial delays related to the need to secure funding for the Trust Fund, the application process is being implemented in September.
H. State and Other Agency Actions (CD Section XII)
Benchmark 1- Securing Technical Assistance §XII(1). By July 1, 2014, the State, including BHDDH, ORS, and RIDE, will identify and pursue a contract with a technical assistance provider, or access the services of an existing technical assistance provider, to provide leadership, training, and technical assistance to employment providers and to the State staff involved in assessing, planning, and providing Supported Employment Services, in order to support the goals and outcomes of this Consent Decree.
Status:
Under the leadership of the new BHDDH Director, funds earmarked for technical assistance were repurposed and used to purchase assistance and services from organizations with particular expertise in key content areas needed to fulfill the requirements ofthe Consent Decree. BHDDH contracted with the Sherlock Center at Rhode Island College for provider and staff training, Advocates in Action to furnish training and support to self- advocates throughout the state, and RIPIN to strengthen the involvement of parents in policy related activities. An additional contract with the Sherlock Center to conduct the National Core Indicators annual survey will permit Rhode Island to compare IDD system performance and support related outcomes with other states and over time from one year to the next.
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In 2014 BHDDH received technical assistance from the Center on Excellence and Advocacy. The contract was not renewed by the new administration, resulting in changes to the schedule of planned trainings. BHDDH continues to work with the State Employment Leadership Network (SELN) and theNational Association of State Directors of Developmental Disabilities Services (NASDDDS) to receive ongoing information and direct technical assistance on the development and operation of effective employment services and supports for people with IDD.
RIDE entered into a contract agreement with the Paul V. Sherlock Center on Disabilities to offer training to LEAs in a demonstration project focusing on three components: (a) Family Employment Awareness Training (FEAT), (b) selfdetermination and (c) discovery/employment. RIDE is supporting the LEAs by providing funding for substitute teachers to enable regular teachers to access training and activities. Twenty-one school districts are participating in the demonstration project as well as one state run school and two non-public special education schools. A number of training sessions have been provided:
• Five sessions of the FEAT training have been completed with 87 participants;
• 112 teachers participated in a two day Self-Determination training
• 16 district coaches continue to meet to refine and develop materials for the upcoming year;
• Regarding the Employment component, 32 district staff participated in a one and a half days training on discovery and career development and ten monthly sessions are scheduled for next year. Some school personnel participated in ACRE accredited Employment Specialist training and a school-focused section of this training is scheduled for Fall2015. Additionally, two mini certificates (12 hours) in Job Coaching are also scheduled for Fall 2015.
• RIDE has supported LEAs in providing access and resources from additional content experts to support the goals and outcomes of the Consent Decree.
• RIDE has contracts with the three educational collaboratives that support and maintain the four Regional Transition Centers that provide support to LEAs in the implementation of the Consent Decree.
ORS reports that it utilizes Title I funding to secure content experts in the field ofVR on a fee for service basis to provide technical assistance to ORS staff and its provider community.
Summary. BHDDH, ORS and RIDE are ensuring that training and technical assistance is being provided through an expansion of contracts with the Sherlock
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Center and working with other training and technical assistance providers to meet its requirements under the Consent Decree. Contracts are in place with technical assistance providers consistent with the requirements of the Consent Decree.
Benchmark 2 -Providing Technical Assistance §XII(2)-(5). The contract with one or more entities to furnish technical assistance will address the following areas: the development of new supported employment providers, assisting day service providers in the development and operation of integrated, community based day services and day only placements for members of the target groups, and assisting providers transition from sheltered work to integrated employment as described by the Consent Decree.
Status:
BHDDH is receiving technical assistance from the Sherlock Center across a wide range of areas. The Sherlock Center conducts an annual Employment Survey, which informs the State's efforts to improve and expand integrated employment services and integrated day services in community settings. BHDDH also receives assistance from SELN, which provides information on key research findings and activities being conducted by other states that are working to improve employment outcomes among people with IDD receiving support. Burns and Associates is under contract with the state to provide technical assistance with the SIS scoring process.
Technical assistance is additionally furnished through RIPIN and Advocates in Action. BHDDH has a contract with RIPIN to provide family training and to ensure that In-Reach and Outreach materials are family friendly and provide information on policies and practices. RIPIN additionally works with the BHDDH eligibility unit, providing input on ways to make the application process more accessible and easier to understand.
A new contract with Advocates in Action will provide technical assistance by making sure individuals with IDD are involved when decisions about systems change are being made by participating as members of the person centered planning workgroup and the HCBS Committee. Advocates in Action will also put out a Frequently Asked Questions (FAQ) document and will poll individuals with IDD to identify the issues of greatest concern to self- advocates.
Summary. As noted above, BHDDH, ORS and RIDE are securing needed training and technical assistance through contracts with technical assistance providers consistent with the provisions and requirements of the Consent Decree. The Sherlock Center is providing training and support to service providers on service delivery issues such as person-centered and career development planning, as well as on workshop conversion and other areas through the Conversion Institute.
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I. Interagency Collaboration (CD Section XIII)
Progress
Benchmark 1- Memorandum of Agreement §XIII(1). By October 1, 2014, the State will develop and implement one or more interagency agreements or memoranda of understanding between BHDDH, ORS, and RIDE designed to ensure the full implementation of this Consent Decree.
Status:
Following the signing of the Consent Decree, BHDDH, in collaboration with ORS and RIDE, accessed U.S. Department of Labor Vision Quest technical assistance to support the agencies' developing an MOU. The agencies included the RI Department of Labor as part of their discussions. The State also brought in the State Employment Leadership Network to facilitate a meeting with BHDDH, ORS, and RIDE to address issues associated with transition-age-youth and the braiding and blending of funding, in furtherance of the MOU. A draft MOU was prepared by the three departments and shared with the Monitor. Following feedback and discussion with the Monitor, the agreement is being reorganized and rewritten to reduce redundancy and specifically address each of the five topical areas identified by the Consent Decree. The State agreed to take the following actions to come into compliance with Consent Decree Section XIII:
• Identify the specific provisions that must be addressed in the MOU, per Section XIII where agencies' obligations are already explicit within the Consent Decree. The MOU will then refer specifically to the relevant Consent Decree sections as opposed to having agencies agree to make operational via an MOU what they have already agreed to make operational via the Consent Decree. This will reduce 'redundancy' within the MOU and allow it to more effectively focus on issues where the Consent Decree is less prescriptive.
• Identify the specific provisions that must be addressed in the MOU, per Section XIII, where agencies' obligations are not otherwise indicated by other provisions of the Consent Decree (e.g. braiding and blending of funds).
• Develop MOU language to describe how the agencies will collaborate on meeting these responsibilities.
• Include within the MOU language describing the strategies the State agencies will use to identify, analyze and resolve future barriers to the delivery of services and supports that are consistent with the terms of the Consent Decree.
The three departments recognize the need for an MOU and the need to collaborate
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on the development and delivery of services to members of the target populations, improving the ability to track individuals as they move during transition from one department to another. The lack of a signed MOU between agencies has not prevented active and ongoing interagency collaboration. In fact, the agencies meet on a bi-weekly basis to update each other, coordinate activities, and respond to barriers. However, a clearer mechanism by which agencies respond and resolve barriers will support more efficient and effective resolution to identified barriers (e.g. data sharing, benefits counseling). The State Coordinator is writing the introduction and outlining the framework for the document's organization. BHDDH, ORS and RIDE will add their materials to the MOU based on the new framework.
Questions regarding the Family Educational Rights and Privacy Act (FERPA) laws related to the sharing of personally identifiable information between schools and state departments have complicated the development of state agency data sharing
agreements on individual students as they transition to adult services (see Section J.
Interagency Collaboration below).
Summary. Operationally, there appears to be a clear delineation of responsibility, funding commitments and authority for ensuring quality among the three state agencies with respect to the delivery of supported employment and integrated day services. Service provision, staff training and outreach/in-reach efforts toward the Target Populations are coordinated between departments where appropriate and all are using a wide variety of supports and resources from the Sherlock Center and other sources. While the intent of this provision is being met, the need for interagency collaboration continues to exist in key areas related to: (a) data collection, sharing and reporting; (b) adult services funding through BHDDH; and (c) the integration of key processes, such as person centered planning and career development planning. Steps are being taken by BHDDH, ORS and RIDE to address these barriers. The State must additionally ensure that the MOU appropriately references the Consent Decree provisions described above at Section D Transition Planning for Youth, Benchmark 2 Interagency Agreement §VIII(2).
Achieving Progress on Meeting the Terms of the Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree:
1. BHDDH, RIDE and ORS are requested to complete the draft agreement and submit the document to the Monitor not later than September 30, 2015.
J. Funding (CD Section XIV)
Progress
Benchmark 1- Ongoing Funding Allocations §XIV(1), (3), (5), (6). The State shall
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ensure that all individuals in the Rhode Island Sheltered Workshop, Rhode Island Day, and Rhode Island Youth Exit Target Populations with a career development plan have ongoing allocation that is dedicated to supports for gaining, maintaining, or improving employment outcomes and for integrated day services and meets the timelines of the Consent Decree.
Status:
Individuals are receiving funding from available budgets as required. However, IDD service providers report that the amount of funding allocated by BHDDH does not meet individuals' needs for employment training and support and does not permit provider agencies to expand options for supported employment services and achieve placement goals as required by the Consent Decree. In the years before entry of the Consent Decree, BHDDH received several significant funding reductions that have decreased the ability of the department to fund services and supports as required by the Consent Decree. The BHDDH Director established the DD Redesign Committee to review funding allocations and rate setting practices and make recommendations regarding changes that need to be made to the funding system to enable the state to achieve the integrated employment and integrated day program placement outcomes detailed in the Consent Decree. The Sherlock Center, in collaboration with the leadership of Community Provider Network of Rhode Island and Chief Financial Officers from four provider agencies, participated in the development of a proposal for a new rate structure that is outcome based (employment is one of the outcomes) and recognizes the breadth of domains in which adults need support. The BHDDH Director has requested and received in the Governor's budget increased allocations for IDD services to enable the State to meet the terms and conditions of the Consent Decree.
BHDDH is working to make sure each individual receives an appropriate level of funding by reviewing the algorithm currently used to determine individual allocations. The department also is reviewing the SIS administration process and developing a more efficient appeals process. Reportedly, appeals are moving through on a much shorter time frame.
BHDDH has been providing funding for the services and supports necessary to comply with the Consent Decree. BHDDH has informed individuals, families and providers through meetings, speaking engagements and direct contact with individuals receiving support that they can always appeal for any additional funding required to meet their needs. BHDDH reports that it is planning to change the SIS notification process in the near future to ensure individuals receiving support will receive more timely notification of reassessments or any changes that might impact their calculated tier level following the administration of the assessment. Currently, computer generated notifications are sent out 90 days before an individual's anniversary date. The anniversary date is the date their new plan year starts. BHDDH is currently working on rate redesign and the department continues to work on the resource allocation.
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In June 2015, the Legislature approved the Governor's recommended budget for IDD services. The Governor's budget addresses the severe underfunding of the DD program that occurred prior to the signing of the Consent Decree. The measure provides an additional two million dollars in State funding for Medicaid services for people with IDD. When matched with Federal funds, these resources will generate a total of four million dollars to expand integrated employment and day service options for people with IDD consistent with the requirements of the Consent Decree. Although not required by the Consent Decree, the State funded an additional $250,000 annually to the Sherlock Center to perform technical assistance, data gathering, and other work in support of the Consent Decree.
ORS reports that it has reviewed its fee for service structure outcomes and deliverables and intends to make adjustments to the fee structure to maximize vendor commitment to integrated, community-based work experiences and employment outcomes consistent with the Consent Decree. ORS has provided a combination of training sessions and individualized technical assistance to all of the DRS-approved DD providers.
Ending Sheltered Workshop Funding [§IV(4)]. BHDDH terminated the funding and placement of individuals with IDD in sheltered workshops, and will not approve interim Individual Support Plans for new entrants to sheltered workshops on March 1, 2013. BHDDH and has not approved any new entrants to the sheltered workshops within this past year. ORS has been prohibited by RSA from funding sheltered workshop placements for over fourteen years.
Summary. The BHDDH director and key administrative staff have taken steps to improve funding for Target Group members with IDD consistent with the requirements of the Consent Decree. Internal efforts have taken place within BHDDH to set up a committee and process for reviewing the strengths and weaknesses of the current system with respect to funding, resource allocations and rate setting. The department recognizes that its past funding system and resources have been inadequate to support the level of services and supports needed to ensure the changes necessary in the IDD system to accomplish the goals and outcomes of the Consent Decree. Efforts are being made to educate key elected officials of the necessity of providing the funding required for the State to be able to meet the requirement of the Consent Decree. The Governor included increased resources in her planned budget for 2015-16 fiscal year, and the State Legislature approved her budget in June 2015.
Benchmark 2- Reallocation of Resources from Sheltered Workshops to Integrated Employment and Day Services §XIV(2). The State will reallocate resources expended on Rhode Island sheltered workshop programs and segregated day programs to fund supported employment and/or integrated day services as individuals in the Target Populations transition from sheltered workshops to supported employment and/or integrated day only placements, in order to have funding "follow the person."
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Status: BHDDH funds are being transferred as people move from sheltered and segregated setting to integrated employment and day programs. However, IDD provider agencies report that current funding allocations, which have been in place for years, are not sufficient to furnish the services and supports individuals need in integrated employment and day program settings that require higher staff to person levels of supervision. BHDDH has convened a committee to review and make recommendations to improve and redesign the current system of funding and rate setting. As noted above the Governor's request to increase funding to BHDDH was approved by the Legislature in June 2015. ORS does not fund sheltered workshop services.
Summary. The State is making progress on implementing this provision by improving relationships with providers and actively working to develop more effective and efficient funding strategies for IDD services that will enable the State to accomplish the placement goals outlined by the Consent Decree. The Monitor requests monthly updates from the Consent Decree Coordinator on the progress of BHDDH's efforts to redesign funding allocations and rates.
Benchmark 3 Supports Intensity Scale §IV(7)- By September 1, 2014, BHDDH will issue a directive to ensure that the Supports Intensity Scale ("SIS") assessment process, set forth under Project Sustainability, is administered with the presumption that individuals with the most severe disabilities can work in integrated settings and receive the services and supports necessary to do so. BHDDH shall: (a) ensure family members and guardians have an active role in the SIS administration process for individuals in the Target Populations; (b) require that individuals administering the SIS assessment are knowledgeable about, and have experience working with individuals with IDD, and have received an appropriate level of training and certification, consistent with Section IX of this Consent Decree; (c) ensure that resource allocation decisions are made by BHDDH staff in a manner that is consistent with individuals' support needs; (d) ensure BHDDH staff who administer the SIS assessment work in a separate, autonomous unit from the BHDDH staff who administer the resource allocations; (e) ensure resource allocations are annually reviewed by an external consulting group and (f) furnish to the Monitor any and all written reports, including those authored by Burns & Associates, pertaining to BHDDH's administration of the SIS tool, resource allocation decisions and documentation of the level of training and certifications for surveyors.
Status (aJ-(fl:
a. Active Role of Family Members. BHDDH states that it has listened to the feedback received from the community and is implementing changes:
To ensure that families feel they are a part of and comfortable with the SIS administration, all SIS administrators are required to ask every person participating in the SIS assessment to sign an "Attestation by SIS Interview Respondents" form following the completion of the interview. This form
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requests the individual to affirm whether or not: (1) the interview was conducted face-to-face; (2) at least two respondents were present for the entire interview; (3) each interview question was explained prior to being scored; (4) each question was asked and discussed during the interview; and (5) the final score of each question was shared with the respondent or was incomplete pending follow-up information to be collected. Respondents are requested to sign the form and note their relationship to the individual who was assessed.
An additional form signed at the conclusion of the SIS interview process is read to the respondents and requires the SIS interviewer to indicate whether the SIS interview was cancelled or conducted and provides a checklist of reasons for each condition. The various checklist questions seek to determine whether parents or guardians were informed of the process, choose to participate, objected to or cancelled the interview and the reasons for such actions. After this is read to the respondents, the SIS interviewer initials the appropriate statements and both the SIS interviewer and the individual being assessed signs off on the attestation statement. The DDD Redesign workgroup established a SIS feedback form that is distributed to providers and stakeholders.
b. SIS Administrator Training and Certification. All SIS interviewers have been informed of the State's Employment First Policy. A memorandum issued by the DDD Director dated August 19, 2014 was provided to all SIS Interviewers and describes the State's Employment First Policy, the meaning of integrated supported employment to the individuals with IDD receiving support, and the importance of employment as the first priority option for service planning for people with IDD receiving state funded services.
All SIS interviewers received training and passed the American Association of Intellectual and Developmental Disabilities (AAIDD) training program in September 2013. SIS interviewers are re-evaluated and re-certified by an AAIDD trainer on an annual basis. BHDDH plans to schedule new AAIDD trainings of SIS administrators by October 1, 2015.
c. Ensuring Needs-Based Allocation Decisions. BHDDH is restructuring the department's allocation and rate setting process to allow for more flexibility within an individual's funding allocation (see Section K Funding). Contact has been made with Burns and Associates regarding funding allocations.
d. Separating SIS Administration from Resource Allocation. SIS administrators work in a unit that is separate from finance and have no involvement with the resource allocation process.
e. Annual Review. Resource allocations are determined and annually reviewed by the Human Services Research Institute on the basis of each individual's SIS score.
f. Relevant documents have been provided to the Monitor.
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Summary. BHDDH has reviewed and is addressing provider and consumer concerns with the administration of the SIS and the methodology for determining individual service funding allocations. The department is taking steps to change the administration of the tool and the process for appealing allocations or tier-level scores that have been determined as outlined by the Consent Decree. Necessary progress has been made in this area.
Benchmark 4- Performance Based Contracts §XIV(4). By January 1, 2015, the State shall develop and implement performance-based contracts for Supported Employment Services to individuals in the Target Populations, linking funding to the provider's achievement of numerical targets and implementation timelines.
Status: BHDDH's provider contracts identify a scope of work that includes tasks to be performed with respect to: fiscal management and oversight, hiring and training staff, benefits counseling, assessment and evaluation, individualized service planning, supported employment services and a number of additional areas that are also identified by the Consent Decree. The contract does not, however, incorporate provisions that are generally associated with "performance based contracting." Such provisions include: (a) a clear set of outcomes, performance benchmarks or deliverables for each of the specific provisions listed in the Scope of Work in terms of numbers of staff trained, numbers of individuals placed, numbers of ISPs and benefits plans written, etc.; (b) a description of the measures to be used to assess performance against the required outcomes; (c) contract language linking the achievement of outcomes or performance benchmarks with funding rates or levels of reimbursement and (d) methods of performance evaluation. It is recommended that the state consider including these provisions in its contracts with providers.
In January 2015 BHDDH solicited information from provider organizations regarding the development and implementation of pilot programs to test, "... innovative approaches to develop, implement and sustain integrated employment opportunities" with the apparent intent of identifying performance outcomes to inform the development of performance based contracts with providers. A review of descriptions of the pilot projects suggest that while some of the initiatives could provide information on the ability of some provider agencies to achieve certain outcomes, no information was provided regarding the relationship of project deliverables to the development or implementation of performance based contracts. BHDDH reports that it intends to develop performance-based contracts with the provider agencies. But no information has been furnished to the Monitor on the implementation of this goal to date.
The ORS Supported Employment fee structure supports a flexible array of individualized support, assessment and placement services funded on a fee-forservice basis. ORS will only fund integrated competitive employment outcomes. The fee schedule includes incentives based on the number of hours per week that an
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individual works in an integrated competitive work setting with a paycheck generated by the business not a provider. Additional incentives are available based on client participation in a company sponsored health insurance program and access to vacation and sick time. The fee-for-service payment structure provides a means of evaluating and monitoring the quality of deliverables as long as agency generated authorizations to CRPs and vendors are directly linked to the accomplishment of identified performance outcomes. ORS has developed and implemented a revised approval process for new vendors or existing vendors who request to expand into a new service provision area.
Summary. BHDDH's current contracts with providers identify several key operational and performance issues but are not yet designed to be outcome based. The BHDDH director has informed the Monitor of her interest in addressing this issue, possibly through the adoption of managed care or managed care principles. However, no additional information has been provided to the Monitor on the department's activities or planned activities in this area. ORS' current payment structure appears to meet the intent of this provision if specific outcomes are identified and provider reimbursements are contingent upon the providers' achievement of those outcomes. ORS states that this is the case.
Achieving Progress on Meeting the Terms ofthe Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree:
1. It is recommended that BHDDH provide the Monitor with a description of its plans to implement outcome based contracts with providers including an identification of the employment outcomes to be achieved, and the manner in which funding is linked to the provider's achievement of numerical targets and implementation timelines within 90 days.
2. The Monitor requests monthly updates from the State Consent Decree Coordinator on BHDDH's efforts to redesign the current process for allocating service funding and setting rates until the new system is established.
K. Quality Improvement (Section XV)
Benchmark 1- Ql Program §XV(1). The State will develop and implement a statewide quality assurance initiative to ensure individual, integrated supported employment placements and services and integrated day services and integrated day-only placements as defined and described in Section V- VI of the Consent Decree are: (a) developed and provided in accordance with the Consent Decree, (b) evaluated to ensure quality and quantity of supported employment and integrated day services provided, and (c) adequate and sufficient to ensure that individuals in the Rhode Island Sheltered Workshop, Rhode
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Island Day, and Rhode Island Youth Exit Target Populations who receive supported employment placements and integrated day services under the Consent Decree achieve integration, increased independence, and increased economic self-sufficiency.
Status:
On December 30,2014 BHDDH issued a Quality Management and Improvement Strategy (Strategy). The published document outlines the purpose, context and background of the Strategy and includes reference to the Consent Decree. Four key components include: key quality improvement projects to be completed; description of the roles and responsibilities of the parties involved in discovery, remediation and improvement activities; the processes for information gathering, remediation and systems improvement; and the performance measures which will be used to assess performance. The Strategy is designed to accomplish its goals, and presumably those of the Consent Decree through the implementation of 8 quality assurance projects. Some but not all of the quality improvement projects have been implemented to date. The projects are not a part of a statewide initiative.
ORS continues to utilize its established process for evaluating the quality and responsiveness of services through its Continuous Quality Improvement (CQI) Team for the VR Program. The CQI Team utilizes Federal RSA Title I regulations for oversight and monitoring. ORS created a Supported Employment Quality Assurance Task Force to focus on services furnished to individuals with IDD provided by DD vendors with funding from federal Title I fee for service dollars via ORS. ORS reports that this committee will be reviewing the credentials of Community Rehabilitation Providers that furnish ORS services to individuals with IDD utilizing a review criteria specific to employment and assessment.
Summary. Currently, the State is assuring quality separately through the three state agencies, BHDDH, ORS and RIDE. While separate practices can be more easily tailored to meet the regulations and policies of the individual agencies, without careful alignment across agencies a compartmentalized approach can present barriers to implementing the provisions of this section of the Consent Decree in a coordinated and effective manner across the state.
The various quality improvement projects included in BHDDH's Quality Improvement Strategy address some but not all of the provisions of Section XV of the Consent Decree. ORS's quality assurance program defaults to federal RSA Title 1 regulations and guidelines. ORS must comply with RSA regulations but this responsibility is separate from its obligations to follow and meet the requirements of the Consent Decree. ORS needs to provide additional information to the Monitor that "cross-walks" the federal Title I regulations and guidelines regarding the assurance of service quality with each of the provisions of Section XV of the Consent Decree.
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Benchmark 2- Program Standards §XV(2). By November 1, 2014, the State will establish detailed program standards for transition planning and services, career development planning, benefits planning, Supported Employment Services, Integrated Day Services, and Supported Employment and Integrated Day-Only Placements, that at least incorporate the definitions, standards, and processes set forth in Sections V, VI, VII, and VIII.
Status:
The RI Transition Timeline was developed in collaboration with RIDE, ORS and BHDDH to address transition planning standards and milestones, but has not yet been converted to program standards for each department.
BHDDH reported that detailed policies currently are not in place regarding all of the aforementioned programs and services. BHDDH staff are working to address this issue and progress is being made, particularly in the areas of transition planning, career development planning and clarifying eligibility requirements for individuals with IDD beginning at age 18 years.
Summarv. BHDDH, RIDE and ORS are approaching quality improvement in slightly different ways but quality improvement activities are taking place in many areas. Clear program standards specifically addressing the requirements of this section of the Consent Decree do not, however, appear to have been developed. Regardless of the approach used to monitor and improve quality, BHDDH, RIDE and ORS need to develop clear standards, or show evidence of standards have been developed and put in place that address transition planning and services, career development planning, benefits planning, Supported Employment Services, and each of the other services and activities identified in Benchmark 2 above.
Benchmark 3- Regular On-site Reviews, Reports and Follow-up Reviews §XV(3), (4), (5). Through its quality improvement initiative, the State will regularly conduct on-site reviews of day activity service programs, including of integrated community-based employment and day programs, to evaluate the services provided to individuals with IDD against the program standards described above. Findings reports, including plans of correction, will be published and follow-up reviews will be made to ensure compliance with program standards and the timely correction of deficiencies. The State will issue reports of any follow-up activities.
Status:
RIDE is in the process of collecting data on the components within the career development plan, which will assist in determining the quality, effectiveness and additional technical assistance of services for students with IDD.
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BHDDH reports that it has a contract with The Sherlock Center to provide quality improvement services and technical assistance out of the Conversion Institute and that part of its contract with The Sherlock Center focuses on data reporting of provider outcomes. BHDDH along with The Sherlock Center will conduct follow up reviews.
ORS reports that the Committee on Quality Improvement Supported Employment Task Force will be developing a protocol and schedule for annual reviews of IDD agency providers. These reviews may include site visits, review of reports, study of authorization history, and satisfaction surveys of client participants as determined appropriate by the task force. In addition, VR liaison staff will be interviewed for feedback. Each agency has a VR Counselor liaison who, at least monthly, discusses participants and steps moving forward. These liaisons also act as monitors/mentors in that they review services and reports, consult on cases, and assist with employment planning.
Summary. As noted above, Quality Improvement activities, including on-site reviews, are taking place by each of the three state agencies, RIDE, BHDDH and ORS. The Monitor has received copies of some of the quality assessments that are being accomplished but the documentation is not sufficient to fully evaluate the extent to which BHDDH, RIDE and ORS are making progress in this area. Quality improvement and assurance activities need to be based on a reference point or standard against which current practice can be measured. As noted above in the summary of Benchmark 2 Program Standards, BHDDH, ORS and RIDE do not appear to have clear standards in place. It is recommended that the three state agencies reviewing current practice standards and quality improvement activities to ensure alignment with the provisions of the Consent Decree.
Achieving Progress on Meeting the Terms ofthe Consent Decree
The Monitor recommends that the following steps be taken to meet the terms of the Consent Decree:
1. It is recommended that BHDDH carefully review its quality improvement strategy to ensure that it includes key activities and outcomes that meet the requirements of Section XV of the Consent Decree. It is further recommended that the department revise or restructure the format of the current quality management system to reflect or incorporate the organizational format outlined in Section XV (1)-(5) and submit the final process to the Monitor within 90 days.
2. DRS's quality assurance program defaults to federal RSA Title I regulations and guidelines. ORS' need to comply with RSA regulations is separate from its obligations to meet the requirements of the Consent Decree. ORS needs to provide additional information to the Monitor on the ways in which its current Quality Assurance program addresses each of the provisions of Section XV(1)-(5) and
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submit its report to the Monitor within 90 days. This report should describe ORS' plans to incorporate any Consent Decree requirements that are not addressed by the RSA Title I quality improvement guidelines.
3. The Monitor will schedule a meeting with BHDDH, RIDE and ORS directors and relevant staff to discuss the implementation of Section XV by each of their respective agencies. Focus will be place on the structure and functioning of each agency's quality improvement plan, the existing and planned program standards against which service quality is measured and the current and planned review process during the next state site visit in September.
L. Data Collection and Reporting (Section XVI)
Progress
Benchmark 1- Data to be Collected and Reported §XVI(1)1 (2)1 (3). The State will report on a monthly basis from October 1, 2014 through October 1, 2015, and quarterly thereafter, the progress of implementation of this Consent Decree. Between the date of execution of this Consent Decree and October 1, 2014: (a) the Monitor and the State will jointly develop reporting protocols and processes for reporting; and (b) upon the request of the Monitor, the State will provide the Monitor with access to data and reports, as set forth in Section XVI(2), reflecting progress under this Consent Decree.
Unduplicated data will be gathered relative to the progress and outcomes achieved by the State and members of the Target Groups on the activities and outcomes required by §XV1(2)(a-r), including the number of COPs, readmissions to sheltered workshops, the number of variances granted, and information identified by other data related provisions.
Status: Monthly data on some of the data points listed at (a)-(r) above was gathered and reported sporadically during the past year. The State initially planned to record and track this information and data through current Medicaid claims reports and began working with a contractor to document this information, but the newly appointed director of BHDDH abandoned this approach. The Monitor secured the assistance of an external expert on state IDD data systems and reporting practices to review current data systems within each of the three state agencies and make recommendations on the steps that need to be taken to develop an effective system or systems for gathering and reporting the data required by the Consent Decree. In collaboration with state officials, the external expert, the Monitor and subject matter experts from the Sherlock Center, a new data collection format was recommended that builds on the existing provider surveys being annually conducted by the Sherlock Center. The new format will include quarterly reviews of the Section XV1(2) (a)-(r) data points listed above along with targeted surveys to collect information that is unable to be reported through this mechanism.
It is anticipated that the new format will be able to be implemented effective
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January 1, 2016. This format will, on a quarterly basis, permit the regular collection, aggregation and analysis of performance outcomes, service delivery barriers and gaps to be addressed.
RIDE submitted a plan for meeting the data collection requirements (a), (k), and (l) on September 25, 2014 and updated to the state coordinator on May 5, 2014:
• Section (a), the number of career development plans in place for members of the Target Populations.
• Section (k), the number of youth in the Rhode Island Youth Transition Target Population who have vocational objectives. Data will be collected through the RIDE special education census (as reported in the state performance plan Indicator 13). The RIDE special education census collection for June 2014 reported 526 youth ages 14-21 with intellectual disabilities. RIDE will analyze and verify this data element in September 2015.
• Section (I), the number of youth in the Rhode Island Youth Transition Target Population who are exiting or graduating, or otherwise expected to exit or graduate each year, their career planning goals, and where they transition to following their exit. RIDE has been able to identify and provide the number of youth who have an IDEA qualifying condition of intellectual disability through the RIDE special education census who have exited or graduated, or projected to exit or graduate for those students in the RI Youth Exit Target Population. Students' career planning goals, and where they transition to following their exit, would be indicated in their individual Career Development Plans. In addition, RIDE may provide results of the Transition Outcome Survey (Indicator 14) as it pertains to youth with intellectual disabilities.
The Section (a)-(r) requirements identify 44 individual data points. Not all of these data are routinely collected by each of the three departments. RIDE, for example does not offer or track adult services and ORS does not fund sheltered workshops and is required to collect only a limited amount of the information needed. BHDDH gathers some of the required information but much of the data resides in individuals' files or in case notes and is able to be obtained only through a personby-person search. ORS gathers quite a bit of needed employment information on the people receiving their services. As noted above, RIDE reports that FERPA requirements prevent the agency from sharing individually identifiable information with ORS or BHDDH to enable them to identify and track new referrals to adult services. However, ORS and BHDDH may obtain consent from eligible youth or guardians to obtain the necessary information.
An examination of the capacity of BHDDH, RIDE and ORS to routinely gather and report the 44 data points required to be collected by the Consent Decree in Section
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XVI (2)(a)-(r) reveals a systemic problem. BHDDH routinely gathers and reports on only 2 of the 44 data points. Additional information can be found in individual recipient files and extrapolated from Medicaid claims data, but not on a routine basis. RIDE, which does not provide adult services, currently collects information on 6 of the 44 data points. ORS, which has the most developed data management capacity, collects information on 22 data points. It is important to note that ORS and RIDE do not provide nor do they collect information on several of the data points that are listed. The most promising data is gathered by the Sherlock Center through its annual employment survey of provider agencies. This survey does, in fact, collect much of the information needed to report on this provision, and can be used as the basis for the development of an effective and cost efficient strategy for meeting this provision of the Consent Decree. BHDDH reports that the Sherlock data system offers an effective and promising approach for gathering the data required by the Consent Decree and is working with the Sherlock Center to develop implementation strategies and plans. ORS and RIDE have expressed a willingness to collaborate with BHDDH in this effort. A full report ofthe data findings, trends, implications and recommendations is deferred until the new data system has been implemented.
Respectfully Submitted,
Charles Moseley EdD Court Monitor August 17, 2015
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Attachments
Attachment 1 Consent Decree Provisions
The Consent Decree details required activities, documentation, progress benchmarks and individual and support related outcomes associated with each of the four Target Populations. Additional provisions address the broad scale systems change actions that are necessary to shift the structure and functioning of the state's IDD service delivery systems away from traditional segregated models to person-centered systems of support in integrated work and community settings. The current report addresses key provisions and benchmarks of particular relevance to the first year of Consent Decree implementation and defers others for consideration during subsequent reviews. As noted in the report, particular emphasis is placed on activities and outcomes related to two target populations; the Rhode Island Youth Transition Target Population and the Rhode Island Youth Exit Population:
• Outcomes (CD Section IV). The identification of a timeline with specific benchmarks
related to key integrated employment, person-centered planning, career development planning and other outcomes for each of the four Target Populations. Summarizes progress on the achievement of key Consent Decree provisions [N.B. Progress on benchmarks in this section is reported under each of the operational provisions included in Sections V- XVI].
• Supported Employment Services and Placements (CD Section V). The Consent
Decree defines supported employment and the criteria to be used to determine the acceptability of supported employment services and integrated supported employment placements made under the Agreement.
• Integrated Day Services (CD Section VI). Under the terms of the Consent Decree, the State is obligated to make available to individuals in the four Target Populations integrated community-based recreational, social, educational, cultural and athletic activities, as well as other non-facility based activities of the person's choosing, in integrated settings during the day with appropriate services and supports. [N.B. Documentation of progress on meeting the benchmarks in this section is deferred to subsequent reports].
• Career Development Planning (CD Section VII). Requires policies and procedures
regarding the provision of career development planning, integrated within an individualized person-centered planning and service delivery process.
• Transition Planning for Youth (CD Section VIII). Requires that the State ensure transition planning and related activities occur for youth transitioning from school to work or adult services. This includes the development and adoption of an Employment First Policy and revisions to existing interagency agreements that
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include timelines and benchmarks for a school-to-work transition process for protected class members beginning at age 14 years.
• Training (CD Section IX). Activities that must be completed by the state with respect
to the development and implementation of a competency-based and value-based training program for supported employment staff in provider agencies including employment planning teams and youth service professionals.
• Outreach, Education and Support (CD Section X). The development and
implementation of an outreach, in-reach and educational program explaining the benefits of supported employment and addressing the concerns of families.
• Provider Capacity (CD Section XI). The steps the State must take to ensure a
sufficient number of qualified providers and provider agency staff are in place to carry out the objectives and requirements of the Consent Decree. Additional provisions in this section require the State to establish a Sheltered Workshop Conversion Institute, in collaboration with the Sherlock Center at Rhode Island College as well as a Sheltered Workshop Conversion Trust Fund.
• State and Other Agency Actions (CD Section XII). Specific actions the State must take
to secure the assistance of a technical assistance provider via contract to furnish leadership, training and technical assistance to employment providers.
• Interagency Collaboration (CD Section XIII). Requirements related to interagency
collaboration and the development of meaningful and effective memoranda of understanding between BHDDH, RIDE and ORS addressing key areas of mutual or distributed responsibility regarding funding, operational responsibility, quality and other aspects of the Consent Decree.
• Funding (CD Section XIV). Requirements that the State shall ensure that funding
allocations and budgets ensure each individual in the target populations receive an allocation that enable the individual to improve his or her employment outcomes, be successful on the job and access integrated day services.
• Quality Improvement (CD Section XV). The steps the state must take to ensure that
individual integrated supported employment placements, supported employment and integrated day services are developed and operated in accordance with the Consent Decree. This provision requires the state to develop detailed program standards, conduct on-site reviews and monitor plans of corrections.
• Data Collection and Reporting (CD Section XVI). A listing of specific data that must be gathered and reported by the State across 17 key outcomes to assess performance and change associated with the full implementation of the agreement.
65

Case 1:14-cv-00175-JJM-PAS Document 7 Filed 09/17/15 Page 66 of 66 PageID #: 184 Final sections of the Consent Decree address monitoring and enforcement (Section XVII), general provisions (Section XVIII) and construction and termination (Section XIX).
66

 
 Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 1 of 40 PageID #: 189
Report of the Court Monitor Progress on the
Interim Settlement Agreement United States v. State of Rhode Island and the City of Providence
United States District Court District of Rhode Island Civil Action No. 13-442L
June 13, 2013 as Modified July 11, 2014 Period of Review: January 1, 2015- September 30,2015
Respectfully Submitted
Charles Moseley Ed.D. U.S. District Court Monitor
Issued: January 15, 2016

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 2 of 40 PageID #: 190

Table of Contents

I. Executive Summary

3

II. Introduction

8

A. Background

8

B. Definitions

8

c. Scope and Target Populations

9

D. Assessing Progress

9

III. Findings: Review of Progress

11

A. Outcomes

11

B. Supported Employment Services and Placements

11

c. Integrated Day Services

17

D. Career Developmental Planning

19

E. Transition Planning for Youth

23

F. Training

25

G. Outreach, Education and Support

27

H. Provider Capacity

28

I. State Agency Actions

30

J. Interagency Collaboration

30

K. Funding

31

L. Quality Improvement

32

M. Data Collection and Reporting

36

VI. Concluding Comments

39

2
i '

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 3 of 40 PageID #: 191
I. Executive Summary
This report reviews actions taken by the State of Rhode Island and the City of Providence Public Schools Department to comply with the terms and conditions of the Interim Settlement Agreement (ISA) during the period January 1, 2015 ·-September 30, 2015. The ISA resolves the United States' findings of violations by the State and the City of Providence of Title II of the ADA with respect to the provision of public services to individuals with intellectual and developmental disabilities that resulted in their unnecessary segregation or risk of segregation. The Agreement broadly concerns two populations of individuals receiving sheltered workshop services from one of two public programs in Providence Rhode Island: (a) Training Through Placement (TTP), a sheltered workshop run by a private non-profit agency; and (b) the Harold A. Birch Vocational Training Program (Birch) at Mount Pleasant High School operated by the Providence Public School Department. The relevant entities responsible for implementing the ISA regarding TTP are three State agencies including the Department of Behavioral Health Developmental Disabilities and Hospitals (BHDDH), the Office of Rehabilitative Services (ORS), and the Rhode Island Department of Education (RIDE). These three State agencies and the City of Providence Public Schools Department (PPSD) are responsible for implementing the ISA regarding Birch. The report documents efforts taken by the State and PPSD to comply with performance benchmarks associated with each of the operational provisions of the Agreement and the extent to which corrective actions identified in previous ISA Progress Reports were taken. During this reporting period BHDDH, RIDE, and ORS, and PPSD accomplished benchmarks associated with each of the requirements, provisions and timelines included within the Settlement Agreement. Although progress has been made in some areas, each of the three state agencies has missed reporting and performance deadlines. Necessary policies and programs have not been fully developed or operationalized across several key performance areas. Barriers to progress due to insufficient funding for employment services, the lack of resources to support state-level systems change and ineffective interagency collaboration have inhibited efforts to move forward. Additional actions need to be taken by the State to fulfill its responsibilities under the Agreement. The following issues require particular attention:
• The numbers ofiSA Target Group Members placed in integrated supported employment and integrated day programs have not reached required benchmarks.
• Required Career Development Planning policies and practices have not been implemented byBHDDH.
• The required Quality Improvement Initiative ensuring the provision of oversight, monitoring, and service improvement has not been fully implemented by BHDDH and ORS.
• State agencies, BHDDH and ORS have not provided complete andjor timely responses to the Monitor's recommendations regarding compliance related changes.
• Although not specifically required by the terms of the ISA, the limited scope and authority of the State Coordinator inhibits th'e ability of the State to direct, manage and implement changes and required activities across departments. Please note that the State has reported to the Monitor that this recommendation currently is being implemented.
3

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 4 of 40 PageID #: 192
• Staffing and personnel resources at BHDDH do not appear to be sufficient to carry out needed activities. Please note that the State has reported to the Monitor that steps are being taken to address this recommendation.
The following sections provide a summary of performance listing key areas where the State and PPSD have met requirements, demonstrated substantive progress or have not met the terms and conditions of the ISA.
ISA Provisions and Benchmarks that have been Met
• PPSD and Mount Pleasant High School took affirmative steps to meet the terms and conditions of the ISA across the majority of performance benchmarks showing marked progress across virtually all key areas including trair!ing, career development planning, quality improvement and support coordination.
o Integrated supports and services. All members of the Mount Pleasant Birch Exit Population who chose to become engaged with PPSD are receiving the supports and services needed to introduce them to work in integrated settings as required by the !SA.
o Supported employment. Each member of the Birch Transition Target Population engaged with PPSD received a full array of supported employment services as required by the ISA.
o Data Analysis and Reporting. PPSD is providing detailed and comprehensive data reports on a quarterly basis as required by the ISA.
o Career Development Planning. Person centered career development planning is being provided to all members of the Birch Transition Target Population.
o Regulatory Reform. PPSD developed and/or revised regulations to define supported employment and related services and supports in a manner that is consistent with ISA requirements.
o Values-based competency-based training and technical assistance. PPSD (in conjunction with RIDE and the Rhode Island College Sherlock Center) furnished training to provider staff, individuals with disabilities and their families.
!
o Provider capacity. PPSD has secured additional staff to provide job development, job training and job coaching se!vices.
'
o Quality assurance. PPSD haslimplemented the required quality improvement activities.
• The State (BHDDH, ORS and RIDE)
o Training and Technical Assistance. The State strengthened its contractual relationships with the Rhode Island College Sherlock Center to provide ongoing provider training opportunities, support to families, technical assistance, and policy guidance. A wide array of courses and training opportunities is being provided by the Sherlock Center to staff from IDD provider agencies and schools statewide.
4

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 5 of 40 PageID #: 193

o RIDE continues to strengthen its ability to meet key benchmarks in the areas of staff training, quality improvement, transition and service delivery

o Values-Based Competency-Based Training. A values-based competency-based training program was developed by the State and was approved by the Court Monitor. RIDE in conjunction with PPSD furnished training to provider staff, individuals with disabilities and their families. BHDDH and ORS established forms and methods for ensuring providers meet qualification and pre-qualification requirements.

o Provider Capacity. BHDDH has worked with TTP to improve the ability of the agency to hire and retain qualified staff.

o Regulatory Reform. The State (BHDDH, ORS and RIDE) developed andjor revised regulations to define supported employment and related services and supports in a manner that is consistent wi~h ISA requirements.

ISA Provisions and Benchmarks with Substantive Progress Demonstrated

• Employment in Integrated Settings. The percentage of Birch Exit Population members who are employed in integrated settings increased from 14% to 31% during the past six months, but continues to fall short of the required benchmark 100%.

• Benefits Planning. The percentage of individuals in the TTP and Birch Target Populations who have engaged in benefits planning and have benefits plans in place has increased, but is still below the required benchmark

• Expanding Capacity. The Sherlock Center in collaboration with ORS and BHDDH, prepared and submitted but not fully implemented a State Plan for Benefits Counseling and Work Incentive Information to increase the in-state capacity for benefits planning activities.

• School Transition. RIDE, ORS and BHDDH developed a detailed Transition Timeline to identify key transition milestones and guide efforts to ensure members of the protected class receive the supports they need and are entitled to during their transition from school to work and adult services. RIDE and the other departments are reviewing activities to ensure the Timeline remains current.

• Provider Qualifications. BHDDH and ORS are collaborating on the development and implementation of a uniform methodology for tracking provider qualifications and training. The format has yet to be completed and implemented.

• Data Collection. BHDDH is working With the Sherlock Center to expand the Center's annual provider survey to gather and repor1t on a quarterly basis the specific performance data
1
required by the ISA.

ISA Provisions and Benchmarks that have Not Been Met or Completed

•

Meeting Required Deadlines. BHDDH and ORS are not responding in a timely fashion to performance benchmarks, reporting deadlines and compliance related requests for information

as required by the ISA and the Court Monitor. Over half (52%) of the recommendations and

5

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 6 of 40 PageID #: 194

wrMeiqothuniiintrqe9rm0deudnratiysnsginatcshleuredpqerudeivrineiodtu.hsSereMevpeoornarilttorrere'qmsuIaeSisAntesRdfeouprnoianrdtfdodrrametesasdteiAdonparsailno1df,Sp2er0po1tg5ermawmbeercreh3na0on,gt2er0es1smo5l.avdeedby the

•

Integrated Employment. The numbers of Protected Class members working in integrated

employer-paid jobs in typical business continues to December 1, 2014. Employment rat(:)S for the Birch

fall Exit

short of the benchmark of Target Population and the

100% by TTP Target

Population are 31% and 36% respectively.

•

Career Development and implementation

Planning. BHDDH has not issued guidelines governing the development of individualized person-centered Career Development Planning for all

members of the protected class, due on September 1, 2013.

J

•

hCmaaevrmeeebnreoDrtseoovcfectluhorepremTdTe.nPAtlTlPaalarrgneneotinuPgtooCpfuWdlaaStt/eiToaTnnPad.rPemeruressqotunbi-erceredenvttoieerbweederdCe.vaCireeawerereeDdr eDavneenvluoeapllomlpyem. nAetnnPntluPaanlalsnrfesovraireaelwlnsot

located in client files as required.

•

Average Hours Worked. Data on the average hours worked per TTP Target Population show a decline over a three-year period

week across of 31% from

all members 16 hours in

of the 2013

to 11 hours in 2015. This level is far short of the 20 hours per week benchmark identified in the

ISA and needs to be improved.

·

•

Variance Monitor.

Policy. A Variance Policy and Process was developed by the State and BHDDH is working with a contractor to develop and conduct training.

approved However,

by the the

implementation implementation

of of

the the

policy policy

has has

not not

yet occurred and is long overdue. Training on the been provided. Additional steps must be taken to

provide

training and information to providers, individuals with implementation of the policy. Evidence reported to the protected class members may be interested in learning

disabilities and families on the Monitor suggests that a number of about and applying for a variance.

None

have been submitted to the Monitor for review.

•

Program Standards. Program standards required by the ISA to in process in BHDDH and ORS but have not been implemented

assure and improve quality are as a part of each department's

quality improvement initiative.

•

Quarterly On-site Reviews. BHDDH is not conducting quarterly on-site reviews of service sqqeuuraavlriitcteyerslaytreTocnTe-PisviceteodnrbesyivsiOteeRwnSts-wofufitTnhdTetPhdesienrredvqiivucieidrueqamulaselniatttysTaoTsfPrtheoeqnuIaSirAmedaotnbttyhhitlshyetbimIaSseAi.s. ObBRuoStthiissangreoevtnicceiowensidnaugrceting

working to improve performance in this area.

•

tbDrheeaecitnoapgmuCprmopeleolrefnscodetriamootnfieo,idmnAsipnnaraoarlyevcsinoinsomgatpsnberdeerivhMniegcnoepnsidrivteeoeplriaivmnregear.ydnT,narheneerdmaaposgrvgroiernveqgigudabietradieordtrnoibeatyrhnstedhadaennidIraSeilAcmy.tsopQisrrsuooavofrifttnheBgerHloyiDunrDtfecoHpormomarnaetdtssiowiOsnRintfShoo. tr

The State has not made substantive improvements in this area since the last ISA Progress

Report was issued.

6

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 7 of 40 PageID #: 195
• Coordination of ISA Activities. The coordination of ISA related activities across State agencies and collaboration between departments needs to be improved.
This progress report documents the status of the efforts by the State of Rhode Island and the City of Providence Public Schools Department to meet the requirements, provisions and benchmarks included within the ISA. A short description of each provision is provided followed by a status report and summary. Each section concludes with a statement of recommendations that the State and/or PPSD should take to meet the requirements of the Agreement.
7

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 8 of 40 PageID #: 196
II. Introduction
This report describes the actions taken by the State of Rhode Island Department Behavioral Health Developmental Disabilities and Hospitals (BHDDH), the Rhode Island Department of Education (RIDE), the Office of Rehabilitative Services (ORS) and the City of Providence Public Schools Department (PPSD) to meet the terms and conditions of the Rhode Island Interim Settlement Agreement (ISA) between January 1, 2015 and September 30, 2015. Focus is on assessing the State's efforts to comply with the performance benchmarks associated with each of the operational provisions of the Agreement and evaluating the extent to which recommended actions identified in the ISA Progress Report submitted by the Court Monitor on April1, 2015 were taken. A. Background The ISA resolves the United States' findings of violations by the State of Rhode Island and the City of Providence of Title II of the Americans with Disabilities Act (ADA) by discriminating against individuals with intellectual and developmental disabilities (IDD) served by two programs, Training Thru Placement (TTP)l and the Harold A. Birch Vocational Program (Birch) at Mount Pleasant High School in Providence. The Settlement Agreement seeks to remedy findings issued by the U.S. Department of Justice (DOJ) on June 13, 2013 that services furnished by TTP and Birch segregated or placed at risk of segregation approximately 200 individuals with IDD across both programs. The Settlement Agreement is intended to ensure that the State and PPSD will meet in a timely fashion the requirements of Title II of the ADA 42 U.S.C. § 12131, et seq., as interpreted by the United States Supreme Court in Olmstead v. L.C., 52 7 U.S. 581 (1999) and through the administration and operation of the day activity services system for people with IDD, including employment, vocational, and day services (46-1-14 R.I. CodeR.§ 43.0). The agreement pertains to services furnished to people with IDD by TTP and Birch, as well as any successor programs to TTP and Birch. Through this Interim Agreement, the Parties make clear their intention to achieve the goal of community integration for all for individuals with IDD being served, identified for referral, or at risk of entering TTP and Birch. B. Definitions. The ISA pertains to the delivery of employment services and supports to members of the protected class by PPSD and by the State through three departments: BHDDH, RIDE, and ORS. Each of these state agencies fund and provide or arrange for the provision of employment related services and supports to members of the three Target Populations (see below) in a slightly different manner consistent with its mission, purpose and the nature and scope of services delivered. Special education services are provided to members of the target populations by the Birch Vocational School at Mount Pleasant High School. RIDE administers state educational policy including the special education services provided to children with disabilities transitioning from special education classrooms to employment and adult services. The mission of ORS is more narrowly focused "to empower individuals with disabilities to choose, prepare for, obtain, and maintain employment, economic self-sufficiency, independence, and integration into society." ORS' Rehabilitation services generally are time limited, addressing the delivery of employment related supports including vocational assessments; the development of an individual employment plan, job placements, job coaching and assisting students with disabilities transition from school to
1 Training Through Placement has recently changed is name to Community Work Services or "CWS." Throughout this document the program will be referred to as "CWS/TTP."

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 9 of 40 PageID #: 197

integrated community employment and adult services. BHDDH's Division of Developmental Disabilities offers a comprehensive array of services to Medicaid eligible adults throughout their life span as they transition from special education classes in school to adult supports in the community. Services are comprehensive, designed to enable people with the most intensive intellectual and developmental needs to live in their own homes with family and friends, participate in integrated community activities during the day and become employed in regular jobs, working alongside nondisabled co-workers and paid at prevailing wages.
The ISA defines key operational terms, service definitions, program types and required activities to facilitate cross agency collaboration and ensure consistency in language, interpretation and understanding among the many individuals and groups who are involved in carrying out the ISA's objectives (see Section II).

C.

Scope and Target Populations (ISA Section III)

Under the terms of the original Interim Settlement Agreement (Section III (A)(1)-(3.) dated June 13, 2013 the State agreed to ensure that supported employment services, integrated day services, and transition services will be provided to the following individuals:

1. TTP Target Population. Individuals with IDD who receive day activity or sheltered workshop services at Training Thru Placement or have received services at Training Thru Placement or any successor organization in the previous year;

2. Birch Transition Target Population. Individuals with IDD who are transition-age youth currently attending the Harold A. Birch Vocational Training Program, or any successor program, at Mount Pleasant High School, and;

3. Birch Exit Target Population. Individuals with IDD who are transition age youth attending the Harold A. Birch Vocational Training Program, or any successor program, at Mount Pleasant High School who have exited Birch within the previous two years, or who will exit Birch within one year.

On July 11, 2014 the parties agreed to modify required outcomes related to two provisions of the ISA. The first modification clarified the interpretation of Section III(A)(3) to include in the Birch Exit Target Population transition-age youth with IDD attending the Birch program or any successor program at Mount Pleasant High School who exited Birch at any point during the 2010-2011, 20112012, 2012-2013 or 2013-2014 school years. The second modification changed the dates specified in Section IV(9) of the ISA requiring all individuals in the TTP Target Population and all individuals in the Birch Exit Population to be provided supported employment placements by December 1, 2014.

D. Assessing Progress
Data for this report was gathered through a number of different sources, methods and strategies including in-depth interviews with key administrators and policymakers, advocates, families and others; on-site observations of programs and services; interviews of protected class members at worksites; and structured meetings with key stakeholders. Specific activities involved:

9

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 10 of 40 PageID #: 198

•

Repeated interviews of the directors and key staff of the state agencies named in the Settlement Agreement from BHDDH, RIDE, ORS, and from the Providence Public School

District.

• Interviews of the Special Education Director for PPSD and the director and key staff of CWS/TTP.

•

Ongoing meetings with the director and Center who provide support to the State

key staff of the Rhode Island College Sherlock and provider agencies involved in carrying out

the

terms and conditions of the !SA.

• Visits to a sample of developmental disabilities provider organizations across the state, visits with people receiving support and interviews of the directors and key staff.
• In collaboration with an independent consultant, interviews with a representative sample of individuals with IDD receiving services from CWS/TTP and PPSD.
• Participation in meetings coordinated by PPSD staff tracking efforts to engage and reengage members of the Birch Look Behind Exit Population who had left school.

• Interviews and meetings with stakeholders on the content and pace of change in state agencies, BHDDH, ORS, and RIDE in response to the ISA.

•

Individual and records reviews of a representative sample of individuals receiving support from TTP and students receiving transition and special education services at PPSD.

• On-site visits to Mt. Pleasant High School classes.

•

In-depth review and analysis of state data, records and documentation of services and supports provided members of the TTP and Birch Target Groups by CWS/TTP, BHDDH,

ORS, RIDE and PPSD.

•

Discussions with BHDDH, providers, families and Sherlock Center staff on the use of the Supports Intensity Scale for needs assessment and individual resource allocations. Review

of related documentation and the use of claims data.

I

Data furnished by BHDDH, ORS, RIDE, PPSD, and CWS/TTP for this review were independently

validated by the Monitor to the fullest extent practicable. Additional validation was provided by an

independent consultant working on behalf of the Monitor to perform individuals receiving services, supports, education and training from

a review of the records of Mt. Pleasant High School and

CWS/TTP. This "look behind" evaluation was conducted to determine the extent to which the

services that are required to be provided by the ISA are documented in individuals' files and

reports. The independent consultant's report additionally includes and recommendations aimed at improving service delivery and the

several important comments support of individuals. Please

note that some, but not all of these recommendations are included in the body ofthi~ report as

actions to be taken by the State to meet the requirements of the ISA.2

2 A copy ofthe consultant's report is available from the Monitor on request.
10

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 11 of 40 PageID #: 199

III. Findings: Review of Progress
This section describes the State's progress with respect to meeting key milestones identified for each of the relevant provisions of the Interim Settlement Agreement during the period outlined above. Subsections under each provision detail the compliance benchmarks that must be achieved and describe the status of the efforts the State andjor PPSD have made to meet performance or outcome requirements. A short summary is provided for each subsection highlighting key activities that have taken place, data that has been or needs to be provided and steps the State must take to attain the benchmark or demonstrate substantive progress on meeting the terms and requirements of the Agreement.

A. Outcomes (ISA Section IV)

The Outcomes section summarizes key performance benchmarks, systems change requirements and procedural obligations the State and PPSD must address to demonstrate compliance with the ISA. Benchmarks related to the delivery of integrated supported employment services and placements, integrated day services and placements, the provision of person-centered career development planning, individual benefits counseling and others are also found in subsequent sections of the Agreement. To improve readability and avoid redundancy, information on the progress the State and PPSD have made with respect to the various benchmarks identified in the Outcomes section is reported within the relevant topical sections of this report. For example, all information regarding the State's progress on meeting supported employment placement requirements is located in Section C of this report, Supported Employment Services and Placements and not duplicated in the Outcomes section.

B.

Supported Employment Services and Placements (ISA Section V)

The ISA defines and describes the nature and composition of Supported Employment Services furnished to individuals with IDD by the State and PPSD. Performance expectations, including the presumption that all individuals covered by the ISA are capable of integrated employment, are accompanied by specific operational benchmarks that must be met regarding the delivery of identified services and supports. This section additionally details a variance process for individuals in the target populations who choose not to be employed in integrated settings.

Progress Benchmark 1- Description of Supported Employment Services §V(A)-(D). Supported Employment Placements are defined in the ISA as consisting of services that include a wide variety of vocational and related services as well as transitional services and supports for transition age youth with IDD.
Status: The State and PPSD have completed ISA requirement to define supported employment in regulations and policies in a manner that is consistent with the ISA requirements. Benchmark 2 - Implementation §V(E)-(H). Provisions in this section require the State to incorporate within relevant policies, rules and regulations a presumption that all individuals covered by the ISA can work in integrated employment settings including self-employment. Status: The presumption that people with IDD and other disabilities are able to work in individual integrated jobs in regular businesses in the community along side co-workers

11

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 12 of 40 PageID #: 200

without disabilities is included in regulations andjor clear departmental Employment First policies for BHDDH, RIDE and PPSD.

Benchmark 3 -Birch Integrated Employment Placement Outcomes §IV (1)-(2). By September 1, 2013, all individuals in the Birch Exit Target Population and all individuals in the Birch Transition Target Population will be provided the services and supports described in Section V(A)(1)-(2) necessary to introduce them to work in integrated settings, according to the youth transition process and milestones set forth in Section VIII, and they will become eligible for a Supported
Employment Placement, as provided in Section V(D), upon their exit from Birch.

Status: The total Birch Exit (Look Back) Population comprises 36 individuals. Members of this population have received access to the services and supports necessary to introduce them to work in integrated settings as described in Section V(A)(1). PPSD, ORS, BHDDH, and providers, including CWS/TTP and Perspectives, meet monthly to review the status of the Exit or "Look Back" population. During these meetings staff from each agency work together to coordinate activities, develop plans for removing employment barriers, and increase opportunities for
integrated employment.

Table 1 summarizes the placement status of members ofthe 2011, 2012, 2013 and 2014 Birch Exit Populations as reported in the PPSD Quarterly Report June-August 2015. As shown in Table 1 by the end of August 2015, 11 of

Table 1

Birch Exit"Look Back'' Population Placement Status August

2015

= 0
';1:1 C1l
=0..
0 ~

Placed

Trial Work

...

"r::: ~ <ll

= tQl
0

>, ..uQ..l

i:: 00.-...o9,.QI

= = Vl~ Vl

•Q,j

~ Q,j

..0........

b.()
C1l
b.()

= = C1l Q,j

~

..... Q,j

b.()
=C1l C1l b.()

::.....
= 0

Q,j I

= Q,j

~0 .s""

Total

the 36 individuals (31%) had 2011

1

0

2

2

3

8

been placed and were

2012

0

1

2

3

2

8

working in employer paid

2013

5

1

5

0

jobs, four (11%) were

2014

5

engaged in trial work

experiences, 11 (31%) were

Tqtal

11

2

2

0

4

11

5

receiving supported

,Ofo

31% 11% 31%

0

11

0

9

5

36

employment services but

December 2014

were not employed, 5 were

Total

5

awaiting information from the

%

14%

State regarding possible entry

12

9

4

33% 25%

6

36

to State Services, and 5 did not want to engage.

These numbers show improvement as compared to the previous review (April1, 2015), which reported that 5 (14%) of the 36 individuals had been placed in employment, 9 (25%) individuals were receiving supported employment services and 12 (33%) were engaged in trial
work experiences. Four individuals were waiting and 6 persons were not engaged.

The Birch Transition Target Population inclusive of students participating in Project Search and the Providence Transition Academy totaled 78 students as of the end of August 2015. During
this report period 73 of 78 students received an array of Supported Employment Services including job discovery, career exploration, transportation services and daily living skills. Of the remaining five students, one had a baby, three were out of school due to illness or medical leave

12

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 13 of 40 PageID #: 201

and one student moved out of the district. Of the remaining 73 students, twenty-two (22) participated in trial work experiences.

According to PPSD's August report, 11 students exited from school or the Transition Academy

in June 2015. This number includes two individuals who left Birch in 2013 and returned to the

District to receive supportive employment services through an agreement with the State. In

total, from

six the

( 6) Mt.

students Pleasant

exited from Project Search/Mt Pleasant/Transition Academy, four (4) Birch Academy and one (1) from the Providence Transition Academy.

Summary: with PPSD

All are

members receiving

of the Birch Exit "Look-back" Population who chose to become engaged supports and services needed to introduce them to work in integrated

settings consistent with the requirements of the Agreement. Thirty-one percent (31%) are

employed, up from 14% during the previous reporting period. PPSD is working with the State

and IDD with the

service service

providers system to

to interest individuals with IDD who have chosen not to re-engage reconsider their decision and receive supports. All members of the

Birch Transition Target Population are receiving services and supports to introduce them to

waePrmPoeSrpDkcloioncmygompnilnteeinntietnudsteeesagrnvtrodiacttfeeausdkrtensoeisswtttheihepnidsgcshttoocthotehneneyasibMaslrteoeennmetintewotmirittbolheendtrhasueqonrfudetaehqrreutetiphrrlreeyomItSbeeAacns.ttieCssdooacmsfltraphesriqsesuhtpoierrnoresevdicivbeseiiyovretnehptoehofAertthgsseuraepIneSpmdAo.edrtnaettd.a

Although reporting

additional steps period, the goal

were taken to improve placement outcomes during of 100% employment for all members of this target

the current group has not

been met. While still short of the 100% benchmark, PPSD has made solid progress in this area.

Benchmark 4- TTP Integrated Employment Placement §IV(9)(a-e as revised).

Status:

· Table2

TTP Target Population. A total of 82

TTP Target Popul~tion PlacementStatus

members of the TTP Target Population

SeptemberZ015 •.

are on the active rolls at TTP fCWS. Of this number, 78 individuals are engagedlwith
the service provider on a regular basis.

Category Protected Class Members Active Participants

N

%

82

78

100%

The report entitled, Septplacement

Participating in Situational

30

38%

updated sept 2015 identifies a total of 58 Assessments

"placements to date" of individuals in

Employed- Employer Paid

28

36%

integrated employment settings, typically in situational assessments. At the request

of

the

Monitor,

the

September

reports

were

updated

to identify protected class members who are actually employed in integrated employer-paid

positions.

Data from the October Monthly Report 2015 corrected this reporting error, revealing that the

total number of individuals who are employed in integrated settings and receiving a paycheck

from the employer listed in this report

of record as being

and not engaged

the service situational

provider is 28 (36%); 30 (38%) individuals are assessments, job development, or "retention"

(See Table 2) with wages subsidized by CWS/TTP. It is important to note that situational

assessments do not constitute a supported employment placement as defined by the ISA.

Overall, the state did not meet the placement target of 100% for December 1, 2014.

13

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 14 of 40 PageID #: 202
The number of individuals placed in integrated situational assessments in regular businesses who were reported as "working" in integrated employment is concerning. The discrepancy was found during a recent review of a sample of 24 client records at CWS/TTP. The evaluator noted that the vast majority of the situational assessment placements are located in one of two businesses, TJ Maxx and Marshalls, and typically, are of an extended duration, averaging 11 months. This period of time far exceeds the length of time generally expected for a situational assessment. ORS, for example, reports that it generally supports individuals in situational assessments for approximately 10 days. Dr. Ashe, who conducted the recent review, noted that the extended assessment process appears to have substituted for actual employment and may actually function to impede the placement process as employers begin to rely on subsidized workers to perform tasks that should be completed by existing paid employees.
It should be noted that placement data reported by CWS/TTP is not consistent across the two reports mentioned above for September 2015. Problems with data reporting from CWS/TTP were identified in the last report as well. CWS/TTP needs to demonstrate tangible progress on improving its process for reporting data on the performance and outcomes of individuals with IDD receiving services from the organization. ORS identified the CWS' reporting of individuals in situational assessments as "placements" to be in error and met with the agency's staff to correct the record. ORS also has been working with CWS/TTP to act upon job placement authorizations and more aggressively assist TTP target group members obtain jobs at minimum wage or above in integrated competitive employment settings with wages paid by employer.
Summary. CWS/TTP is serving 78 of the 82 protected class members. A total of 58 individuals are receiving supported employment services. Of this number a majority, 30 individuals (52%), are receiving services in extended situational assessments that are subsidized by TTP/CWS, while 28 persons (48%), are working in employer paid integrated employment. Performance · during the current review period is below that reported during the previous period (April1, 2015). These data show a decrease in placement outcomes over the past six months and overall performance at a level that is far short of the 100% required placement benchmark BHDDH, ORS and TTP /CWS are not meeting their obligations under the lSA for this provision. BHDDH, ORS and TTP jCWS need to take tangible steps to meet ISA placement requirements (see below), essentially tripling the numbers of individuals in employer-paid employment during the next six months.
Benchmarb:: 5- Birch §IV(4). Effective April12, 2013, by Order of the PPSD Superintendent, PPSD ceased providing sheltered work at the Birch sheltered workshop, and the program was terminated.
Status: PPSD does not provide services to individuals with IDD at Birch in a sheltered workshop setting.
Benchmark 6- TTP §IV(S)-(6). Effective on the date of the ISA, the State will no longer provide placement or funding for new entrants to sheltered workshop or segregated day activity services at TTP.
Status: CWS/TTP ceased the payme.nt of subminimum wages to service recipients with IDD by the end of October 2013. CWS/TTP closed its workshop program on March 27, 2014. The program's 14(c) subminimum wage certificate was not renewed when it came up for renewal in July of2014.
14

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 15 of 40 PageID #: 203

Benchmark 7- Supported Employment Wages and Hours §V(H) and (I). All individuals in the TTP and Birch Exit Target Populations who receive a Supported Employment Placement(s) must have: (a) the support they require to work the maximum number of hours consistent with their abilities; (b) access to integrated day services in sufficient amount, duration and intensity to complement their employment; (c) an ISP that affords them the opportunity to participate in integrated settings when they are not working during a normative 40 hour work week (consistent with the individuals' choices and preferences); and (d) access to an integrated employment setting and work averaging, across the entire population, at least 20 hours per week, as determined by a point-in-time survey.

Status.

TTP Target Population. Data reported by TTP/CWS in the October Monthly Report indicates that 27 of the 28 protected class members3 working in integrated employer paid jobs worked a total of 255.5 hours, averaging 11 (10. 7) hours per week for the month of October. This number represents a significant decrease over point in time averages of weekly hours worked that were conducted in September 2013 September 2014 (see Table 3). Data on hours worked per week reported by the 2015 Sherlock Survey suggest that the majority of protected class members at CWS/TTP (63%) worked less than 10 hours per week while one quarter of the group (24.5%) worked on average 11 to 20 hours per week. During this period protected class members at TTP jCWS earned an average wage of $9.06 per hour, slightly over the State's minimum wage rate of $9.00 per hour.

Birch Exit Population. The 11 members of the Birch Exit Population who are engaged in integrated competitive employment are working on average 6 hours per week (Range 2-12 hrs.jwk.). Seven (7) of the eleven individuals are working in employer paid positions and receiving minimum wage of $9.00/hr. One individual's wage is subsidized by CWS/TTP. Data

was not reported for three individuals (see PPSD Quarterly Report june-August 2015
Revised).

.table 3 Point--in-Time Survey ofHoursWorked
l>y TTP.TargetPo J'ulation Members

Summary. Data on average weekly wages earned by members of the protected class

Month/Year

Average Hours Per Week

during the current reporting period is slightly

(Rounded)

above the State's minimum wage. Data on the

September 2013

16

average hours worked per week across all members of the TTP Target Population gathered by point in time surveys conducted

September 2014 October 2015

15 11

during September 2013, September 2014 and October 2015 show a decline of 31% from 16

hours in 2013 to 11 hours in 2015. This is far short of the 20 hours per week benchmark. The

State and TTP /CWS need to develop a focused strategy and plan for increasing the hours that

members of the protected class work during each week. The decline in the hours worked over

the past three years is concerning. The State and CWS/TTP need to take affirmative steps to

reverse this trend.

Benchmarl{ 8- Establishment of a Variance Process §V(J)-(K). A variance process must be established by the State to accommodate individuals who make an informed choice not to work in integrated settings, provided they meet identified criteria. All variances are re-assessed after 180

3 Hourly wages for one individual working in an employer paid job were unable to be calculated.

15

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 16 of 40 PageID #: 204

days and annually meaningful choice

thereafter to receive

to ensure individuals have supported employment in

the opportunity to make an integrated setting and

an informed and are subject to

review and approval by the Monitor.

StOrtSnThoetetrcaaqaaeittttnuoiduensdebsoiarsien:vesmtrgseTpid2iedohasu0trenpaa1atdrvsln4vosaca.sttwrheruTeiiacpaiarittnatnnpheidccoinddiemeris.ictncpsplPgouaarlnobressoossmictnlivehimoetitseindnhseeseVtesmwir,hnaasbafagrparseivpaetmrehdnlpsiieictcolscavieareokepttsPuilertoooloonhdnplvraipecibptpsldyeartirhonocoaaneeecnvnf.yedidwidsTtaPspiehfrtrrrrhheeooosavmcuSaosientncsnascoiotstoolbehnetnntetahayaerraialueenlsacdstyisetnnosoatogcotoproctfaptutpotbrhvhrroerepaoeevrrvpadVieoirap.dvdoanpAiervbcldidliieayetcd,nhtatenrncohtadieeuoeoiewgnnPnMdheirinepotoihhdgrtcnaooeatovicrustpreaosetpi.ssrndeusTieianpnhalrapgensyo.d.rt

Achieving Progress on Meeting the Terms of the ISA

The Monitor recommends that the following steps be taken to meet the terms of the ISA: 1. InmtoegnrthatleydpElamcepmloeynmt epnetrfPolramceamnceentdsa. tCaWbyS/tThTeP15isthreoqf utheestfeodllotowrinegpomrtotnoththfeorMthoeniptoerriod January through June 2016. The report should include:

a. The total number of individuals in the TTP Target Population

b. Total number of individuals currently receiving services from CWS/TTP c. Total number and percentage of individuals receiving situational assessments and the
duration (number of weeks or months) for each.

d. The total number and percentage of individuals employed in employer-paid jobs.

Tm20ho1en6ft.ihrTsothfimsDosenuctmehmmlybaedrrayt2ad0ar1te5apamonratdyiesbvteoeprbyreo3vp0irdodeavdyidstoetdhthenreoetMalfaottenerirtfotohrraatnsheaJapcneourmaiorpydo3Jna1en,nu2t a0or1fyt6hthfeorTroTuthPgeh June Monthly Report.

2.

dPwaleatrceeedmpAreponrvtiiOld1ue,tdc2ot0om1t5ehs.e.DNMRoSotena:intTodhrBirsHergDeaDcroHdmidnmigdepnnrdooatgtmrioeensestwotharesaircneticpolounrdsteitnadgkinednethaoednlpitnrheeis.viNoousr

report eports

recommendation.

PDofloamccueemmmeebnnettrasotiuootfnctohomef CeTsTaraPeteTTraTDrPgeehvtaePvlooeppdmuelcealntiitnoPendl.aTdnhuserainSndgtatathecethivacisutirnerosetnisdt enrevopetloeorvptiiedndegnapnteidrnipotrhdoe.mculilegnattfeidlesa new ISP /CDP process as required over the past year (see Section VII below).

For each member of the TTP Population CWS/TTP, ORS and BHDDH must:

a. Rasesveiseswmaenndtsreavnidsepearssnoenc-ecsesnatreyreedacphlainndainvdidsutaral'tsecgayrfeoerrsdeecvuerlionpgmemenptlpolyamn,evnotcaantdiofnoarl integrated day supports (see above).

16

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 17 of 40 PageID #: 205

b. Review each individual's support needs and, as necessary, revise the staffing plan to ensure adequate personnel and resources are devoted to integrated placement activities, including job development.
c. Review the perspectives of family members with respect to employment and efforts to involve them in the process of job development, placement and individual support.
d. Develop a new ISA/CDP plan or revise existing plans, where appropriate, with a goal of achieving a placement in an integrated employment setting within 90 days.
e. Complete Individual Support/Career Development Plans for all 78 individuals by February 12, 2016.

2.

Supported Employment Wages and Hours. ORS, BHDDH and TTP need to develop and implement a plan for increasing the number of hours worked among TTP Target Group

members in integrated supported employment. A copy of the plan and report on the status

of implementation needs to be provided to the Monitor by March 1, 2015.

3. Training on the Variance Process. BHDDH needs to provide training and support to service providers, families and persons with disabilities interested in seeking a variance from the ISA requirements regarding the receipt of services in segregated settings. The training/orientation program should be developed and implemented as soon as possible. A copy of the program and implementation plan needs to be provided to the Monitor for review not later than February 1, 2016.

C.

Integrated Day Services (ISA Section VI)

TwbfpoaehhrsretesehnIodSintAnrh'esearccenrihqenioaundtoidiirvsoieivinnsdiagdutlhua,inelasloiSis'scntinatIaeSotleg,Pt retiiaondntusefacucdah4rsnto0ieioo-sthtnlhioaontlugro,rsicTn;wuTSsloPtuuurcpkrahapwnlsod,eerearBtktvehi,dirlccceeehotsmincEmspxailuisnottsdyTetmnaobtrteegwhnaeeitvtrtfhaPnoiorotlahpntbehu-lfeleiaancrtddeiiuolimivrntiiyasndibuwgnaadtislhte'ehserdncodoaefacemaytdlimlasv,ttiuittminiemiestyeso-sef tthe preferences and choices.

Progress sBE(Bexer)invt. ciTIchnaetmrseggbaerartaskPteeo1ddp. oPucnolramoativm4oi0nsui-snohdinotuyuor-rifbnwlangsotetrehdkgewsrheaerotevuekidrcsSe, siIunnapddnpividovirsditdusuupaaplarseoliarztrtoesedbmneCouptosrrmtoebvcmeeiduimvenidanidtgayet-stabuivampaspieelosadrbatDlenedadtyoefrmSTeeqpTrulPvoeiyancnmceidseen§sBVtiorIfc(hA}individuals' own choosing and must not be provided in congregate centers or workshops.

Status.

TTP Target Population. Members of the TTP Target Population are receiving services during the

day to access employment

integrated community services. Using the TTP

activities during times when they are facility as a base, "small" groups of 2

not receiving to 10 individuals,

averaging about 5 persons, venture out into the community with staff to participate in a range

17

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 18 of 40 PageID #: 206
of activities, returning to the facility at lunch and different times during the day. Activities include attending recreational programs at the YMCA, the knitting club, art classes and programs at the North Providence Recreational Center. Educational activities include attending computer classes at the local library, English as a Second Language classes and attending adult reading and writing classes. Such day supports are identified in individual support plans but do not appear to extend throughout the day, five days per week. Although such group activities do provide opportunities for TTP target group members to leave the CWS/TTP program site at times during the day, large group sizes of more than two or perhaps three individuals rarely offer the level of individual choice and personalized community access required by the ISA. The State and CWS/TTP need to develop effective strategies for increasing options for individualized community participation and limiting the numbers of persons served in the community in large groups. Day supports are classified into two categories, day habilitation services and pre-vocational services. The external reviewer in his analysis noted that work focused activities were recorded as pre-vocational, and other non-vocational activities were considered day-habilitation although the records themselves did not always clearly identify the specific type and intent of the program. The September Monthly Report indicates that virtually all protected class members at CWS/TTP received access to one or more of the following integrated services to complement their employment: Integrated Day Activities, Community Based Day Activities and/or Prevocational Services. A review of the total hours provided to each of five randomly selected individuals at TTP across all services found that three of the five persons exceeded 40 hours per week, in one case significantly (L.C = 34 hrs.; R.B. = 43.75 hrs.; P.A. = 45.5 hrs.; M.A.= 56 hrs.; I.A. = 20 hrs.). The fact that one or more individuals may have a combination of work and support hours that exceed 40 hours per week is not necessarily a problem, particularly if the person is receiving a combination of both paid and unpaid "natural" supports. Indeed, for some individuals this would be a very positive and successful outcome. The numbers do raise questions however, regarding the accuracy of the hours being reported. The State and TTP /CWS are requested to review the hours being recorded to verify that they accurately represent the services being received. Furthermore, the descriptions of the various integrated non-work day services listed in the monthly are unclear and make it difficult to distinguish one from another. Birch Exit Target Population. Members of the Birch Exit Group hours are engaged in integrated employment and day activities. Programs and services are reviewed at weekly ISA implementation meetings and reported monthly. IEPs are reviewed annually and students are integrated according to their needs and desires. Day services for this group emphasize community-based trial work, supported employment services and community activities. Services are included in transition plans and CDPs. Summary. Day services furnished by CWS/TTP to members of the TTP and Birch Exit Target populations consist of a variety of individual and small group (less than 10 individuals) community based activities. Small groups generally should not exceed three individuals. CWS/TTP needs to receive training and technical assistance from the State to develop strategies for reducing the group size for community activities. Many non-work community based activities are classified by CWS/TTP as prevocational activities but the difference between prevocational and non-prevocational is not clear. It is recommended that CWS staff review the Core Service Definition of prevocational services
18

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 19 of 40 PageID #: 207
provided by CMS in the 1915(c) HCBS Waiver Application Version 3.5 (see Section 10, page 150-151) for the purpose of better defining the differences between integrated day services and prevocational services (see http://www.medicaid.gov /medicaid-chip-programinformation /by-to pies /waivers I downloads /technical-guidance.pdf). Achieving Progress on Meeting the Terms of the ISA The Monitor recommends that the following steps be taken to meet the terms of the ISA: 1. Integrated Day Activity Weekly Hours. CWS/TTP is requested to review the documentation
of the hours of integrated day activities furnished to individuals who are employed in integrated jobs to ensure that they are being accurately recorded and report findings to the Monitor by February 1, 2016. 2. Prevocational Services. It is recommended that CWS/TTP staff review the Core Service Definition ofprevocational services provided by CMS in the 1915(c) HCBS Waiver Application Version 3.5 (see Section 10, page 150-151) and clarify the differences between integrated day services and prevocational services for reporting purposes. 3. Technical Assistance. It is recommended that BHDDH provide technical assistance to CWS/TTP staff on support and funding strategies to reduce the numbers of individuals in "small" groups who are provided with integrated community services to no more than 4 persons. CWS/TTP is aware of BHDDH's funding appeals process. If CWS/TTP determines that an individual's funding allocation is not sufficient to support the services needed to accomplish the outcomes identified by the ISA an appeal can be made to BHDDH. BHDDH and CWS/TTP are requested to report to the Monitor on the technical assistance that has been provided to resolve this issue by March 31, 2016. Note: This recommendation was included in the previous report dated April1, 2015. The BHDDH and ORS did not meet the reporting deadlines. No reports were provided by the State to the Monitor regarding progress or actions taken on this recommendation. D. Career Development Planning (ISA Section VII) The State and PPSD are required to prepare policies and procedures for the development and implementation of Career Development Plans (CDP) for members of the TTP Target Population and the Birch Exit Target Population by September 1, 2013. Policies will be based on the assumption that all individuals are capable of working in an integrated employment setting and will take an active role in their own career planning process. The CDP must be: (a) revised at least annually in conjunction with the ISP or IEP person-centered planning process, (b) identify the individual's interests, skills, strengths and abilities, and (c) describe the nature and scope of services to be provided to enable the person to acquire and maintain an individual job in an integrated employment setting and participate in appropriate integrated day services. Progress Benchmark 1- Birch Person Centered Planning §IV(3). A person-centered planning process will be engaged in every year that a student attends Birch, starting at age 14. The person-centered planning process will minimally include the standards and milestones set forth in Section VIII.
19

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 20 of 40 PageID #: 208

SrwcoCeotnoaapmslttolhuapcresbtloi:eoumntPrsegapPedtplSieofvDeotfereriecdotftoodfwfeno.PoctrPPitnisSe7vtuDr6eusedooMdsenfutAntpochPteesepSrnvrw7ptoie8hslvraooisendrtdwsnue,idpepnTlergeaeenrnastsoncstoruhiianntnetgorectfgehuLsnieseecitantshedrgorwaeeontradhlsss,ediptapuliManoreondnctnvGoIyiiinndolmltgeueAedtrfdhcvobitrecpiyonaBotntlphiiriouPelclnllhnaNaeStsniostponsrueni.tdnch.AegieTadnrSlhndtieyssiRttsdspitoheurinoonmradicJnlee(ugMtslIryssatAhlwi2aPni0snaSi1nds)5gn. ot

Summary: The use of person-centered planning is occurring at Birch Mount Pleasant as required.

Benchmark 2 - Implement Career Development Planning Policies and Procedures by September 1, 2013 §VII(1)-(9) and §IV(7).

SipwcpCmctnhotlorOiasaaeolntPtlntnhgicauintnnfrebtsuoiedhero.ntrsnireerTmgvsiatdnghihtpaodiogeatarnnu,aotcMMgaliwcmatlooseeorhsfesndencuesieieiarntpcttrh(eroastpIeedeiErao!deg'eSsPpdrrrvAf)pteaRduelvptaaneleiileocsnnvpdalapgrodeenobemlrdpilCoqt(ne,mIeDpHuS.dnimiesPBiortrvsn)meeHepuitqdhndDleeoua.utadDfnaTisaprnHanolhletdainaissmnscnikuCAngoneeppgnonipnprpnlmtotrreoiswgiocnl,mrpec1eputarselu,repsolsosns2lcowschai0tetvenoa(e1ysCsensl5sswlrBOi,,cfnaaaooPoiOsgnsr)rynRerdkwetbaedSiiasooniccrStrntueaaheheanteapperncdtavdolaadn.gyirrrcteeOsttehiewnstsRoesiacslt.SrftpiluhTetdbeaiehassherond.teesvntdiDofhietopenBnulitdRrdose-HoceIipcnDctvDoremooaeimEDndlsweBtHpusarneHleaunortewlgDesdftpuieederDlnP.dlaerpagHPuBendtrScni'ieHostoDasiscDlnnitaeigoDgsocsnwHknsiinnanolgaf has not met the terms of the !SA for this provision.

TchhircrseelTouaacqedmrPsedrusebieTuevmnecsadetetaredluengtymeidtenwuhbttfgoseorePiitrrnrsothseittgpigehqsaunnCiuslsiiWaniifhprntidiaSceeoiv2advrsnin0sien.adot1rgnCunvm3nai.,CWeculTtOdehaSahsiPlrb/c.eeTsrao.OeesTluOvefPi(tctisn3'heoosse)weupnShoepd7eiafson8ppdtrahte2itnbeenur0mdesdn1teowiilb5vnatn.eioicewdrTikssiuMhinrnriaiednetgloitspInvteSthoatihnAhdetrelutoCrycemaerWodlRqrosmSeauetwvsmiipwvriobiesuatireeshtnttiihd,oitnothiuCyigndnat.Oet7tACo2nP8aO0tslvwi,yl1fPaie7Co4srea5iOrsiaarskP(snn79dscd8Co6eebWfn%oseahcofSg)arrn8eiesreo0bevanfep(ipntod0sohrde)toraedbthntssepeaolcletidtavhtneniandstgitat

annually.

'

AAsrtwDwibrdde(sheeebnxuiseeoicragtr)hptvtyvveeuotaheieenpiceelnwnrvcldotlOiodd-colcotehsniyRalnsapdp(niiutuS3lltomlOmigdleetico3tyhnaeceethn%ribenkhtncnenasoecedeod)vt.tsbvodunieirPIwiBevametranndtlrHivrwoeaitduudpish1inrDeicsuctoeov5"ertuhtDeaney,fieriaeesldHcenid2tlxonsuonahi,0taafnuddagntao1dmnjsduplindnoe5vyifarpwiibvv.iiilsznsnodonoeFiueesteddurlngfrirdepodtuliategstepatphptlahthsslhftooellremgeoe'aoaoresrduruntctpcfeImessienSsosotn2dcttPidromrr6t(oeoeepeIdmplrionrSqlpininsmdarnsrnPeuogocsadie)iiin(tcnoentnristhaweevmdfehdCetstnsitdiiaeoledWshvttvaetrsh.nbuiiieneahdsSdetIyaonds,teuiu/lsfstenTtasiaatnhursctxnrTlldewpeearu'tsdsPveplreeruocasaideenIftg)cweaeSwoersut,ewsgtPslrartt,n(slaeoosleecosdeshe.sn)drwsewcetmmAia-.esbvdocnhfmdSeadeeeemoedisydinnlctneufnotopihttohbanncttmiplaaiecbeeftdeommgrisutlltenecfiyr"esCeaesodadeanedhrmnfWulerdoeirsetefnnmco:buoSdoeepdometr(epv/rnlnhaTprianitpdn)cesstdahTntohkee.repenPoepreviranDexil,ftenMmelncrtitrirpsloss.genhesooeltowtAveoaiwtonpacnnaennselofipmgilrhtn'rcltauorsoseleheioseafarnCInaienttrSnb7ngbenritaetPoo8ovycedprptptrniethraplerocaDeeeaeondaeetrddrrnicdtnr.IoneseScadBnCdoislPnnaisOn,ldslg,sPsi,t

20

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 21 of 40 PageID #: 209

definitions or requirements issued by ORS, RIDE or BHDDH which can effectively be used to establish in-house policy and practice at CWS/TTP.
The April2015 report from this Monitor references a previous finding that the ISA requirement for a COP for each member of the protected class was substantially met on 11/20/2013. While the requirement was apparently met in 2013, CWS/TTP and the State continue to be responsible for ensuring each individual's COP is annually reviewed and updated. No documentation of career development planning or annual review was evident in any of the files of the persons receiving support. At the Monitor's request the State and CWS/TTP performed an in-depth search to locate the missing records. The COPs were ultimately found at CWS/TTP. (Note: ORS has requested COPs completed in 2013 be updated and reports that as of 12/31/15, 21 are completed. ORS noted that CWS/TTP staff are working to ensure all COPs are updated by 1/31/16.)
Birch Exit Target Population. PPSD has met the requirements of this provision. All members of the Birch Target Group attending Mount Pleasant High School for the 2013, 2014 2015 school year had Career Development Plans when they left school.
Summary. Individual service plans (ISP) for members of the TTP Target Population have been completed. The ISPs do not, however, include a MAPS, PATH or other person-centered planning process, nor do they include the components of the Career Development Plan. Documentation of career development planning activities with members of the CWS/TTP Target Population was unable to be verified during the recent external review of client records. These records subsequently were found in another location. Neither copies of the COPs nor annual updates were evident in any of the client files that were examined. BHDDH, ORS and TTP are not meeting the terms and conditions of the ISA in this area. The BHDDH, ORS and CWS/TTP must take immediate action to remedy this deficiency (see below). COPs for members of the Birch Exit Target Population were in place when they exited school.
Benchmarl{ 6- Benefits Counseling §IV(8). All individuals in the Birch Exit Target Population and all individuals in the TTP Target Population shall receive benefits planning information and counseling from an experienced, qualified professional by September 30, 2014.

Status.

TTP Target Population. CWS/TTP identified 90 members of the TTP population in need of benefits counseling services. Of this number, 34 individuals (38%) have completed benefits plans. Another 44 individuals (49%) are engaged in benefits planning activities, 5 persons refused to participate in benefits planning and 7 individuals could not be located (see Table 4).

CWS/TTP staff noted that the

I

Table.4

benefits planning process takes a

CWS/TTP Benefits Planning Summary

great deal of time and the number ' Total Target Group Members

90

of individuals with completed plans Individuals with Completed Benefits Plans

34

increases on an ongoing basis. An

Number Engaged in Benefits Planning

44

external review of a random sample Refused to Participate

5

of records of 26 protected class

Cannot be Located

7

members at CWS/TTP, however, revealed that less than half, 10 individuals (38%), had received individual benefits counseling from a certified benefits counselor while the majority, 16 individuals (62%), had not. The

21

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 22 of 40 PageID #: 210
reviewer noted that CWS has two certified benefits counselors on staff who work with protected class members on the development of individual strategies to protect income received. ORS has a contract with the Sherlock Center to build the State's capacity to provide benefits counseling services over a three-year period. Deliverables include increasing the number of Social Security approved benefits counselors, expanding local training and developing diverse funding streams to pay for Benefits Counseling. The Sherlock Center will coordinate eight regional benefits counseling orientations, four directed toward students, families and educators and four focusing on the adult population and providers. An additional session will target nonEnglish speaking customers and their families. Birch Exit Population. The Monitor's Report issued on April1, 2015, indicated that 100% of the 2014 and 2015 Birch Exit Populations and 77% of the 2013 Birch Exit Population had either received or been authorized to receive benefits planning. Lower penetration rates were reported for the 2011 and 2012 Birch Exit Populations at 25% and 20%, respectively. The majority of individuals in the 2013 and 2014 Birch Exit Populations have received benefits counseling at 77%, 91% respectively. Participation rates in the 2011 and 2012 target populations remain at very low levels, 27% and 0%. Summary. CWSjTTP has service contracts with two certified benefits counselors to furnish benefits planning information and services to all TTP Target Group members when each individual is scheduled to enter supported employment. The numbers of persons with completed benefits plans are increasing, but the overall percentage of individuals with completed benefits plans, 38%, must be improved to meet the 100% benchmark. Benefits counseling rates for the Birch Exit Population during the current reporting period show a slight decline in comparison to those reported previously for the 2014 population. ORS, and PPSD, to the extent it is providing services to this population, need to develop and share with the Monitor a plan for ensuring all members of the Birch Exit Population receive benefits counseling, consistent with the requirements of the ISA. Achieving Progress on Meeting the Terms ofthe ISA The Monitor recommends that the following steps be taken to meet the terms of the ISA: 1. Career Development Planning. Documentation of required career development planning
activities with members of the TTP Target Population was unable to be verified by an external review offiles and documentation. BHDDH, ORS and CWS/TTP are not in compliance with the terms and conditions of the ISA in this area. BHDDH, ORS and CWS/TTP must take immediate action to remedy this deficiency. a. Past Career Development Plans and planning documentation must be placed in each
individual's file at CWS/TTP not later than January 30, 2016. ORS and BHDDH are requested to review TTP client files to verify that past CDP plans have been placed in client files and report to the Monitor by January 30, 2016. b. Evidence that updated CDPsihave been completed for all members of the TTP Target Population must be provided to the Monitor by ORS not later than February 12, 2016.
22

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 23 of 40 PageID #: 211

c. It is recommended that CWS/TTP, in collaboration with ORS and BHDDH, develop guidelines to ensure assessments are: (a) person centered and directly linked to the individual's strengths and needs as identified in the person's ISP and CDP, (b) include a variety of job trial options (at leasttwo), (c) be focused on skill evaluation and development rather than long term placement, and follow established parameters and expectations. It is recognized that some of this structure may be found in existing service definitions or requirements ORS, RIDE or BHDDH which can effectively be used to establish in-house policy and practice at CWS/TTP. Draft operational guidelines need to be provided to the Monitor not later than April15, 2016 (See Attachment A Independent Consultant Review Recommendations 3-5 page 9-10).

2. Benefits Planning/Counseling. Members of the TTP Target Population and the Birch Exit
Target Population do not appear to be receiving full access to benefits counseling services as required by the !SA. To meet the terms and conditions of the !SA the following actions need to be taken:

a. CWS/TTP,ORS and PPSD are requested to prepare an action plan or timeline for ensuring all members of the TTP and Birch Exit Target populations receive benefits counseling services by March 31, 2016.

b. CWS/TTP must ensure a copy of each individual's benefits plan and summary of planning activities is placed in each individual's file at TTP.

c. CWS/TTP is requested to provide to the Monitor a monthly summary of benefits planning activities beginning with the month of December 2015 and including:

i. Total number ofTTP Target Group members. ii. Total number of individuals with completed benefits plans. iii. Number of individuals engaged in benefits planning activities. iv. Number of individuals who refused to participate.
v. Number of individuals who cannon be located.

3. CWS/TTP should identify training in person-centered planning and career development planning as a high priority and obtain assistance from an individual/organization that can train CWS staff in these two areas by March 1, 2016.

4. It is recommended that CWS/TTP (in collaboration with ORS and BHDDH) develop its own

internal guidelines and of the staff responsible

expectations for developing Career Plans for completing and monitoring CDPs and

including timelin~s

the identification for completion,

updating and review consistent with !SA requirements by April1, 2016 (See Attachment A

Independent Consultant Review Recommendation 1 page 8).

E. Transition Planning for Youth (ISA Section VIII)

The State and PPSD are required to develop and implement a comprehensive process for transitioning youth with IDD between 14 and 21 years of age from the Providence Public Schools District to state funded adult services.

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Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 24 of 40 PageID #: 212

Progress

BSttsiPhrnctraeetahoonntovfesciaoiirhadntlsi-mnetoitndnoanac-tn-PreewadPkrgPoSape1urDgrkbyei-olantoiErrrccuaeiymttnShyrascpe'isshgqlteoroipuroeoyovienlrmsimecDtpsedeeriensonotctotcrptoiFettacnihsitdodrs,aonasitftnprofiyctPnorlcravoturlnoylduaicoiEcdnnauyesmtgtisiahtopBitnnoilsimodanerylce-eIhmapklngilisetnanetenenugrytsndtaoFireagnuainnergnttdshnssto,cis(bPtpya1ijoeone4Alccndi-ictg2fiwpyi1rvcremoeoybesrvea.mkeiakTndpriechinslnnheagotgmcSfi§efntaaoVmatgrretkIeeegsI)sntIratuwsa(nsAedtideatet)tdhnn(iPn1dPteIgs)DSmf-'DDo(fap2orcl)isrcno.thheyaTsmlashl eeteonntter the services and supports set forth in Sections V(A)(1)-(2).

Status. PPSD has developed and implemented required policies, practices and agreements in accordance with ISA timelines.

Benchmark 2- Employment Planning§ VIII (3)-(8)._The ISA requires the transition process for each student enrolled in Birch that requires transition

development services to be

of

a

furnished to youth according to key age related milestones.

StrTaahenntisarmddoptueougPlsngPri.ansShdieDTb2eahi1rltneieoytdpSieieoCdtasaerrhtstanee.nttcihhPdfkaaPylrstiS,esvDadtqloeruiecegvimafnreetelpiaromoelnponnedeaycndlstetrasaaatshcocTsekfoerRmsattrrsnIaapDmsnnriEeests,inhiiottOetiinsoRonAnasnSircvareateceninqvtdTioiuvtrBtyiiartpHienCeeDmshsriDmeteiicHdnoikettnltsnfieosTtrdriteifmftfitoreoeaerdrnbleSioesnntniceuptiedteodhderenefnbtioatTnyrsigilmtmwihyneieegodtlhuiItniShtn1hAee/.D.sasTeTgDpghheereesbceyig1Sfia4tacatgeteed settings.

PraORdcppahscePptesluoraIRvuaDsSopnesmSniidDlgEts,ghitnemerecoBniiraenrdarnueeHesmntebgddnspspDddl,eieloiteoDtdatPnoo.yrdhnniHPSntctutesssSerme,haciaDpvtdtfleaVenheaerurtetmssoaconieratioovtctiafiitrynnloaninis7gyos-rtgogd7e,pisinnosouittlst.oxuhanshnctpfP.unpeate(ooPe7Fld7ppuppfdS8Re6oosuasrDn)rraiemouslttntahyotvijp,egevtoa-yfipmPimtsebitoe7Pwonihpina8obeSrlteolirtnmDeosaTtiMtrsaev(ytphas4tpresoMAirlav2eooogfoetPi)trfntcey.mnSwshtoetPmoeChepepfGlnreoejrelr7eIonroeSonuaB8vobeAyctnsupiilieamsesr.dpnrcasenewOeedeshnrltmvpRo.vindoHTvearSTitencilriroms(wdogheaeCeuJuhpsnadoubrtoaesvssleaSiyolmriiinrsnocdtcfws9ihmndeepcto,orhehs/oanuve2ooeorlVance0llTtrs.nae7ini1oetajcbi8ddPyo5cvrioraboprgteiPetrortnraoedsaitiavdotrtaprtreaaiiiienlPotadovdnspnawnolesinlrediispenpnoenRwriusuclsbrdsataLeleeikriiaclthlivpnishStaieeaairtiticxmwldoayboashpuwtlonigeeliioleansorrinoroprlt)eenettiiarlasoszectk,toDrsoeinewatfouedicioeinwnevtnxhepndpsedposoeCaed,Cefin9rrrnorakOstsCijcmucnooePwOlhndnbuneosPicdn-teosehitllnsoo.grr coaches.

Strheuqamtusmi rteuaddryeb.nyPt stPhSaeDr e!SinsAo.ptDrroaovtuiadtioinnnegleysaecrrhevcsiectiuevsdineagnntdt'wssoiunptvrpoioallvr twesmotoer knthtewexpiBtehirrciTehrniTcaerl asWnosofirtakipoEpnrxPopxoeiprmiuelanatcteieloysni6na0sdidcaaytses in length each (see below).

Bib1sa8essunyeecedhadormisrneaatcrhntkiedv3RteosI-teSPoneoscflauoicrcnieydliyatDarotyiuerEtethchdtiuenicvataebrtsaiiloni(nts§yiVRtoiIeofIgneIul(ail7gar)iet-bi(o"l1en..1.sip)n2)rd.o0iTv1vhii1ddeeauSdnatldaasltnlweooaitptnhbpdeoIDPrutPDnuSnntDoeitcwiaeecisslcsletaousrspieldSyaartoatnetrecuprsnoeejldruivcesinitecitsfeiiasaalbnsaldtyage

24

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 25 of 40 PageID #: 213

excluded from the opportunity to receive a high school diploma as a result of their participation in the Birch program."
SbasBrE1eoeevitn8HpdarrqasputDvatiuuhulocinDaicrdarsrdbeHeatt.esluisy2mTeohnta1nhthteaishoetysanRyrietStoBnietsasautdogisraltrgiulsuhctvreh.lsheeaiaStdcdatwttuetiurnmoduaeiaadvndeenlpuessnkePsosinltwPadtltysitSibucisdoaDIteyrSinhatipAnmd-naBlIagioDrdiiergermmeDItfceEcwathpaPottymilorAaoveamiersulmenckaieataesiraehendsinfrnttgefewiaitaimonsarrthumohnegtyoilisopiefgtancrannrhoroghonsefmmsovudttcnohhirehtsdoseeeehcoeetittrhdoidrihtonoelnopawugopadatwgslapiiratphtrtpaohpoitlnrwcrmopioktdimnrrhppeoiifreanrantoepitttaraageirt'mosdhstinueaneulcsalltaleoyteeictrinttmoosestrfetmnyexemohrrscprbmsevtilto.yetiuhBumcrTmdPtnebihseePrsiybicdntSishyaenttDfhncttrpptwooeodhrrrmmeioeeRpsogegurImSrtanorphStarutvapotedemnihtocideiten.rochitMnganaesgtgditeiahreaomrser2neyo1o.sft

Achieving Progress on Meeting the Terms of the ISA

The Monitor recommends that the following steps be taken to meet the terms of the !SA:

1.

TlcseetenhnunsegduttSeerhrint.anettPdgsePrctSaehaDncaredetiiesevPraPercdeSihqeDnvusteatehulrseoedtepremedmngetteuoernlteaditcnrpoegqlciavuuInSemaAnrtietwnrenegortqltyftuhroiirerareelBnpmwuiormrecothnrsbktyespoerrwxuoopitvftheiwhdriironeeedrntskrtcpaoteenrsctishatoilettfsiooaMBpnthioprbencruoihpttxortdiorrmaovnnianosstotiieotltlianyoatnpoe6-prf0aeptgdhaeeaarrysntsoonibne

February 28, 2016.

F. Training (ISA Section IX) TbscaeosahrsaseveceiIshdcSsieAntmrgpare,rienoneqtfmi/uenpispgrrsloeipofosryinoltmehagsleers,an.ScmtTtaashrtufeeeopertaprrTnoadTdirentPv,PinbPeaglSenoDndppermBtfooiitgersdncreachtvompseultlaanmofnsfpues,lsamaitnnneagddmd, itdsmbruraeeppnrslpssseioomttrihfoteeeennmddtpeepalvmalconeopyslmol;mopjpyoemembnteteednpnnetlctvao,yenfi-lnnvbotioapencsmggeardettaienotaaetnn,mdadjolsdvbaaaynludey-outh services, intake and vocational rehabilitation services; and service coordination.

Progress Benchmark 1- Develop and Implement the Training Program by October 1, 2013 §IX(1).
Sbpytraottghuresa.MmCohunarivrtioecrub. lTeaehfneordSetthavteeelvoiasprweidooufroskricntohgmewpCiotonhnetsnhetenstSoDhfeecrcolromecepkeaCtneednnctthyeer-bapatrsoRegdhrovadmaeluhIesaslsa-bnreadcsCeediovltleerdagieanptionpgroval implement the program.
TBpSrrueoapncipnceohisnsrmgt, etaidhsrekEr epm2qrpue-lpiToraeyhrdmaetteioSontbntaeataenpndardonIivndmitdePpegPlderSamDttoeeWdnaltDlailptaliyeoErnSsneoosrnufvsrciceainertsevheofeorlvrPdemerdvoeievnmliostbiphoemernsdeoinosftfcNtpohlveeacenTresysaasraangnrdedyttaPhTseorspaepusirnlosamivtniieosginno§tsnI.Xo(f2). St rtaaitnuisn.gRs IJDuEnehtahsrporuogvhi dAeudgausttr.aTi nrianingianngdsetescshionnicsaaldadsrseisstsaendcejocbadleenvdelaorpimdeenntti,fyjoinbgccooamchpinlegt,ed

25

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 26 of 40 PageID #: 214

transition services, supported employment services, vocational assessment, job development and career development planning to name a few. Additional trainings have included topics on inclusion and collaborative teaching, IEP development, and the special education process. Participants included Special Education Administrators, Teachers of the Life Skills Network (TLS), and staff from the Regional Transition Centers as well as to students and families. Training was additionally provided at local, regional, and statewide transition events and direct technical assistance was provided to teachers and education staff by the regional transition coordinators. PPSD staff attended these trainings along with teachers and staff from other LEA's and schools. PPSD staff additionally attended trainings in self- determination, job development, job retention and teaching skills, task analysis and person-centered MAPS training. PPSD has provided a significant number of training opportunities to staff. It does not appear, however, that PPSD has developed explicit professional competencies that must be demonstrated by staff following the training they receive to show that they have learned the task or understand the material well enough to be assessed as Ifcompetent." A competency based training program should include the criteria by which the learner will be determined to be competent in the application of the skills or concepts being taught. Over the past year several training opportunities have been provided to service providers and educators by the Sherlock Center BHDDH's technical assistance contractor, RIDE and others.

BtPrrHaeiDqnDuinaHgliifrmiecqpautlieiormneemPnoetlneicdtsyaaafdnoddrrmetrsafsocirnkgipnrigonvdfoiidvrmiedruswataol ssdedorevcviucemeloeppnleatdnthsa,encdqaurimeaelpirflidecmeavteieonlntoespdomwfetinhttehiporlarsitneanfniftn.agAt,iojonband development, employer negotiations, job training, benefits planning and other topics.

BHDDH, RIDE and ORS met in September 2015 to coordinate documentation of training for the purpose of quality improvement. The agencies agreed on the development of a joint team to review the credentials of providers that furnish services to individuals with IDD with criteria specific to employment and assessment.

Summary. A Employment

values based competency based training program has been developed by the First Task Force and approved by the monitor. RIDE and PPSD implemented

the

program and furnished training to provider staff, as well as families and individuals with

disabilities. BHDDH and ORS established forms and methods for ensuring providers meet

qualification requirements. A wide array of courses and training opportunities have been

provided by the Sherlock Center to staff from IDD provider agencies and schools statewide.

BHDDH has established a form for tracking provider prequalification and qualification requirements. BHDDH and ORS are collaborating on the development and implementation uniform methodology for tracking provider qualifications and training. The format has yet

of to

a

be completed and implemented.

Achieving Progress on Meeting the Terms of the ISA

The Monitor recommends that the following steps be taken to meet the terms of the ISA:

1. PPSD should provide the Monitor with information on the professional competencies

established in its competency-based values based training program.

Note: This recommendation was included in the previous report The State did not meet the reporting deadlines. No reports were

dated Apri/1, 2015. provided by the State

to

the Monitor regarding progress or actions taken on this recommendation.

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Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 27 of 40 PageID #: 215

2.

BHDDH, ORS and, as appropriate, RIDE are requested to report to the Monitor on the status of the Joint Provider Review Team that was to be developed to review provider credentials,

and the documentation gathered from providers by March 30, 2016.

G. Outreach, Education and Support (ISA Section X)

The State and PPSD program explaining

must develop by September 1, 2013 an the benefits of supported employment

outreach, in-reach and education and designed to encourage individuals

with IDD at TTP and Birch and their families to seek Supported Employment Services.

Progress

Benchmark 1- Targeted Training §X(1). The ISA requires the State to develop an out-reach, inreach and education program addressing the State's Employment First Policy, benefits planning, strategies for combining integrated day services with employment in integrated settings and others.

Status. A draft Outreach In-reach and Education Program has been developed by the State in collaboration with BHDDH, RIDE, ORS, the Employment First Task Force and the Sherlock Center and has received provisional approval by the Monitor. The Consent Decree Report iMasssoruneeiqdtuoirinrfeAodruaagnpudpstrho2av0sa1nl5obryterSqeeucpeiritevedemdtbhfeeinr Sa1lt5aa,tpe2p0tro1o5sv.uaTbl.hmeTihtdetohcEeudfmuinceaanlttivowenrassPiornonogtorsafumthbemmpiutrtsoetgdbretaomstuhtboemtMhiteotendittoor the Monitor for final approval not later than January 30, 2016.

PPSD continues to provide regular training and outreach to families of members of the Birch Transition and Exit populations.

Summary. Training programs were developed by the State approval by the Monitor. BHDDH has not provided the final

and PPSD and version of the

received program

provisional for approval

and must do so by January 30, 2016.

Boanpedpnocdrhatymunsaierttyktifn2ogr-sOinwbdhiseverirdevuiiannldsgiviInindttuheaeglrsTawatreigtdhetEIDPmoDppruleolcayetmiiovenensSttuo§pXvpi(os1ir)tt.eaTdnhdEemopbprsoleogryrvamemeinnwtteialglnrpdartIoenvdtiedegmeratphtleeodymDaeynt Services.

Status: The benchmark was reported as being met in the previous Monitor's report dated 11/20/2013. The State reports that members of the target populations continue to receive wopoprokretuxnpietriieesntcoeos basnedrvoethaenrdovpipsoitritnutneigtireast.eBdHeDmDpHloryempeonrttesdettthinagt sitdhuardinwgoarskseedsswmiethntCs,WtrSia/Tl TP to set up a Job Club to link individuals who are working with other who are seeking employment. However, no information has been furnished on the status or outcomes of the effort. Data from the PPSD Quarterly Report June- August indicates that Birch Target Group members are being offered opportunities to observe individuals in integrated employment and integrated day program activities.

Summary. Members of the TTP and Birch Target Populations are receiving opportunities to meet with individuals who are working in integrated placement situations and taking part in

27

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 28 of 40 PageID #: 216

integrated day activities and programs. Establishing a Job Club at TTP is a good idea and should be implemented by CWS.

Benchmark peer-to-peer

3 -Networking §X(2). to link individuals with

The IDD

State will and their

support families

personal networks, family-to-family and to individuals with IDD in the Birch and

TTP populations.

Ssoaaedtftatfrdeevtiunritecidsode.ensBdbaayHltnhDtidhneDsfesoHeuSrptmharpaenaoirdntlrioitoOnscnRgkfSsohC,rapwesiannhbrtdtieeiicrcevhinaipdptfaurRutaoerhlvndsoiiddaisnehnededtIhdsdfelateaomFntaadtiilhmliCeeeidsolM.ylilenEoPgfnmeoai.rrtpeomTlnroahtoytseinmsoaetnenhntdaertarSAdoicneuwhivnonaedogrleloednTpmiemrsspacsenluonsTsyitsrtmeoaiodirennnseiuntmC.gpopNspulooo(nFrysEtemAoloefTrn)st personal and family networks.

Achieving Progress on Meeting the Terms of the ISA

The Monitor recommends that the following steps be taken to meet the terms of the ISA:

1.

BHDDH is requested to provide information and data documenting (a) employment sites and (b) family and peer-to-peer networks currently

visits to integrated receiving support

within 90 days. Note: This request was not meet the reporting

included in the previous report dated April1, 2015. deadlines. No reports were provided by the State to

BHDDH did the Monitor

regarding progress or actions taken on this recommendation.

H. Provider Capacity (ISA Section XI)

The State and organizations

PPSD have agreed, "to ensure that to deliver supported employment

sufficient capacity exists among State IDD and integrated day services to individuals

provider at TTP

and Birch, consistent with the terms of the !SA."

Progress Bepdnereofvnovecrlichodepmerprsarereolka-fqft1ieuora-inlnsiPgfhiricsopeavsrtiviwodincieterrhseCetqoamupiipnraledcomiiyvtyeeidnr§sutXsatoIlfs(oi1rda)teaanTllntTiSdfPuy(paa3pnn)od.drTBtpehirdreochmES.tmoaSttpueelpowipnyiotmlelrgteeernsdattataeebnmdlidspehIlmon, pytiemlmgoperylanmettmeepdnertDonpvtalaiyadncSedeermsrvweicniletlss in state and federal agencies and in private industry.
SaSpnrtpaodetvcuriiesda.lleaissBtteiHndoDfftoDerraaHmcckhahitapni osrgonwfvooririndmtettserh.neaTganhenuendmcdyibem. peOpraRlroeStfmmsreeet anpnftotfe' rstdtrPsaairtnepheqraedutq,apultrirafealiqiicnfuaiiactnilaogitfniitocyAnapgtepie,oonnclciecyrryetTiqffrouiacricarkpetiirmonongevniaDdtnsaedtrhaLaaSgvehaeednebecJetyoebsntaff completed and given to providers for feedback BHDDH and ORS provided the Monitor with a description of pre qualification requirements and the Values-Based and Competency Based Training Program as required. Summary. BHDDH and ORS have met the requirements for this provision of the ISA.

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Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 29 of 40 PageID #: 217

sBpurefonfciccehidemunrtaearsrkrna2eyc-eoPsfsrtaroravyiintdeoedrfuaSrnntdaisfsfhuQpsueurpavpliiosfierctdaesdtitaoefnmf,spa§ldoXeyIqm(u2ea).nteTt ahsunepdSeitranvtteiesgwiorianltleaednnddsuarryeelsatuthepadptopprortlosivctiioedsTeraTsnPdhaanvde a Birch populations.

SqmaauaidiMrnnutntegteaaittatdBeovleietailnnneuigzigsircfiltnisurcrtoiany:aoeahpipqg'tdstn.rTeiiueerosnBthasadvhxgntbHelaiaaiicissDssfSlfltoiiitthifDotelsirtmatoonyadtnoHtugwmto.etselopfAwtpdughfarseupniaoofplternroafisvrlssotdfotakiyoaofvdtnikesnonaiaedesdwlngcniuentekwtedhanrirselvaiseegiut,nttitdharotdhbeetigeeeetemsrfCiehgavtsirflhep.WirleirqnanelPolkMooustSdmrepetyapo/iyoodrTvlmevoBinriTpdfcimdvieHidoPotcutinoDieossmaanttriritDoltogaaimtsaioHhnnsoagiwnusaddndeoispntehsdsn.ftriatoCrcrtnPaeasteyyWPnesmhnsrSeeddaesseSaDndadilrsy/atytaeomTitgttdaaolnrTseeeifaneomninPdfscnrit.icsnvaktstawyeFogeijtsnrcoorgaivdccapencrrniootsruacbBhotomnstebairtifecsrorywsmredeicrsrncrdahpiuseengeosiainmqhssronriaoc,autntttpdunivyooiiaclnrdserolsieatsugiphtyctsddiearinautemeeonibtgtfivvnenoiferyziewigantiacratllintthbeihoethesiaspiecpaeotnl,neaotminntItadrfScryiantfenAtnoaldunatdtgm.iosaonmtnCuytmdahthbpWhciseueprteeieSnrorvs/viraiTtttioynsicTfedePss as required by the ISA.

Summary: BHDDH has worked with TTP to qualified staff. PPSD has secured additional

improve the ability of the agency staff to provide job development,

to hire and retain job training and

job coaching services.

BtiphnaeetrnetSgcntrheaarmttseehatdiorpekcsmr3wep-ailtotIheynpimcneecernenstnotitsnvievestsetwistnihtgtohrso.eIDuSngDcuohc, hufPariamungcbielelyintchtm-iePveertmrsiavbanaersteriestt,iPooeanmbreoptnfilmoienyrpdeslirhevsmi,ipdeesumna§tlpXesldoIfr(tyo4hmm)r,oe(u7Tn)gtT.hpPTrphoaunevbdiIdlSiBeAcri-rsprcerahiqnvutdaoitrees community organizations.

SsiptnhttlracaeeentaBunfmstooi:nvrsTuiItzSshoeSeFsPseDuryepDospavtRreoiedmreetdcrtreuhsesredirtgoeeinnsniitniggltcyrinaor.betuiOaevpsiRenehSsgataphsrnreedodvoivistveihcdewueerseasusdltelaibdlnQiyuziunamOactiRleboiSnteny'triQoIvonfeufcpsaheelofnirotutfyciorvuAsresmtsiBhnsaugaonrtncoaiuennnscdbifeidaeveseTinedefdtuaoifamrcylos'.isnnerwgtvranoicceretwkstoaRfunandtedisitnsfgor

Stmhuaemdtermatanorsiyint:icoDonrispocofurisanstdieoivninisdchueaanvltsievfteraoskmiennTbpTolPtahcaepnoadltiBcOyiRrcaShnadtnopdirnaBtcHetgiDcrDea.HteHdaonewdmervpeelporo,yirmntecedenlntytsipevlteatsinntsogasertnehcrbooeuuirngaghge public-private partnerships have not been established.

Btwooerueocgtnhrcaknconshimichzmaoaeltaspiaroossknfseaitr4shvlt-eisacunIQeSpcsAuepa,aottol(ricTtt)eTyanpPnAsrduotsorsvseuuicdproseaeunrnipvvncpeicerosetir§nottXhteniedv,I(i(eSrebsm))s.ahupTnesldhloeteyeseurmSfepftedeapnctoeettimrvwpterpitoollblvouqpiysdurmioeanvreleisinfs:ditsee(padmro)oponhgrdgaoreovavliesmnidgatseodrrteesomvqoieiunefeawtsttehe,tgehosrletavtaetegferrfoedisandilggsh, atnadn d employment options.

Status: See Section L joint provider review

Quality team to

Improvement (§XV) below. assess provider credentials,

ORS reported plans to establish a agency competency and certification.

Progress on this effort will be reported in subsequent reports.

29

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Achieving Progress on Meeting the Terms of the ISA

The Monitor recommends that the following steps be taken to meet the terms of the ISA:

1.

ORS and BHDDH are requested to submit to encourage the transition of individuals from

the Monitor documentation that incentives TTP and Birch to integrated employment

to

settings have partnerships

been developed and are being implemented through public-private as described in Benchmark 3 above. Documentation needs to be provided

not

later than March 30, 2016.

2.

TrNDehRopetSoeS:rdttTiaidthtenihs(aoBrstHemcqDoueDmeeHpts,tltehOwteeRadrSse)fipopnrorcorTltuvTiidnPdegeadddaiendcarotedhpslyeisniopnefrgset.htvNheieoomubroseensprtceorhpremtocsreawtnrdket asrpetnreoopdvtreiAoddpveairrdib1qeo1udv,aebl2iyw0ty1tihta5hes.isnBSuHt9raa0DtneDdcatHeoysat.hned

Monitor regarding progress or actions taken on this recommendation.

I. State Agency Actions (ISA Section XII)

Progress tmBaenecudnhsncttrhicacmonanlsatiarrtsiakoscin1tswtp-arinCotchgoernntaetomrwasstcoaftrfrwfoemfxirtiohssmthianetTglhteeetecrSchehtdnantiweicc,aoaPlrlPkAaSssshDssoi,isspTttsaTantPnocceaiennpPdtreorBgovriviradcitdheerdetsoret§mopXlfpauInlIor(nay1inms)d(he2pnn)r.teoToevhdpieepddoeSrttdtrauaatnyeinisatiiennerdgsv.iaPcnPeSdsD
StDssahuystiarsbssotitajuseuebtmsgcia.lthnistmcBitceehHahseftaDtuSnSeDnegrhrHdeeveerixihdlcspoaesbecsusyrkeeatsRssCn.tIdteaRDonbIoEtDflet.iuhEsrPr,henPhtreihSasdeDeshncNatthoirstaanasistetiiirnssoaat.incecnOacdtgslReaasAStlosnlshedLspdaoErtscoReAcicvIasDohitdwnnEioeiticnrftnauahocelnsfteadstSdsaewstetdaiedisttwtetrthaaeiDndciancheinrienetnuriocgcamtnaioanblarniesandwrsogsTiofidAafsDentcaaedoanvnrntcedresealucoryhaelptnvnomaiidfnceettawtnosrltpasaaiinlcndsinagnd training and TA needs on a quarterly basis. Summary. The State is effectively addressing the requirements of this provision of the ISA.
Achieving Progress on Meeting the Terms of the ISA
Actions are not required for this provision at this time.
J. Interagency Collaboration (ISA Section XIII)
The State is required to develop and implement one or more interagency agreements between BHDDH, RIDE and ORS and with PPSD to implement the ISA.

Progress
Benchmark 1- Agreements between state agencies: BHDDH, RIDE and ORS §XIII(1). Agreements will address:

30

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Status: The Interagency Agreement was signed with an effective date of July 11, 2013 addressing the three areas identified above.

Summary. The State is effectively addressing the requirements of this provision of the ISA.

Benchmark 2 -Agreements between the funding, ORS involvement, the engagement referral relationships and policies assuring

State and PPSD §XIII(2). Agreements will address of trained transition specialists, supported employment, compliance with the Americans with Disabilities Act.

SIaiSmptAapp.teulTeashmr:etTeoanhgtbeirensegimegmtenheeeetdniIntSIghnAat,teshwrenahgogiectenhbnceeiysreanfAlurglpleryrveoiievsnmiecsdeoionrtonpt soarrdeoafdftlrteehecdsetswtIehnistetheeciranhacagthnheognefecstycohofAepMgperroeoonevfimttihoseireons.ntI.nTsPthierderoeaSgngrtteaeinftsiecseyadonnidn

the PPSD

Agreement, is described in the sections of this report.

Achieving Progress on Meeting the Terms of the ISA Additional actions are not required for this provision at this time.

K. Funding (ISA Section XIV)

The State and PPSD must fund the services and Settlement Agreement for all eligible members

supports necessary to comply with the Interim of the TTP and Birch Target Populations according

to the standards and timelines set forth in the Interim Agreement.

Progress
tBohneagntociinhndmgivfauirdnkuda1inls-giOnalntlhogceoaiTtniTogPnFsautnonddsBiuniprgcpAho rlTltoatrchgaeetmitoPinnospg§uaXlianItiVinog(n,1sm)-w(a2iit)nh.taTaihnceianSrgetaeatrneddae/nvoderltiohmpempPrePonSvtDinpgwlaeinlmls eprnelcsoueyirmveee n t outcomes and for participating in integrated day services.
Snispnietataeiiudtndauteteesidm:og.nrIpHnasltdooaeiywrdvmeiewdvaeuoebnarrlt,le.ksaCtsisonWentrttSeohicn/teTeegTdTisvTPaea,Pbrtaeohasveenewnds,geetBlahrlvgieraieccsmdheBasiTnHjaoaDenrrxgiDdtteyHestunoPapdfonepTpddoauOrrtltrgaRsietaSittlo,hGwnnesryeooearnudrkpeeteeomrdxeepetconemersimibvueieronnervcgseieno(st5dnoa3igvni%oniddi)tnuengpgaoalrftsruaettniimnecddipispnulagoctyhianesrgemployer-paid supported employment placements.
Bpineedrnifvocihrdmmuaaanlrsckien-2bth-aesPeTedrapfrorgorevmt iPdaoenprcuecloaBntiatorsnaescd,tslCifnooknrinttrhgaefcuptsnrod§viXnisgIiVoto(n3t)oh.feTshuperpopSvotiardtteeerds'hseaamlclphdlieoevvyeemlmoepenntatsneodrfvinmiucpemsleetrmoiceanlt targets and implementation timelines.
SpcsCeoetWarurvtfnSuoisc/sreTe:mlTsiBnePaHgdn,aDwdraDeisatHsmhne'susaresmdcmseobpneoeetnnrcrtatoaactfontfae:wddefdieifstivohctariaTollsunTemaaPrtvlaioiinadcnraee,egnaibetnsaimdfstiiiheevsnas.itdtOauaaRsnracSeldoirzapoeelevspdoeoosrfrisedtwirsgevonhtihcrtti,keafhittpeihilrdtaaisnnbtfgnyienieantc-hnglfeudo, drsItSerusAasepir.tpnvaPoiisnacrkygtesemspdttoeaaenyfbmftm,espbetleonontyemfietsnt system is performance based.

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FglBsnaaieeescHusetsnhtmDeeoeifdsDebrofsavreHoilneprulsmsyeaettchrnroaeofvedfsnomiisctSrSOomeeocPRcsofpaSsi,poanapaetauyceenptemodrcdpffoaeworbWgmonreiamattoneihcssnerahykf"snoesitpcitrtsnsteeehpprmptbfeereloreosarrfrnmvnemomciqsrsdahamuweynmoiarrrcfoaeinerntrrdectubkemieommasnabus,obbyeeterceudntnorcdrcscom.seh;oetlome(inmbfbvstea;s)reertaran(aakcactfst)pbdfidlanewcteorsrgosiatc.ntni"rfhonotoifrSpetfraauudticeincn,potahcdnencloiaruhpnofrnmrgopogforotfbuvrmhrateaihaestgrateiesnemeoscsonlpeopeifsnareriobikscnlnvauiiedcfnsirviislgeevceuidsilotdpdshntecruoeoos:oafvbn(tlahsiets)rapaiutaolcsaantcec.rsldeeedato,r reimbursement; and (d) methods of performance evaluation.

Sdpociprneueoafrcovynampovemtlpmramliaaocdeacrmepnettr.rmtiseycBman.teuHgydnBelepDaectHnirDdhacDcsaanHitDenlehdlrsHiayavswnttimiorcidnBleeslcmHpOlbttDuoRhoeedreDSaptuettsHhasemptyaesahrvdteosnaaeeevfdbtrotnilavsriOiodiistCRcoteeheSnfWmneustpdrlpiSletrfylpo/oivaTeevmitedTreeivfdwPeooafet.ourlrctBumrtshuca.oaearottrenWphmreceeanBeherqntsifHulgdoceaDiorotrnmasDaendlukmHstacre.rnaheeacaTcnqnsecthtuydstsibiissworOoatenecfsRimmatetbShhpdeasiaupnssccctrteoiiapsoldtnn,iryvzotpoibedrvdenaeoifercseteftrihteiossoeeirsnfntdmooa.outrbIaotentisnnaldeiticspshetreyuvperribeocedaafeerstlheitvoedyebrayere performance based (see below).

Benchmark 3 -Funding the State to CWS/TTP for

Post Placement Follow-along Supports §XIV(4). Funding supported employment will continue to be available to each

furnished individual

by

following placement to provide ongoing support as needed.

SptphtlraaaoctttueeOsmcR:teeSFnduits.pnwBdoipHinluDlgilnDaigstHioatopvnarsroiewlv-aoihbdpoleeesanfrojeocrabeisncleiodgsiaivbfcoilhderiuTnfaogalrsragBrneHedtcDGejoDirvbHoiunrefpgutesmnnudetpeimdpoobnsreestrrevsfrrivtocoimecsree.TscCTetWoPivaSeflo/lTalildTnoddwPiitivsintoigadnfuafalrletsrpaioninrttihneg or placement assistance as needed.

Achieving Progress on Meeting the Terms ofthe ISA

The Monitor recommends that the following step be taken to meet the terms of the ISA:

1.

BHDDH is requested to provide a copy be using with CWS/TTP to the Monitor

of the performance based contract not later than February 16, 2016.

format

that

it

will

2. fOaunRrdSnimisshirleeedsqtuaonendsetsea.ddOmtRoiSnriiessvtrieeerqweudiettssotceeudnrctrooeunrretapfguoenrdpt ironongvtidhdeeesrirsgenstoutloatscehonifseutvhreiespfereerefvofioermrwsatenorcvteihcebeaMpsaeoydnmiotoeurntctnosomatrees later than February 16, 2016.

L.

Quality Improvement (ISA Section XV)

The State, for TTP Target Populations are required

Populations, ahd the State to develop and implement

and PPSD for Birch Transition and Exit quality improvement (QI) initiatives for

each

population.

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Progress

Basdi(ncesee)rsdnvvueaceirhpdlcaomeeenpnsqcaeduaerdealn<intadne:cnii1etadnina-atptdeniTrgvdosTreuvaiPfnittfodeciQecdredelinedaPinsasnrutyeortadosegceerceircanovnomdriandcibvoea§lisnmeXdcaupiVescae(lwdos1,eep)iilf.tnlfhie-TtnsetrheugheedfcerfaSeiacItintSeivaeAdditnne,dscg(weuybss.p)iculplerpoivdpbreaeotvleduredtaliottneoepmdSaaepctncolhdotiieeyoinvmnmseVuepinrlnoeettfmepqtgluhearaenacltteiIiStamoyAnqea,unaniartndeslic:taqry(nueadaa)nsetidty,

Status: BHDDH, ORS and RIDE/PPSD have designed to evaluate the quality of services Groups by each of their respective agencies

adnedvesluopppeodr tasnfduirmnipslheemd etnotme desmebpearrsa toef itnhietiTataivr geest and departments.

PmdutieqmrPesauaaseScpannidhDlrgsnetitns'eesmtoteriruQo,dleeydnnsuvteetoabaparnllavltieutastiinyaoiqncsstnAueneut,siasornppsreagtueter:eh.rrerrtfaTeslhoonyoheSrfc.nemtheIJaScpoiatPAgeliennlahnaciCntstneqeRowmufraoIoeaigDarrldldlaniEItiibpaym/nnePrgasoapPeittnclomSdkeedrDempsa.yisnledoFeedsnesnmottn,ialasmeltsntoiinuitfdpwoeitpaelen-pemdrdumdoopooisrfnenutatanehitNctccdtetoerooirooeDdvmimnsnOeisesngm]p,s5Ilatrbaoneekesrtcypeeoerhmyoru2nbirnmea0ietcdnrs1iea,nt5Saalrgs.erseeaetC:marstvlcssuseeiiouartmcsr.nrbteeeeaAamsnennb,trfitclljtoyeoAedtu,ebeganrdPvnrt-ePrepeodeiSleoandoDemilspnfsa,femmteanscnoetctdnniiavstileteoirss program concerns, etc. are noted.

OtastifrrscagohsuoseeReonussecggprrSuyniiusveuuegdesesvrirdllneisceaavismioleeetptsaiitcidinssweeomooouoenelarnnnmeorsttttssshssianiww,encemdagatn"goiihinns.tptntts-.ahh.dtadhlrgaiittioestarneitotthveouioqwtitsloiqonnshuoonoqsudeiconrtgeuviiorekOfsrvaatva-aeORhslitlsviidodmueSRetteaumyenpTwSeiqSpa,ltpnTiaulufcnIpwsotbPuSaopsirrAlnilsim.opentaittdtOgohrtnpymtteharroRdhrtdetitoouhSeisenshfvvncedsoaaIrseili,SeivsttsenEeAyebsipsre-onmtn-veadoaTbbntreirirpfctarsessattfileissauserooaeaegbnpntodynrtdelhptsfemdme,estaotldtuinihPretoernvcednieoetitenjhqetttepotrIdiudmhVSgyuabniiAservlegooradaasiemacntdtateeomanieiCunvpnottmdaeiodealWnoaolnnlreessnCoystSmeam.ras"pmolt/qe.lyTiopmnOcunesRnTlseagiRonetePseilshynStvnih,tlmtsipt"ayhyc/neceDpboaegribrrilvnsnneoilaaoOiicstsnsccctdirsRaaiooeese-isStttstcmmwei,ew.waofahnpieRlnuniallotnltykneighCwwtta.gidhenanoiTteieseoghntcuvd/hhn"eedbpneeaseRrsrRwsrelop,entSeSrOiavlupeAvlAtofeirRrfhirsfpovciTqSsitaRevoaosuitastSnisnal.rdTAeetleToeiTtIodfhyPfe

OrmrcRpsbeeeeRreeoqprnoSpnvtoutgaoieirdirtckrtrreaoieteeenvsmrsmdnigeonpel.sctfgoorntBaooaptarrunvnseeent-iddemfddstorahiaeeotrrdeedddQvsepisbqeuvualruypaaetasaelpglnTiiolgatoiiTypddtihrPynmotetIesnemprmetdestlnwpiaveefntnriiehmooeep,tiwtdvlpcptaahehrlspnodomornsoydvsoeiefemrinbrTndevglsteTseei,tnPscraPmbetlniIeaSnshpdannAcaraareoevearrfpnveedadirttissdomisnd,vrtveocheeieridtosasrssebusosi,aoninueuanntnsergnigdeesnfhdlydvieip,mantendhrgenpsoepev,udflvraaianrooiclnsidevruinseeeeoacegnddmtafscetpsctthieoomateoenhcsrtedteirdhsatneeyeenecvtil,,nxdteiMipvjtloodteoreohnbeanprne,qtyttaiaaursttoiosoactpaferlolrrwippsletofl,ehshiqevcraaiuctiascnhtdtiothirdaiieondeotrtnodenhntneabhetneeiyfddrytsht.oe ISA.

BthHaDt DadHddreesvseelsopqeudalaitnydapcrroovssidfeodurtopothliecyMaonnditporroagQraumaliatryeAass:ssuerravniccee/pQruoavliidtyerIsm, sperrovviceement plan

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psbdccrtreeraoroiimatntnvetedeegisrsudgiaiccaiioraeatneairstng,ri,soigtaaeernirntadneiadisonvnntgiiudtwenehtwgnihebmeisyacfrpnuthaBordtlHousdtdryvDiieamessD.ttmcaeeHTo.lmehivGnsneetateora,pnsafptlldfhfsaroaeoniarnngrpdddaerrociaoiviecnm~disoidecmsnrunoeioatplolilltlafnaiioitsbeneouhdocdftmrlctuuaseoentdtcmnridehoeteen.nnssriWpgwceewtahchialitiicslhflalheiascbOnssaepRiodrsermSmtwoaaea,egneanarcaasadlekcoum,tnTnripeevTgqldsiPautws,,inaeenifslsstuio,hotlhrylafkariacsevmeotyceaarplsnroebleedbaiencmrjaeteprninceodretnanosievtn,cdaoedetrsois,aosfrnefor monitoring or ongoing review.

SsQIedpitnnuveorufdamatpaoeletluruemripmltmagyeaatyantieriitndmytoipheoe.nprannRtsorhtcIvowweaeDivdaedEeaesdrexnm/erPrftdeuePeaqsinrnSdusnnttDeaecitiqlssornihuhefmiiweaaatcivdstoaaheeesttitdiioctaovohoneunetfdhctstshltoeisfhaennrueMnooefsdmdmfkeoi,ertcnirvyObciiaeituRicasonnteeSrrtielsnntfoaaoo-gannsstn.uedrifdBfndeufBavuelislHcbnutiyielDttpeeiwhinfpDmeticsoheHpydrcde"ltooamesiacrnnmfesud"utemtrubhronecneeetqtgaienIesucidSthdnhiaA,renitbaeediiaydovnqntengtuobdhaiytwmenorlietatOtehebvsymgReeineirSImbiaowSmetatApisrnpos.rsadulnoerof,vBemffieiHnctoemhicDnceerectDneeunttHadarttsr.roeigtnodegt.

BSiasenuntveatdpanetlepgcduhoraeaarmnstttecdeadardPidrtbsPkeoeuSq2depDunpi-answotBuersirltietlereoccddtqhaieuoecvTamnhelsirlipeotaVvlypno-eaVysaniimnIntdditaeoeqrningemutr:aaapp(nntlalitade)oictmndyeE,e,mexivn(niecettcn)lTarotaesapqdareuaesgdnaqeeldduaittansyiPtendeaordvpspaesirpnucuoedelrvansaistdndauiecoenfnfedndicciiQiennineIiatantePinctagdcrttroiooavigrnetedrecnatadraonembdcaelaesen§yewsXpdsueiVeretorhec(pv2otiilnh)nce(deeoarisme)vIS-caii(Adescbiu,dsv)a(.eeiblnlTf,)fighneed

sufficiency.

Status: PPSD reviews are being provided in

aacncdoardnaanlyczeews iinthfotrhme aptrioovnitsoiodnesteorumtliinneedthine

extent to which services Section XV(2)(a)-(b).

Summary. Monitoring activities are being carried out in a manner that is consistent with

the ISA.

BsoufepInSpcAohrSmteeacdrtiekomn3sp-VloPayrnmodgeVnratI mabnydSthtianentSedgtaarrtaedtesfod§rXdTaVTyP(s1es)re(varvi)c-iec(bep)rreoacgnirdpaim§eXnstVsta(an2nd)d(aaSr)de-s(cbttih)o.anDtsieVnv,ceVolIorIppaomnreadntVet IopIIfrobvyisthioens State and PPSD for Birch students.

SMpmpiRttersaeaoorvtiafnvuniosiiesttssrawo:emiirorEntCnaoisvssohvitnderhcecee.arakqnsnRtlicuIigiseDistuhrtfEtebtothdosalral.tneoctiIpdtwoptuomprastroeprptRogsplfSygroetAarrhawmaratTmhisttisehtictlmtlaeItehSnhoaIAaednrrsaeirtCtdrhegodoequarsvnulitaneshiBterlgaiHoenovapmDtneseDDsedabneHweapcteisnraitnsedrhbetudulrowsaeetifuvshnhinpeigatclscesothhcqhpptewueerdtaodoiIllvSalihqAnitbaydueEsreaiednlmaniqidtontpuyidtolaieoabrtidseiyenvsmmefteuooneeraorannfmtnuttqTscraFunTetaaiiiPrsorsas.thnnateOedQrtgdRolutuyShtisaodauleitptthyttpoheoerste monitoring ofPPSD ISA implementation.

Summary. Program standards as a part of each department's

required by the ISA have not been quality improvement initiative.

developed

and

implemented

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Bcdidoeeefnnnidcctuiihefcmintecqdaieurdskaeraf4tniecd-ri,elQynifcuoninaee-rscstehietsaresvlayrereyObv,ieneae-wnpsisltcaeoonfrRorTeefTcvcPtioeeradwrneasdcnt§odiXofrnBVe.pi(Fr1oco)hrl(tlcsao)nww-d(-ieluwl)pbialerlneiidvsssis§euuXweeVsdrew(dp2oio)lclcru)bt-sme(ieecd)noe.tnnTitdnhiugfeyctSithnetegadtrpeteorssouhegnalrtlssalumoref follow-up reviews.

Status: BmrrIuSeeHpAoppDnoaotDicrrhttttoHaiieonrtdindginnisogdpcnrelvenuraiqoidsoqutiedtuisfsr.u:aewArrd(ntseaeio)rsnreflhooTyctneTebo-vdPasniis,dditineeousnrctrachet(needevdd)itleoatofwoosrttlghelsraoevcenwhapMile-zouudoerapuntdt,leirewtfeo,osivrer(tmibhrdev)ioawniolccstuneqhm-duqesoauieftclaneriutlatyimrimtneyrevgeenaiwvtetthiiwoCenarwgWtkrerstoSohpnu/uoaTetttrleTitirndsnPeeeqotdodourunibbfrr-ieyiensniddcSgtieoeantnccrghtdetseiiv,uoocinc(necutswX)erdwVrsfeoaeoanlnlrnftoeddtwh-e taken by TTP. OotCpjnnTohovlReonoTbaeeeS-tuPnrssddbn,ssditse,eistoaegeveistfrvnholfueroe(gtelapd,brlovtopsc)aepiToponaefmoTneorrdwrtdedPlegsltnusoeaaatnctcwcosnQehthasi-eereirznuuegddedeiapvnecudlaaidiealrneltweeld,sywd,ovaaiaI(tisrntsmdbheeshd)iwiicpepsnsooocostrsat-utnorhdlthnts-viaoeeaescsteidcieerufmtsdu.erisoosa.mTennrosmAnwesuefatsveenoitPoniswqnte.iOdluonTaowSiRatngvTreuSrkriPtdttpdehehSopupairaanuualoonttytplrrdtlisrthptinbeesnhreocaqdeeaorlsucpdvutiereesiredmbrfe.ideivebyvTnpsEdieidnhlSopmeoaigeeunrncycpogseOtmtmlvisxirRooo,iieeeSysnsnnp(eitmscoistotX)neiwnrpeVngfrtsnlo,evgaoQtlrfifclfoocVeooueerntrwaotmhsmaplcae-ikeirataunmoyn!etlpScivtnooIqAlsiamunnubdacdatatyepnhthlilirnrdiTaloRotygmtTnybveisPbsohanere.aenrramcresrviblvitiuqeiioseieldnucrriwweettiisanrsPsitet:gtoilhdaoa,(rnnaoe)f RStiCpinemIeoDttrotehfElr.oeed/rOPmirmnPeneaiSp-nntsDootigAtrre.thqgmaaurFvnaeooedrelntlmiefiomotrewollpnlyr-oliturenwtpeomg-vaueteicpaventkwaitoeoelsucsdncatsphuateloraaQsrstcueaeaeartnfvolftyieinhtccyteeeatAiscnvq,sheeusrnlxueayitrmrcaaqtaeednulrdcdaalieryrsaetsPtbesielsrasaltpsnyatirhnsfomeocabreotnleneIndrmimemtreopeasdrlpeirsanoem,ngarcedtsovsnnacitasaocnritetndei.rodnRisnimustIi,DbopoomrfEnrots/ihPvitoestPesefSDudqtDOheutse]oaalIa!irtnSrtheyAteee.ornSivomtetaerted
ScTrqceououTcnnamPesldiimisvutseyectaredtivrinmynibtc.gpyewBraOqoiHntuvRhDdaeSDtlrmh-ieHftepyeunnoirasedtrstnqipinrounregoitgqrigceunsromeidanrrimeevdvdniuictdtcbhesutyaiaoqntltufsghctaoeahqlmtieuItSTyapIATSrort.APerePvtrabPslitSyeuwtwDthoiitsin/shRs-onsIttnDiiohmtteeaEecrqr.hoeeuOanvqasdRiureuSdtiwerceeirtssvlimnyeorlgeefbognsaqputesueslriaadvsor.rifaltcyetnehrdrlqeeyiuv!mSoaieAlnpiw-tlayseiinmntaedgteTrinsseeTtverPvideiwacess of

Achieving Progress on Meeting the Terms of the ISA

The Monitor recommends that the following steps be taken to meet the terms of the !SA:

1.

IiiqsntucifaslulurridettyhecseomrmkaremneyaceagoncemdtmiemvdeietntintehdssaeytadsnBttdeHhmDoautDttotHchoreremefdvleeeispcettawhroatirmttsimneqcneuotearrtlpeittovhyriesaiemtreeopqtrrhuoreievrsoeetmrmrgueeacnnnttituszsratoetrfiatoShtneeeagcfltyoifotroonmrmXeantVasotoufofrtuethhtelteihnc!aeuStdArirt.ienInt t

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Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 36 of 40 PageID #: 224

Section XV (1)-(5) and submit the final process to the Monitor not later than March 31, 2016.

2.

OOrwSsaehdeRRaqocdySSutur's'isielonrdisnqenesumdeXewaeddeVlshintcbito(tcyr1ysih)cba-too(ehsifm5tsesOt)uphcRrRaleauSynSnArI'dwSrcpeATesilntu.aiphttbnOlreQsmRRoSuItSgioAatqrnlaiuiirtenmtaseyeclgrdiodAteusyreplspftasiooaotmuriurrpotaplarntttrnsooesocvttviaoeishnedepfsmyeeerMdoCaepedgnaoordrtrnnaaaiglsitmttueieRoonirSdanftArebdaDolyldiTmenriMicneetrilfssateeo.ssreercIomsrhrbeeea3lqgati1giuuco,aihlnr2ateiot0otimof1ont6nesthh.nsetTeotasphnMmrtidoshoevagreniteutisptaiitodorhoreenerlotsinnnooettfsh.e

3.

TwsththiaeleflfebMtxeoiospdntliiianstcocgeuraswonsnidtllhtphselecaihnmsetnrdpeuuldeclmetpuraeroenmgtaraeanteimdtoinnfsugtonawfcnStidietoahcnrtBdiinosHgnDaXogDVfaHeibn,ayscRthIewDaaEhcghiecanohncfdyste'hOsreRvqiiSrucaredeliiqsrtpueyecaictlmoittirypvsreioasanvmgdeeemrnaeecslinueetrvsep.adlnFatoancn, uds

the current and planned review process.

M. Data Collection and Reporting (ISA Section XVI)

The State activities

and PPSD agreed to each collect in order to monitor the monthly

and analyze relevant data and implementation of the ISA. ·

quality

im

provement

Progress Bqcouelanlerctchetrmulynadbrukaps1ilsi.c-aTDtheaedtaIdStaAotaibdoeennCtiinofdileliesvci1dte7udadlaasntwadictRahteeIpDgooDrritienesdtth§heXaTtVnaIre(ge1ed)t-t(Po3o)bp.euTlghaaettiSohtnearsteeadnaednndrcePopPmoSprDtaosasngirnaeged to approximately 44 individual data points.
SeceetcBraafrhoemntxouepsHaeqngllsrppptlDateudaeueerhltsDgoirucoxeserstetxc:HdytresmeedtimmAd,dsefmnebrOedoetdbbonaryRrtnaybrvmtteoSteottyir,thacloaewhtaytteehvduiehhnhss4eetMeabdiScba4actSaotMoelnRhtashedminhdItendeoatDeiehedrgttonEtolaeamhiudoar;rtnpetiacsoaoatcddpsokttronoseaeoinPdCtdnmnwsrroPuctsteteS(neiosoermncqfDsierdmi)ttnuekehei,ogdsidpntraawrofertttetnadtvehhiomdhataatheeefhrleRtlebeyetaoasnerthhyznpuheipstoeedSnmlrioddIaeeveSueSievmneeccAnaataattoInltsesiisstnamofdsyterlintauanas'eopusStdrnrtdeXfrseevatdeCea2VbmebachdtC0oIyygieuel1fnoetoitrnooaot5lnhsrfylfsrgee.ecetiisenhgncAiamveeIneotenteSrslp,cnlDvdAylIsyratwSeioetocctbcAara:cievaeteanonrripe(it(enndepadneaaegp)arggcnCgdoloriiiydaeoredtvlnsyitepquneiotfchdphoantbusyreoeeoerrtjiraaimretrnrigfpCmsencnttyaaepmtdogtDettdtrhmnihhneoapeoasaenletcraantlenartrhctnhdosecdtoahe;teaeatrnanig.rstDt(caddoabaAeeebesm)tmtrx.e,cnehhedTnrpadeapeapeesjsenhrletooutroeew)emrtrrdyirtewewtmmuylttlaahsehiossteannafsbetttehe completed by the Sherlock Center for the past several years. uDreIaesmsnalpenatposaunlradaootlenydlCdymitofhwblfeleeyenirgtcteBheasnHteqtteoDrufgvoDaroirecrHrmtveie,esirsO.saleTnyRiddahSuene,fpndCordtreiWeafmvxiteSieapsd/staeT.ntdaTBodtfPHIdoiSDtaorAsmDnccdu§HauXmtRriwVrsIeDeniIcln(Etlo2tpng)oe(rtanaloret-aghaicc)rettmerariosnroansegnn,iacdwtfhnosirldrtuyehrtcpohvhtohreearyeqntmgueSooeamfhsrpaettprcerpllorrooaolvycyrsitkmsd,beCbeaarsneeniiatnsungi.tgmneeErfngbaocaacerithtmerhRsoaae'hgftroieekoddnenecyaynd

36

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 37 of 40 PageID #: 225

taocMrgouiageltlcrngecocechmyrtiivoesnanusp.rrtivrPoaeelobpayllnasewssrta,oicltclaiboloblennefscofdiorosemrttvehtpenhellteoerwtepaeveicdtidthsuiianatonhlnJdeadonaIiSfmutAatahprceyaloen.clmdDlueeracCnrttoeaitoenn"ndstcestotonoulltrebgvDceaetetoycchroraesem"nreddwp. AlatielhtltaseebhoddeoneirtntsvrtaseAaiulfnpopfrepptidlrmlaeaieimnnnndiFetnneMogtbfaaarolyunnpad2lrri0noyo1evta6hidn.deadeDrtrkaaetay analysis and reporting are to be completed in June and July.

itBTCpOePg§aromemenPXHhaWRargSetdpDSVpchsDSalodDhEleeIat/o(TnahrmxrHo2eyeet'eTin)dsatemdr(rPdunPaeeaisoeesc-tmpoaoiqnnvaa)rponmtupetenturdiolpalvheotolouerseBieanptyelotrtteeciinwisfmphrncrooocutrlaegtnhmehnoymrtdneotngmewibhbtnttersraoepeehaielhscirlmmoqwneaciassrusannbas.oaeopisrrePcrr(afmuaeekr§eoPncqrqsidXSorreidunuedtDanViaygcietnntnkloeshIticdifde(iofntoloiv2ieeiyrderlv)icpdpelmend(sioeripnndgTpncolaa-outltrgevqtneiOsreaifc)ictdosRyla)ddhstsy.ndSetnaaatsrrCsrhtoannsetahaWelseaeddcioemngirewddegrSvreeieetaevyei/nfd.TmcplntoeclITaesTtro.inotitsehoPrhOafcfvsetitnfraeR.eehfgadsi,dSRarssanebavoutItifqtacrDmhounopauoruceEgrpra§lcoaamrlihonXternsertutireaacirVaoetrtttvtgshssensrniIieotle(deactodFym2nhlwunau)rbeece(iretusnsyaamaronpmd-setuutnkoohpiinbssnsn)enrlet.eeosetgeoiAstdrdeyrdnhnvflamidropfoeinctoaocdfrraedolimeirsiqlnnimntmtsvuiaBtdhsot.taiaaniahiidhnvBrlstrdteiuiiacatiHfloiedlhatiiSysDnnneuldwtTgd-ttaDadasoriarwltlytaeHsaeltamtsahinabatttcaiesoehesethnoirmeteenaditoad.bouclnbteh-y reporting requirements and track individual services.

TadaggehevreneeMecloimeopsenm.niAtetongtroetmnafcaneycdtiwaliidmtiamtphteilBnetmiHhseDternDdatatHaott,ariOsosRnhaSgaorrfaienIneSgddApRorrnIeoDlctaEhetesetosdimbdduipasttocahrutagsavsanettchhneeeoroitnfnbetgeehdeaecntntoiaevbecilodteilefltsoaobramocarrudaottasuetsaaoltlhsnyhetaahtrgheirnreegee

state on the

structure and functioning of such an arrangement.

StChuWimsStmi/mTaTerP.yP.aPnDSdDatRacIDoolnEle.IcSBtAHs DirneDfloaHtremddoasetiesornvn6ioctenaspeaapncedhariontuodticbvoeimdgueaastlhisseerbrievniegndgaangndadtrheuepsroeesrdttihannegddthraeetaproteorqtuiemidrpebrdyodvOaeRtSa,at service delivery and planning.

Benchmark 2 - Data Collection, Analysis and Monitoring §XVI(3). The State will regularly collect, aggregate and analyze data described above and will:

• Identify problems or barriers to placement in or retaining jobs in individual, integrated
employment settings.

• Recommend to the Directors of BHDDH, RIDE and ORS remedial actions to resolve the
problems or barriers.

•

Review this information quarterly thereafter and

on a monthly basis for the first year of this Interim Agreement develop and implement effective measures to overcome the

and

problems and barriers identified.

•

Analyze identify

service data, and address

monitor services and service gaps, report on any service gaps and any obstacles to the implementation of the goals and outcomes of the

Interim Agreement.

37

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 38 of 40 PageID #: 226

StahtnaedtduCasW:taSAt/osTnrTeoPvt.ieePdwPaSbpDorovregec,roadmradtssaaaisnndbdesaiennrgavligycazeetshsdeeurmeridpnlagonayddmmreeinpntoiisrnttrefaodtrismveeaptamioreaneteotilnnygabsnyaoPnnPdgSotDoi,naOgsRsbiSas,stiRsI,DuEs,ing teachers with individual service planning. Work plans are developed to identify gaps and improve outcomes and results. Staff at ORS review TTP data to ensure appropriate and effective service delivery. RIDE collects the required data and reports quarterly. The iitnnhffeoodrrmmataaa.ttiiMoonnotirsheorroevvuerige,hwthceeadsceaawnsedormskhaeanrraevgdiseiamtmsebonuntgtsdyaosdtemesminnoidstotpreaestrinfvooertmshtaasvfyfe.sttBehHmeDsaDttaiHcffagonaratchlyaesprisascsaiotnymdteoregvaiethweor f and report data as required. To address this issue BHDDH has contracted with the Sherlock Center to gather the required data.

An external review of the individual records of TTP Target Group members conducted by the Monitor revealed inaccuracies in th~ employment data being reported by CWS/TTP. These inaccuracies resulted in the misrepresentation of the numbers of protected class members who were employed in employer-paid jobs. ORS staff also noted the error and informed CWS/TTP that long-term situational assessments in which individual's wages were paid or subsidized by the vendor agency does not meet ORS standards. CWS/TTP corrected the reporting error.

Summary. CWS/TTP gathers individual information on a number of the key data points stgrbBoeuauHqptetDhupmdeDioorrpHreesltdsosicnynbfofmryoloolteerSmmgcnetetctsanhtttsiheiaoooratnamntalXmlgeoyIenVainunyTcsofyTonef.PrettmhTehTedheaaetItdirSooigaAnnbetfatfeoooGfrnaromrdrTtodahtTuthrepPieeossmTnepsraeueivsrdmrigpucbeboesyteessGretdahssrnteoroodeuvuctpsorteulacmiipcvanpetkieinmoodpgrnebbtOarseylfRrfotrsSuhrermrihfnseuaacisnbsneehdiicclveeietdidtinaoasgttnnoieodsroinevnifrdidctvcehoiievnecusitendi!asSfsutyAeaaCl.nblosWdarr.aSrtOi/TeTRrTTSsPP,.

As for

noted in the the purpose

previous ISA Progress report, the aggregation and analysis of the of improving service delivery, removing barriers and improving

information outcomes is

not being performed in a comprehensive manner. Required quarterly reports with recommendations are not being prepared and provided to the directors ofBHDDH

and

ORS

as

described in this section. The State capacity as an issue and is working

has identified the lack of a coordinated data gathering to improve its performance in this area. The State has

not

made substantive improvements in this area since the last ISA Progress Report was issued.

Achieving Progress on Meeting the Terms of the ISA The Monitor recommends that the following steps be taken to meet the terms of the ISA:

1.

The State is requested to provide the Monitor with (a) evidence of policies or practices used to regularly review, analyze and:monitor data listed in section XVI(Z)(a)-(q) above for the

purpose of identifying barriers related to job placements and job retention in integrated

employment settings and (b) recommendations that have been made to the directors of

BHDDH, RIDE and ORS regarding remedial actions to remove identified barriers by

February 16, 2016.

Note: This request was included in the previous report did not meet the reporting deadlines. No reports were

dated April1, 2015. The provided by the State to

State the

Monitor regarding progress or actions taken on this recommendation.

38

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 39 of 40 PageID #: 227
2. CWS/TTP, BHDDH and ORS are requested to collaborate with the Monitor in the development of a standard report form and format to accurately document and tabulate individual services and support outcomes consistent with the ISA data requirements at Section XVI (a-i).
IV. Concluding Comments
This report describes the nature and status of the changes that are taking place within the three state agencies, BHDDH, ORS and RIDE, and the Providence Public Schools Department to comply with each of the provisions and benchmarks of the Agreement. Progress has been made in some areas. But key objectives have not been accomplished, agreed upon timelines have not been followed and many deadlines have not been met. It is recommended that the State address the following key issues, needs and barriers: 1. Improving responsiveness of state agencies to the ISA (and Consent Decree) requirements and
the Monitor's requests for documentation, information and policy implementation, consistent with the timelines outlined by the two agreements. State agencies, BHDDH, and ORS have not provided complete or timely responses to the Monitor's recommendations for necessary actions or changes. RIDE, for the most part has met response deadlines. The most recent !SA Progress Report (April1, 2015) identified 27 actions the state needed to complete within approximately 90 days to meet the terms and conditions of the Agreement. A progress review on September 21, 2015 revealed that five months following receipt of the report only 7 (26%) of the issues and recommendations had been resolved, 6 (22%) were pending resolution and the majority, 14 (52%), of the recommendations had not been initiated. Steps must be taken by the State to respond to requirements and requests in a timely fashion. 2. Strengtheningstaff resources. The ISA requires the State to change the structure and functioning of the developmental disabilities system to ensure members of the protected class receive the supports and services they need to access integrated paid employment and participate in integrated community activities alongside people without disabilities to the fullest extent possible. The majority of the Agreement's requirements fall on BHDDH which is required to implement policy and program changes, coordinate mandatory expansion of supported employment and integrated day services and assure and improve service quality and responsiveness. Personnel resources and staffing at BHDDH remain at pre-ISA levels and do not appear to be sufficient to meet the increased demands on the department to meet the requirements of the ISA. Please note that it is acknowledged that BHDDH is taking steps to address this issue. 3. Coordinating !SA activities across State agencies. It is strongly recommended that the authority and role of the State Consent Decree Coordinator be strengthened to ensure that BHDDH, ORS and RIDE meet reporting and systems change deadlines and take necessary actions as required. 4. Addressing key ISA outcomes: (a) the number of ISA Target Group Members who have been placed in integrated supported employment and integrated day programs have not reached required benchmarks; (b) required career development planning and practices policies have not been implemented by BHDDH; and c) the required Quality Improvement Initiative providing oversight, monitoring, and service improvement has not been fully implemented by BHDDH and ORS.
39

Case 1:14-cv-00175-JJM-PAS Document 10 Filed 01/20/16 Page 40 of 40 PageID #: 228
Respectfully Submitted, Charles Moseley EdD Court Monitor January 15, 2016
40

 
 Case 1:14-cv-00175-JJM-PAS Document 14 Filed 03/18/16 Page 1 of 3 PageID #: 276
Rhode Island Consent Decree Progress Status Update
March 9, 2016 Charles Moseley Ed.D. Court Monitor
Assuring adequate funding for integrated employment, integrated day services and transition from school to adult services. Additional funding requests have been included in the Governor’s budget proposals and strategies have been identified to expand the dollars available by enabling BHDDH to achieve savings within the department’s current budget. These savings would be achieved by moving people with DD from state run group homes to lower cost shared living alternatives, reallocating the costs of some professional supports to Medicaid managed care, and reducing funding for some individuals through the use of the department’s resource allocation system (Using the Support Intensity Scale or SIS).
The impact of the additional funding and internal expenditure reductions on the ability of BHDDH to achieve the Consent Decree performance targets and outcomes is not clear, however. A specific Consent Decree “budget” showing the ways in which funding will be used to meet Consent Decree requirements has not been provided, nor has the department furnished an estimated or target individual allocation amount that could be used to project the numbers of individuals who could reasonably be supported with the amount of funding allocated for caseload increases. Hopefully, the State will be able to provide this information in the status report that it will be preparing in response to your recent Order (3/3/16).
While the state appears to be making some progress in this area, I remained concerned that: (a) the savings targets related to the movement of individuals with IDD to lower costs residential alternatives and targeted service reductions are too optimistic and will not be able to be achieved by BHDDH within the stated timeframes; and (b) that BHDDH will not able to clearly identify a cost based individual allocation amount that can be used to project the amount of funding needed to enable people to secure supported employment and integrated day services as required.
Although the state has not yet provided needed financial data, it should be noted that it is, reportedly, meeting consent decree placement targets. This must be confirmed, however. From my discussions with providers and state staff it appears that these placements are being funded by providers through existing resources and, as such, may not be sustainable over time. I will be tracking this in the months ahead.
Lack of Responsiveness. RIDE has been responsive to the Monitor’s recommendations and has kept up to date with needed actions and responses. ORS has appointed a single individual responsible to Consent Decree activities and has markedly improved its ability to report on and carry our needed changes. BHDDH in response to my request has recently (yesterday) established a single point of

Case 1:14-cv-00175-JJM-PAS Document 14 Filed 03/18/16 Page 2 of 3 PageID #: 277
contact within that department for all Consent Decree related activities and actions. This move reduces the number of individuals reporting on consent decree progress from four to one. I am optimistic that the department’s past response pattern will be improved.
Consent Decree Coordinator. Mary Madden has been taken on by the state in the role of Consent Decree Coordinator. Her position has been moved to the Executive Office of Health and Human Services. Reportedly, she is being given the authority, responsibility and support necessary to ensure the state agencies take the steps necessary to achieve or comply with the benchmarks included in the two agreements. I have requested a copy of her job description including scope of authority, duties and responsibilities.
BHDDH Staff Resources. BHDDH has hired a transformation officer to guide the department’s efforts to make the structural and functional changes necessary to implement the consent decree. The department has additionally posted a position to coordinate supported employment activities with provider agencies and, reportedly, has been given approval to hire a Chief Operations person and a Quality Improvement Coordinator. These positions are important to provide leadership and guidance over the systems changes that need to take place.
Career Development Planning. A policy, procedure and format for person‐centered career development planning is yet to be implemented. I requested that BHDDH provide the required policies, documentation and implementation by March 31, 2016 and have been assured that this deadline will be met.
Quality Improvement. BHDDH and ORS and RIDE are collaborating on the implementation of a quality improvement plan and strategy consistent with the ISA and Consent decree requirements and will, reportedly, conduct their first review of the CWS/TTP program at the beginning of April, issuing a report by April 15th.
Data. Most of the data required by the two agreements is not being gathered, analyzed and reviewed by BHDDH at this time. As mentioned in my most recent ISA Progress report, the Sherlock Center is revising its annual provider survey to gather virtually all of the data points listed in the ISA and Consent Decree and will be reporting statewide on a quarterly basis beginning in June 2016. The implementation plan calls for data to be gathered during the last two weeks of this month, data processing and cleaning will take place through May and the final report will be issued in June and quarterly thereafter.
Summary
The state is making progress in many areas, and has taken steps to build its capacity to respond. The hiring of a new Consent Decree State Coordinator with sufficient authority to require state agencies to respond is an important steps forward, as are the staff improvements within BHDDH, assuming they are fully implemented. The

Case 1:14-cv-00175-JJM-PAS Document 14 Filed 03/18/16 Page 3 of 3 PageID #: 278
barriers that require immediate attention include, at base, the need to adequately fund services and supports consistent with the requirements of the consent decree. Additional information needs to be provided by the state to determine whether or not the current funding is adequate. Other key areas that must be addressed are identified by the recent Order. The Court’s close oversight over the state’s progress on meeting the terms and conditions of the consent decree is having a very positive impact on the both the quality and the pace of change in the state. Please let me know if you have any questions or need additional information. Respectfully Submitted, Charles Moseley EdD Court Monitor

 
 Case 1:14-cv-00175-JJM-PAS Document 27 Filed 04/29/16 Page 1 of 2 PageID #: 2013
United States District Court District of Rhode Island Civil Action No. CA14‐175
United States v. State of Rhode Island
Status Hearing
May 2, 2016 Charles Moseley Ed.D. U.S. District Court Monitor
On March 1, 2016 a Joint Motion was filed with the Court requesting a hearing to review the current status of the State’s compliance with the Consent Decree’s requirements. The Parties jointly determined that a court ordered remedial action plan would facilitate compliance with the Consent Decree. A Court Order, filed on March 3, 2016 required the state to produce a written compliance status report addressing progress across nine key areas by April 1, 2016 and to appear before the court on April 8, 2016 to show evidence of the state’s current level of compliance with the Consent Decree. The State prepared and submitted the evidentiary report and presented testimony on April 8, 2016 regarding the progress that the State has made in each of the areas mentioned in the Court Order. The Department of Justice indicated that it did not believe the State was in full compliance with the Consent Decree. The Court Monitor reported that while progress had been made by the State in addressing the provisions of the Court Order, additional steps needed to be taken to fully comply with the terms and conditions of the Consent Decree.
The State is requested to report on its status with respect to compliance with the following activities, provisions and benchmarks:
1. The development of the client database and dashboard to track the status of each member of each Target Population with respect all required services and supports identified in the Consent Decree including, but not limited to: (a) placement in integrated employment, (b) receipt of services resulting in full access to and involvement in integrated community activities, and (c) the receipt of an individualized person‐centered career development plan and benefits plan.
2. The unduplicated count and identification of each of the 3,405 individuals comprising each of the Consent Decree’s four Target Population Groups.
3. The development and implementation of a new or revised individual resource allocation methodology that fully funds the provision of employment supports and day services in integrated settings to Target Group members to enable them to achieve and maintain employment and community participation consistent with the requirements of the Consent Decree.
4. The completion of the final version of the in‐reach outreach education plan. A draft plan was submitted to the Monitor on April 1st. The extent to which the plan provides clear

Case 1:14-cv-00175-JJM-PAS Document 27 Filed 04/29/16 Page 2 of 2 PageID #: 2014
and concise “user friendly” information for people with disabilities and their families regarding:
a. Individual intake, eligibility determination, resource allocation. b. Service planning including needs assessment, person centered career
development planning and support coordination. c. Community engagement with respect to the Consent Decree, the meaning of the
State’s Employment First policy and the focus on community integration.
5. The implementation of Career Development Planning (CDP) statewide:
a. The State submitted to the Monitor copies of a draft policy, draft format and draft implementation plan for Career Development Planning as required on March 31st. Final plans and detailed operational information needs to be provided by the State, including:
i. Final state policy regarding career development planning ii. The date(s) for the initial announcement of the new format to providers
and families. iii. A detailed plan by which the new CDP format and process will be
provided to each Target Group member across all providers according to a time frame, estimates of numbers of individuals affected and a final date at which time CDPs will be in place for all members of each Target Population. iv. A plan for ensuring provider agency staff receive necessary training and support regarding plan implementation.
6. The further development and planned implementation of the Quality Improvement program to include: a. The development of measurable standards against which service quality will be determined, including statements of desired outcomes. b. The implementation of a process that gathers data on each individual and individual record reviewed to determine the percentage of quality outcomes achieved during the review period and the extent to which the standards are being met by the agency being reviewed. For example, “During this review a sample of 25 of 100 client records were reviewed. Of this sample, 20 of 25 records (80%) of the records contained up to date career development plans that met department quality guidelines. c. A summary of programmatic strengths and areas in need of improvement leading to a plan for remediation.

 
 Case 1:14-cv-00175-JJM-PAS Document 38 Filed 07/22/16 Page 1 of 9 PageID #: 2151
REPORT OF THE COURT MONITOR
On
UNITED STATES OF AMERICA v. STATE OF RHODE ISLAND Case No. CA14-175
DEFENDANT’S THIRD STATUS REPORT
Filed July 1, 2016
Charles Moseley Ed.D. U.S. District Court Monitor Report Issued July 22, 2016

Progress Summary

Court Order Provision

Assessment

1. Allocate Sufficient Budget Provision Met

5(a). Management Plan

Provision Met

5(b). Transition Timeline

Provision Met

5(g). IEP Meeting Attendance Provision Met

5(c). Communication Plan Provision Met

5(d). Communication Plan Provision Met

5(e). SIS Resource Allocation Provision Met

CD XI.(10) Conv. Trust Fund Provision Conditionally Met

1

Case 1:14-cv-00175-JJM-PAS Document 38 Filed 07/22/16 Page 2 of 9 PageID #: 2152
I. INTRODUCTION
This review assesses the documentation and actions taken by the State of Rhode Island, as described in the Defendant’s Third Status Report, to determine progress and compliance with respect to certain requirements set forth in the Court’s Order of May 18, 2016. Specifically addressed are provisions of the Order that were required to be completed or addressed by the State by July 1, 2016. This progress report utilizes the same organizational format of the State’s Third Status Report to facilitate comprehension and tracking.
During the review of the budgeting process related to Provision 1 described below, it became clear that the State had not complied with the requirement of Consent Decree provision XI.(10) to begin distributing Sheltered Workshop Conversion Trust Fund dollars to enable provider conversion to supported employment services. Trust Fund dollars are necessary to build the capacity of provider agencies to achieve the employment placement benchmarks under the Consent Decree. The importance of this requirement and status of activities was discussed during the Evidentiary Hearing on April 8, 2016. The State is taking action to fully comply with this provision (see below Section VII Other Matters).
A draft version of this report was shared with the State and DOJ. The State was given the opportunity to provide additional information to clarify its responses in three areas. This report acknowledges and reflects the additional information provided by the State and the Department of Justice.
II. THE BUDGET 2017 Budget Analysis
Court Order Provision No. 1: Appropriate the additional money contained in the Governor’s budget for fiscal year 2017 in order to fund compliance with the Consent Decree.
Status. The Governor’s original budget request for developmental disabilities services submitted to the General Assembly on February 3, 2016 was $114,259,149 in general revenue funds with a total DD budget commitment of $235,223,032. Following the Court’s Order of May 18, 2016, the Governor amended the DDD budget request and proposed an increase the general revenue funding to $122,540,564. The amount finally approved by the General Assembly and signed by the Governor on June 21, 2016 was $119,651,536 in general revenues and a total budget commitment of $246,242,419. This represents an increase of $11,019,387 over the original
2

Case 1:14-cv-00175-JJM-PAS Document 38 Filed 07/22/16 Page 3 of 9 PageID #: 2153
request. Specific budget set asides relevant to the Consent Decree include:
 An additional $4 million ($2 million state general revenue dollars plus $2 million in Federal match) to expand integrated employment and integrated day services as required by the Consent Decree.
 An additional $5.1 million ($2.5 million from general revenues and $2.6 million Federal Match) to boost compensation for private provider Direct Support Staff.
 Funding for four staff positions focusing on Consent Decree Implementation including: Consent Decree Coordinator, Employment Specialist, Chief Transformation Officer and Program Development Director.
 Funding for the Conversion Institute at the Sherlock Center will covered by existing resources.
The amended budget also includes a restoration of $2.2 million in professional supports provided in day centers as part of the amended budget request. The original request reallocated such services to existing Medicaid contracts with managed care organizations (MCOs). Because some professional support services will continue to be provided outside MCO contracts, the Governor’s amended budget restored some funds. The Governor’s request for $5.8 million (general revenues plus Medicaid match) to address DD caseload growth was not approved by the Legislature citing the lack of data on caseload growth during the past year. The Legislature did, however, recommend that additional funding be provided when the growth occurs.
Assessment: Provision Met. The total increased general revenue funding of $11,091,387, as detailed above, will provide sufficient funding for the State to meet the requirements of the consent decree during FY2017. The final approved budget does not include funding for caseload increase, but the Legislature recommended that additional funding be available when growth occurs. A BHDDH Eligibility Unit Update dated 6/29/16 reports that 125 new individuals were determined to be eligible for State funded services between 7/1/15 and 6/30/16. The report states that as of April 15, 2016 approximately 70% of applicants were between the ages of 16 and 21 years and were not expected to exit school during the 2015-16 school year. The Consent Decree provides a process for ensuring the members of the four target groups will be offered supports and services to transition from school to adult services during the current 2016-17 fiscal year. BHDDH is requested to report to the Monitor on any members of the Transition Target population whose acceptance into the adult DD system is delayed or deferred due to lack of funding.
3

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III. MANAGEMENT PLAN
Court Order Provision No. 5(a): Finalize a project management plan developed and agreed to by BHDDH, ORS and RIDE.
Status. The State’s project management plan identifies Consent Decree goals and tasks, the project lead or person responsible for ensuring each task is accomplished, the current status, due date for completion, and comments. Sufficient documentation is provided to identify and track key requirements and accomplishments. The plan does not include a description of the organizational strategies being used within BHDDH to accomplish the required system change benchmarks, nor does it reference current collaborative efforts such as the Interagency Consent Decree Advisory Team that meets regularly to coordinate activities between departments. Given the personnel changes within BHDDH, the departure of the department’s director, the DDD director and the chief transformation officer, it is understandable that a more developed operational management plan has not yet been put together.
Assessment: Provision Met. It is recommended that the current management plan be expanded to reference organizational roles and implementation strategies as noted above once the key management personnel are in place, but not later than December 1, 2016.
IV. TRANSITION TIMELINES AND IEP MEETING
Court Order Provision No. 5(b) and (g): Finalize a transition timeline by BHDDH, ORS and RIDE. Finalize a plan for ensuring consistent attendance by ORS or BHDDH at IEP meetings for transition age youth.
Status. Transition Timeline (No. 5(b). A comprehensive Transition Timeline developed by RIDE, BHDDH and ORS provides detailed information on the activities to be performed and accomplished with and on behalf of students in transition. BHDDH provided additional information on the activities and benchmarks that the division intends to accomplish during this period. The actions to be taken by the three departments are clear. However, the sections on the Timeline referring to the evidence to be gathered and used to determine that the required actions were taken needs to be strengthened. Specifically, RIDE and BHDDH need to identify how and
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by whom career development planning (for example) and other activities will be evaluated to ensure the intended outcomes are achieved.
Assessment (No 5(b). Provision Met. The Transition Timeline identifies each agency’s responsibility for engagement and associated timelines.
Status. IEP Meeting Attendance (No. 5(g). The Order requires the State to finalize a plan for ensuring consistent attendance by individuals employed by BHDDH or ORS at IEP meetings for transition age individuals. The Transition timeline (Document 37-3 as revised by the State and submitted on 7/18/16) establishes a plan for attendance by ORS or BHDDH at IEP meetings for transition age youth (14-21 years of age). The timeline and BHDDH Eligibility Unit Update revised by the State and submitted on 7/18/16 provides information regarding the actions to be taken by RIDE, ORS and BHDDH to meet the needs of Youth Transition group members at key stages or “touch points” in the transition process. Activities are organized into sections according to student age brackets between 14 and 21 years. The Transition Plan states that State representatives from ORS and BHDDH are available for consultation and participation at IEP meetings for transition aged youth in layers of increasing involvement as students progress in age and move toward transition to the adult system. The Plan states that ORS Counselors are regular members of the school teams for all Transition Age youth and are available for IEP consultation and involvement as requested. BHDDH representatives are available to attend IEP meetings for younger (14-16) age youth on the basis of a school or parental request.
For students 16 to 18 years of age, BHDDH has contracted with the Rhode Island Parent Information Network (RIPIN) to attend IEP meetings. The Transition Plan indicates that an ORS Rehabilitation Counselor will be present at IEP meetings as well as during annual Career Development team meetings. Once the individual is 18 months from exiting school, the BHDDH Eligibility Unit will attend IEP meetings. RIDE describes a variety of actions taken by the State and by the Local Educational Authorities (LEA) during this period.
Assessment (No. 5(g). Provision Met. The Transition Plan and supporting materials provided for attendance by ORS or BHDDH at IEP meetings for individuals in transition ages 14 to 16
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years only at the request of the school or the family. Following feedback from the Monitor in the draft version of this report sent to the Parties on July 21, 2016, the State provided an Addendum to the Consent Decree Transition Plan (dated July 2016) reaffirming and clarifying its commitment to have ORS and/or BHDDH staff available for all IEP meetings for Transition Age Youth, including those aged 14-16. The State commits to amending the IEP Meeting Notice that is used by all school districts in RI to include a statement informing parents that as part of the Transition Process they have access to and can request the participation of ORS and BHDDH staff at their child’s upcoming IEP meeting. The Addendum is incorporated by reference into the Consent Decree Communication Plan already submitted by the State. The Plan itself is being amended to reflect the State’s commitment to ensuring that families understand that ORS and BHDDH staff are available to participate in their IEP meeting for youth age 14-16 as appropriate to the needs of their child and based upon their choices and expressed preferences.
V. COMMUNICATION PLAN
Court Order Provision Nos. 5(c) and 5(d). The State will finalize a communications plan for communicating with individuals and families on pending BHDDH services. The communications plan will describe efforts for gathering information from the community.
Status. Communications Plan for Pending Services (No. 5(c). BHDDH’s Eligibility Unit Update on June 29, 2016, as revised on July 18, 2016, reports on the roles and responsibilities of the Eligibility Unit and the process used by DDD to determine eligibility for adult DD services. The eligibility determination process describes a plan for communicating the status of eligibility determination requests to individuals and families. The Eligibility Unit Update states that a member of the eligibility unit will meet with each individual and family to explain the procedures the State uses to determine service eligibility, assess individual support needs and allocate funding for services to be provided. Furthermore, the description of the eligibility determination timeline and related communications identify key points of communication between the division and the individual and family with respect to: the need for additional information, the scheduling of the SIS evaluation, tier assignments, the start of services, self direction, and response to pending applications.
Assessment (No. 5(c). Provision Met. The revised Eligibility Unit Update describes the methods used by DDD to communicate with individuals and families regarding the required
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elements of eligibility determination and resource allocation. An eligibility worker is on call to answer both general and specific questions. Contact information is provided on the BHDDH website, on brochures and on all correspondence from the Eligibility Unit and is shared with families during IEP meetings. Upon receipt of an application a letter is provided to families and the individual confirming receipt of the application and the timeline for review and decision making.
It is important to note that the eligibility determination process frequently is associated with a great deal of anxiety and concern among individuals with disabilities and their families. By its nature, the process is technical, complicated and difficult for a layperson to understand. Direct contact with an eligibility determination staff member offers an important opportunity for families to learn about the process and have their questions answered. It is recommended that BHDDH develop and distribute a description of the eligibility determination process that is clear, easy to access, user-friendly and written in plain language to assist individuals receiving support understand how the process operates and the staff at DDD to contact with questions and requests for support.
Status. Communication Plan (No. 5(d). The Consent Decree Communications Plan outlines BHDDH’s plans and strategies for gathering information from the community including individuals, families, providers, members of the media and the general public. The plan identifies target audiences, objectives, messages, communication strategies and outcomes. A chart describing Proposed Outreach Activities by Core Consent Decree Topics identifies topics, primary audiences, tactics materials and the staff with lead responsibilities for organizing the training or communication activity including intended completion dates. Specific dates are provided for attendance at future Employment First Task Force meetings as required by the Court Order. At the request of the Monitor, completion or target dates were provided for updates made to agency websites that provide individuals and families with practical information on services and deadlines to support seamless transitions, and for the specific Consent Decree Update to be shared through the BHDDH newsletter by July 29, 2016.
Assessment (No. 5(d). Provision Met.
VI. SERVICE TIER POLICY/ASSIGNING RESOURCE ALLOCATION (SIS)
Court Order Provision No. 5(e). Revise BHDDH SIS Policy.
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Status. Service Tier Policy (No. 5(e). BHDDH revised Policy number SIS-4, Service Tier Policy/Assigning Resource Allocation initially approved on 11/28/12 on June 29, 2016. The revision includes the provision that “All decisions involving tier assignments and any changes to tier assignments are made solely on the basis of individual support needs as indicated by the SIS assessment in a manner that is consistent with the individual’s support needs, separate and apart from resource allocation considerations.” Tier assignments are made by an independent entity under contract with BHDDH utilizing a statistically determined algorithm that assigns individuals to funding levels based on their support needs as indicated by their SIS scores. The DD division director has authority to adjust an individual’s funding allocation outside of the SIS tier assignment process based on documentation of the individual’s need.
Assessment (Par 5(e). Provision Met. The language of the revised policy meets the requirement that of the Court Order that “all decisions involving SIS tier assignments and changes will be made by BHDDH staff in a manner that is consistent with individuals’ support needs, separate and apart from resource allocation considerations.”
VII. OTHER MATTERS
Consent Decree Provision XI.(10) Establishment and Distribution of the Sheltered Workshop Conversion Trust Fund. By October 1, 2014 the State, including BHDDH and ORS, will establish and begin distributing a Sheltered Workshop Conversion Trust Fund in the amount of $800,000 to provide up-front start up costs to providers that have agreed to convert their services from primarily sheltered employment to primarily supported employment services.
Status. Provision No. 4 of the Court Order filed on May 18, 2016 requires the State to comply with every deadline in the Consent Decree “from this day forward.” The review and analysis of the State’s final 2017 Budget (Section II above) revealed that the Trust Fund dollars to be distributed to providers to cover approved start up costs had yet to be dispersed as of July 21, 2016. The State of Rhode Island’s Compliance Status Report filed on April 1, 2016 noted that the State had provided “full funding of $800,000 over two years (FY15 and FY16) for the Trust Fund called for in the Consent Decree.” Testimony offered during the Evidentiary Hearing held on April 8, 2016 (p. 90; pp. 151-152) indicated that invoices for Trust Fund dollars had been
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submitted by provider agencies to BHDDH and were awaiting payment. As of this date, July 21, 2016, three months later, payment has not occurred. Trust Fund dollars were included in BHDDH’s FY2015 and FY 2016 budgets. Applications were completed by provider agencies and submitted to BHDDH in accordance with an established timeframe. Applications were reviewed, revised as necessary and received approval. Provider agencies submitted invoices to BHDDH in March 2016. As of July 21, 2016, however, no Trust Fund dollars had been dispersed.
Assessment. Consent Decree Provision XI.(10) Conditionally Met. The State was notified by the Monitor that it is out of compliance with Consent Decree Provision XI.(10.) by the draft version of this report issued for review by the Parties on July 21, 2016. Following receipt of the draft report, the Deputy Secretary EOHHS provided the Monitor with a detailed description of the State’s efforts to meet this requirement to date. She assured the Monitor that payments from the Conversion Trust Fund are in process and will be issued and received by each of the provider agencies that were approved for Trust Fund grants not later than Friday July 29, 2016. The Monitor recommends to the Court that action on this finding not be taken until after July 29, 2016, following a determination by the Monitor that funds have been received by each of the nine provider agencies and the State is in full compliance with this provision. It is further recommended that if funds have not been received by this date that fines, as provided by the May 18, 2016 Court Order, be imposed by the Court for failure to comply with this this provision effective July 1, 2016.
Respectfully Submitted, Charles Moseley EdD. U.S. District Court Monitor July 22, 2016
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 Case 1:14-cv-00175-JJM-PAS Document 43 Filed 09/09/16 Page 1 of 10 PageID #: 2223 

REPORT OF THE COURT MONITOR
On
UNITED STATES OF AMERICA v. STATE OF RHODE ISLAND Case No. CA14-175
DEFENDANT’S FOURTH STATUS REPORT
Filed July 29, 2016 and Revised on September 3, 2016

Charles Moseley Ed.D. U.S. District Court Monitor
Report Issued: September 9, 2016

Progress Summary

Court Order Provision
2. Live Database 3. Database Access 5(d)(4). BHDDH Newsletter Update 5(f). SIS Interviewer Training 5(h). CDP Training 5(i). RIDE Census Clerk Training 5(j). Hire QI and Employment Spec 5(k). Verification of Services 5(l) Supported Employment Authorization 5(m) Performance Based Contracting 5(n) Increase Salaries and Benefits 4. Compliance with Other Deadlines

Assessment
Provision Met Provision Met Provision Met Provision Met Provision Met Provision Met Provision Met Provision Met Provision Met Provision Met Provision Conditionally Met Evaluation Deferred



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I. INTRODUCTION
This review assesses the documentation and actions taken by the State of Rhode Island as described in the Defendant’s Fourth Status Report to determine progress and compliance with respect to certain requirements set forth in the Court’s Order of May 18, 2016. Specifically addressed are provisions of the Order that were required to be completed or addressed by the State by July 29, 2016 through August 1, 2016. This progress report follows the organizational format of the State’s Fourth Status Report to facilitate comprehension and tracking.
A draft version of this Monitor’s Report was shared with the State of Rhode Island (State) and the Department of Justice (DOJ). The State was provided the opportunity to clarify several points, update exhibits and furnish additional information regarding the activities it has taken with respect to meeting Court Order Provisions 5(k), 5(l), and 5(m). The State issued revisions to the Fourth Status Report on September 3, 2016. The assessment of progress documented in this Monitor’s Report is based on the additional information provided by the State and DOJ.
Provision 4 of the Court Order issued on May 18, 2016 requires the State, “from this date forward to comply with every deadline in the Consent Decree…” Although significant progress has been made by the State in achieving the requirements of the Order, other provisions of the Consent Decree have not been accomplished as required. The evaluation of progress on this provision of the Court Order is reviewed below in Section XI. Other Matters and is deferred for consideration at a future date.
II. LIVE DATABASE TO EFFECTIVELY TRACK EACH MEMBER OF EACH TARGET POPULATION OUTLINED IN THE CONSENT DECREE
Court Order Provision 2: Create a live database that that will allow for the efficient and effective tracking of each member of each target population outlined in the Consent Decree and all related and required services and outcomes…
Status. The State has developed and implemented a live database, the Consent Decree Data Tracker System, to track all of the benchmarks included in Provision 2 and detailed in the State’s Exhibit 1(a), 1(b) and 1(c), as revised on September 3, 2016.



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The Consent Decree Data Tracker System reports data on the services and outcomes received by each member of each target population, longitudinally tracking each individual using a unique identifier. The Transition Population consists of a rolling census of students ages1421 with I/DD identified by RIDE. Reports on the Youth Exit Population focus on students with I/DD who have left school since 2013, documenting their entry to the BHDDH developmental disabilities service system. Members of the Sheltered Workshop and Day Target populations were identified in 2013, one year prior to the Consent Decree, and are static groups whose membership changes only by death or their exit from the service system.
The database provides information through five reports:

1. The Consent Decree Total Population provides an unduplicated count of the individuals in each Target Population, the number of individuals who are deceased and the current census of each target group.
2. The Consent Decree Employment Report provides counts and percentages of individuals who are employed in integrated settings.
3. The Report on Career Development Plans and Certified Benefits Plans provides both the count and percentages, broken down by Target Population of those individuals who have documented in their files a Career Development Plan, a Certified Benefits Plan or both.
4. Transition Process for Youth Exit to BHDDH Services provides a timeline from date of application or first contact through the start of services for the Youth Exit population.
5. The Report on Weekly Hours Worked provides data from both ORS and the Sherlock Survey on the hours worked, broken down by target group and type of employment.
Additional reports are available to the Court Monitor and the Department of Justice on request. Assessment: Provision Met. The State reports that the database was developed as a short– term (12-18 months) solution to be replaced by a more modern and comprehensive Case Management System that will include an electronic medical record. The data is being made



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available in two phases (See Exhibit 1(b). Phase I (April - June 2016) includes the core information described above that could be gathered and reported during an initial threemonth timeframe. Phase II (July – December 2016) will expand reporting capabilities to include attendance of BHDDH or ORS staff at individual education plan (IEP) meetings and the delivery of Benefits Counseling Sessions, as well as key activities that take place as individuals transition from school to BHDDH services. A summary chart, provided by the State at Exhibit 1(c) as revised September 3, 2016, entitled the Consent Decree Proposed File and Database Layout identifies the information that is summarized in the database including, the source of the data (state agency or external source such as the Sherlock Survey), a description of the data being collected, and the type of information provided. Each of the various data points identified within the Court Order has been identified as an element of the database.

III. ACCESS TO CONSENT DECREE DATABASE
Court Order Provision 3: By July 29, 2016 provide the United States and the Court Monitor with either access to the database or a list of database entries from which the United States and the Court Monitor will select files for verification.
Status. The State provided access to the database as required. The plan described by the state and included in the Fourth Status Report was itself revised on July 18, 2016 following discussions between the Monitor, the United States and the State of Rhode Island (See Exhibit 2 as revised September 3, 2016). The Department of Justice and the Monitor received the full list of Target Group members from the state and each selected a sample of 40 files selected at random from the target populations. Copies of client files were provided by the State in advance of the deadline.

Assessment: Provision Met.

IV. SHARING OF CONSENT DECREE UPDATE THROUGH BHDDH’S NEWSLETTER

Court Order Provision 5(d)(4): As a part of its communication plan the State will outline



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its efforts to gather information from the community, including but not limited to a specific Consent Decree Update shared through the BHDDH Newsletter by July 29, 2016.
Status. BHDDH issued a Consent Decree Update Newsletter on July 26, 2016. A copy is included in the State’s Fourth Status Report as Exhibit 3. The Update provided descriptive information on the Consent Decree, a description of targeted groups, placement goals, state actions, advice for individuals and families, and a contact person for additional questions.
Assessment: Provision Met.
V. TRAINING OF BHDDH POLICY NO. SIS-4
Court Order Provision 5(f). By July 29, 2016 file with the Court agendas or meeting minutes that demonstrate training of all SIS Interviewers and Assessors on the change to BHDDH Policy No. SIS-4 required by Provision 5(e).
Status. Documentation was furnished by BHDDH that was signed by six SIS reviewers attesting that each had read and understood SIS Policy No. 4 Service Tier Policy/Assigning Resource Allocation. The seventh reviewer was out of work on medical leave. The State is requested to ensure the document is signed by the seventh reviewer after she returns from medical leave.
Assessment: Provision Met.
VI. IMPLEMENTATION OF ONGOING CDP TRAINING
Court Order Provision 5(h). By 29, 2016 BHDDH, ORS and RIDE must implement ongoing training on the use of career development plans and provide regular supervision to ensure all relevant agency staff are using the plans as contemplated by and required in the Consent Decree.
Status. BHDDH, RIDE and ORS furnished documentation that training in career development planning has been provided on an ongoing basis since July 2016 as required. A a copy of the PowerPoint presentation used by BHDDH to train all social services staff, providers, families, individuals with disabilities, and stakeholder groups was reviewed by the Monitor. A training schedule was available for the months of August and September 2016. BHDDH indicated that career development plans will be reviewed by the DD division





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Associate Director/Employment Specialist on a routine basis. ORS reports that it uses the career development planning format developed and implemented by RIDE in 2014 and that ORS staff have participated in RIDE sponsored trainings as well as trainings provided by ORS since that time. RIDE reports that training on career development planning for LEA and RIDE staff begin on September 26, 2014 and has continued since that time. Additional training occurred in October 2014, April 2015, October 2015 and April 2016. RIDE has furnished reports of training on career development planning provided to LEAs on a quarterly basis.
Assessment: Provision Met. BHDDH is requested to report to the Monitor a short summary of all training on career development planning that was provided through September 30, 2016. The report should indicate the dates that the training took place and the individuals and groups who received the training.
VII. RIDE’S IMPLEMENTATION OF CENSUS CLERK TRAINING
Court Order Provision 5(i). By July 29, 2016 RIDE must train all census clerks to accurately report the number of career development plans in place.
Status. RIDE provided a detailed memo to Special Education Census Personnel regarding the addition of four new data fields to the eRIDE Special Education Census to comply with the requirements of the Consent Decree on August 25, 2015. The goal was to have all records up to date by the close of the Special Education Census in June, 2016. The RIDE Special Education Census Manager provided individual technical assistance to school district census clerks to ensure the accuracy of reporting. The requirement to report the Career Development Plan "date" was added to the Special Education Census and Special Education Census personnel were notified of this change on June 2, 2016. Special Education Directors were notified of this census change on June 16, 2016.
Assessment: Provision Met. RIDE is requested to provide the Monitor with copies of the three memos identified above.
VIII. HIRING OF PROGRAM DEVELOPER AND EMPLOYMENT SPECIALIST
Court Order Provision 5(j).
Status. Documentation confirms that the Program Developer – Associate Director for





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Quality Assurance and program Improvement and the Employment Specialist have been hired by BHDDH.
Assessment: Provision Met.
IX. IMPLEMENT A SUPPORTED EMPLOYMENT SERVICES INCENTIVE PROGRAM
Court Order Provision 5(k). By August 1, 2016 implement a new reimbursement model for services rendered including, but not limited to career exploration/discovery services, vocational situational assessments, work trials, development of job seeker profiles, job search and job placement, job training and job support, support coordination, and transportation services
Status. BHDDH’s Supported Employment Services Package, Person Centered Supported Employment Services Program (Exhibit 8 as revised September 3, 2016), describes a payment system verifying that the services listed in Provision 5(k) above are included as required.
Assessment: Provision Met.
Court Order Provision 5(l). By August 1, 2016 [the State must] implement a new service package design that includes service authorization for Supported Employment Services.
Status. BHDDH’s Supported Employment Services Package – Person Centered Supported Employment Services Program (Exhibit 8 as revised September 3, 2016) includes supported employment services as authorized services as required.
Assessment: Provision Met.
Court Order Provision 5(m). By August 1, 2016 the State will properly implement performance-based contracts for Supported Employment services to individuals in the target populations that link funding to graduated levels of provider achievement of quality numerical targets and implementation timelines.
Status. Exhibit 8 of the State’s Fourth Status Report, as revised on September 3, 2016, describes the structure BHDDH intends to use to provide targeted payments to provider agencies that incentivize the achievement of employment outcomes among individuals with





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IDD receiving support. The plan is designed to link service related payments to “numerical targets and implementation timelines” set forth in the Consent Decree. The new incentive based system makes provider payments contingent upon several variables including the achievement of identified placement criteria, meeting set credentialing and training requirements, and developing the capacity to achieve high levels of placement over time. Incentive payments are designed to augment existing funding for employment services and, as with the current rate setting system, are based on SIS acuity scores. This structure ensures higher incentive payments are available for individuals with more complex and challenging needs.
Assessment: Provision Met.

X. APPROPRIATELY INCREASE SALARIES, BENEFITS, TRAINING, AND SUPERVISION FOR DIRECT SUPPORT PROFESSIONALS AND JOB COACHES
Court Order Provision 5(n). By August 1, 2016, appropriately increase salaries, benefits, training, and supervision for Direct Support Professionals and Job Coaches.
Status. The State summarized its plan to increase wage rates for direct support professionals and job coaches in Exhibit 9, Notice of BHDDH Direct Support Professional and Job Coach Wage Increases Methodology and Verification Requirements. Under the plan, BHDDH will adjust all rates for Direct Support Professionals and Job Coaches to a base rate of $11.55 per hour. Additional adjustments will be made to reflect increased fringe benefit costs that providers will incur as a result of the wage rate increase. Wage increases for direct support workers and job coaches are intended to target the lowest wage earners within Developmental Disability Organizations and will result in an overall increase of approximately 3.1%. All providers are required to submit payroll data reflecting wage scales pre- and post-raise to ensure that the additional funds are given to direct support professionals and job coaches in the form of an ongoing hourly wage increase (with the exception of the increase designated as “Employee Related Expenses”). Rate increases will apply retroactively for all claims billed subsequent to July 1, 2016, pending approval by Medicaid. An adjustment payment will be provided to each agency covering the incremental additional amount due for claims billed during the period beginning July 1, 2016. Retroactive payments will be made by provider agencies to direct support professionals and job coaches in accordance with post-rate increase compensation levels set by each agency.





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Assessment: Provision Conditionally Met. The plan submitted by BHDDH provides what appears to be an effective structure for increasing salaries and benefits for direct support professionals and job coaches as required by the Consent Decree. The plan mentions that the funding includes “employment related expenses” but does not describe the nature of those costs or affirm that such expenditures specifically cover costs related to training and supervision as required by the Consent Decree and the Court Order. Additional information is needed to verify that the increased funding approved for direct support staff and job coaches will be used to “increase salaries, benefits, training and supervision” as required by Provision 5(n).
Also, the State is requested to notify the Monitor following the disbursal of the one time payment to provider agencies as described above and the date at which rate increases were fully implemented.
XI. OTHER MATTERS: FROM THIS DATE FORWARD COMPLY WITH EVERY DEADLINE OF THE CONSENT DECREE
Court Order Provision 4. From this date forward comply with every deadline in the Consent Decree with compliance measured in part by regular reports of supported employment placements filed with the Court by the Court Monitor.
Status. Since the issuance of the Court’s Order on May 18, 2016, the State has made substantive efforts to change policies, procedures, operational practices, program structures, funding, and provider services as required by the Consent Decree. In June, the Rhode Island Legislature approved the Governor’s recommendations for a substantial increase in funding totaling over $11 million to pay for improvements in client services, supports, staff training, and program infrastructure necessary to comply with the requirements of the Consent Decree.1 During July and August 2016 the State has taken steps to increase provider funding to improve salaries, benefits, training, and supervision for direct support staff and job coaches. BHDDH has developed and is implementing a new performance based provider contracting system that is designed to incentivize the placement of individuals with I/DD in integrated supported employment and integrated day situations. The department also is implementing a new Career Development Planning process and is training staff on person-centered planning and personcentered service delivery. System change funding has been distributed to eligible service providers from the Sheltered Workshop Trust Fund and the Conversion Institute at the Rhode

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Island College Sherlock Center is working closely with provider agencies to assist them in shifting the delivery of supports from segregated sheltered workshops and day programs to integrated individualized employment and day services. In addition, the department hired three key staff to manage and direct supported employment, quality improvement and systems transformation, among other duties. Additional technical assistance is being utilized by the State to make needed changes in policy and practice.
Assessment: Performance Evaluation Deferred. The State is implementing substantive changes across the array of day and employment services furnished to individuals with I/DD by BHDDH, ORS and RIDE, as well as other departments and agencies within state government. Not all of the systems change requirements and deadlines set by the Consent Decree have been met to date. Placement benchmarks for individuals in the Youth Exit Target Populations, for example, have not been met. Continued refinements need to take place in the State’s data system and additional policies and practices need to be implemented in the areas of quality improvement, provider capacity, and the expansion of integrated and individualized day services and supports, among others. While challenges remain, the foundational steps taken by the State to address key areas related to funding, administrative oversight, training, and documentation, consistent with the Court Order, are moving the State on a path toward achieving the requirements of the Consent Decree. As a result of these efforts, I believe that it is appropriate to defer the assessment of the State’s progress on meeting every deadline in the Consent Decree, as described in Provision 4 of the Court Order, to a later date as determined by the Monitor following consultation with the State and the United States.
Regular reports on the status of the State’s progress on meeting supported employment placement benchmarks are a key measure of the State’s compliance with the Court Order and the Consent Decree. A summary of the current status of supported employment placements will be filed by the Monitor as an addendum to this current report. Additional reports will be filed with the Court by the Court Monitor on a quarterly basis.




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 Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 1 of 17 PageID #: 2320
UNITED STATES OF AMERICA v. STATE OF RHODE ISLAND
Case No. CA14‐175
COMPLIANCE PROGRESS REPORT
Charles Moseley Ed.D. U.S. District Court Monitor
October 31, 2016
Background. The recently released Quarterly Status Report On Court Ordered Placements, amended and issued on September 16, 2016, summarizes the Court Monitor’s findings with respect to the identification and placement of all members of the Rhode Island Youth Exit Population.
This Compliance Progress Report provides a review of the two documents submitted by the State on September 30, 2016 in response to the Quarterly Status Report. Both plans were resubmitted in October 2016 with revisions made in response to the Monitor’s recommendations.
Requirement. The Court Monitor recommended that the State take the following actions to come into compliance with the Consent Decree’s placement requirements for the Youth Exit Population:
1. Identification of All Members of the Youth Exit Population. RIDE, in consultation with ORS, BHDDH and EOHHS, develop and submit to the Monitor for approval not later than September 30, 2016 a plan and implementation strategy for identifying all members of the Youth Exit Population. Implementation of the plan should begin not later than October 3, 2016 and provide for the identification of all members of the Youth Exit Population by November 15, 2016.
Status: RIDE, in conjunction with BHDDH and ORS, submitted the Joint Plan for Identifying All Members of the Youth Exit Population on September 30, 2016 See Attachment A). The Joint Plan identifies members of the Youth Exit Population who have exited school during or immediately after the 2013‐14 school year, the 2014‐15 school year and the 2015‐16 school year. Data on the Youth Exit Population who left school following the 2015‐16 school year continues to be gathered and entered into the State’s Consent Decree database. RIDE will update the database as additional census information becomes available, no later than June 30, 2017. BHDDH and ORS will additionally identify members of the 2015‐2016 Youth Exit Target population as they come into the service system. The Joint Plan provides a strategy for identifying all current and future all members of the Youth Exit Population.

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 2 of 17 PageID #: 2321
The Joint Plan details the number of individuals receiving services from BHDDH and ORS, as well as the number of individuals who are not enrolled in adult services. The plan provides a creditable strategy for identifying, contacting and following up on the 22 Youth Exit Population members who are not receiving publicly financed services; gathering information on their current status, ensuring appropriate referrals have been made and contacting them to determine their interest in receiving additional supports.
The second section of the Joint Plan outlines a strategy for identifying additional Youth Exit Members.
RIDE will report all youth with a disability, aged 14‐21 who are categorized under IDEA as having an intellectual disability, autism, or multiple disabilities and will provide the names of youth ages 14‐21 with autism and multi‐handicaps to the Consent Decree State Coordinator by November 15, 2016.
BHDDH, in collaboration with ORS and RIDE will develop a list of members of the (2015‐2016) Youth Exit group based on adult service data drawn from the Transition Target population census in the Consent Decree database. Focus will be placed on identifying individuals who turned 21 years of age after September 1, 2015. BHDDH will identify the members of the (2015‐2016) exit group who are enrolled in ORS and/or BHDDH services and the individuals who are not receiving any adult services. The State will attempt to contact member of the Youth Exit population who are not receiving assistance to information of their status as a member of the protect ted class and potential eligibility for supported employment services. The State’s plan includes relevant procedural deadlines with the objective of identifying all eligible individuals by November 15, 2016.
The third section of the State’s plan outlines a strategy for improving the future identification of the Youth Exit Population. RIDE will continue its outreach to individuals scheduling presentations of an introduction to state services with each school district, inviting BHDDH caseworkers to attend transition meetings and contacting parents regarding the eligibility of their sons or daughters for BHDDH and ORS services. RIDE will continue its practice of providing correspondence to members of the Transition Exit Population about their eligibility as a Consent Decree member.
BHDDH will refine its information describing eligibility criteria for adult DD services in order to improve the identification of future Youth Exit members. Guidance materials will be created for the LEAs to assist in identifying individuals with intellectual disabilities and individuals with developmental disabilities who will likely be eligible for BHDDH services. A new policy entitled “Eligibility Determination by 17” will establish a referral process for youth at age 16 years that will result in an eligibility determination by age 17. The new process will ensure that all individuals with disabilities enrolled in Rhode Island LEAs will be affirmatively identified as eligible for adult services long before their exit from secondary programming. LEAs will be guided to inform families of youth who are categorized under IDEA as having an intellectual disability, autism, or multiple disabilities, or are believed to have a developmental
2

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 3 of 17 PageID #: 2322
disability, of their right to apply for BHDDH adult services by the age of 16. BHDDH will assign a Statewide Transition Coordinator to organize the department’s activities and involvement in the school transition process by January 15, 2017.
Assessment: Provision Met. The Joint Plan provides a credible process for identifying all members of the Youth Exit Population.
2. Development of a strategy and timeline for ensuring supported employment placement opportunities for all individuals in the Youth Exit Population. BHDDH, RIDE and ORS collaborate on the development of a strategy and timeline for ensuring supported employment placement opportunities for all individuals in the Youth Exit Population. The strategy and timeline must be submitted to the Monitor not later than October 1, 2016 and be designed to ensure the placement of all individuals in the Youth Exit Population by June 30, 2016.
Status: On September 20, 2016, the Monitor met with State administrators and staff to discuss a framework for the supported employment placement plan and to review the essential issues, components, benchmarks and evaluation points that should be addressed or taken into consideration by the State’s plan, implementation strategy and timeline. The key points of the framework are addressed in the State’s Plan for Achieving Consent Decree Placement Outcomes For The Youth Exit Population (Attachment B). The State’s plan is divided into the following five sections: (a) description of the Youth Exit Target Population, (b) financial plan and rational, (c) managing the placement process and timeline, (d) youth exit placement initiative communications strategy, and (e) progress documentation (See Attachment B).
The plan and implementation strategy provide measurable objectives for the placement initiative for the State as well as each provider organization involved in the process. The plan additionally emphasizes the use of an individualized person‐centered career development planning practices that are consistent with the requirements of the Consent Decree. The proposed project management plan and timeframe identifies the individuals responsible for managing and overseeing the placement process system‐ wide including relationships with provider organizations, collaboration with the Conversion Institute and steps the State intends to take to ensure service quality. The communications strategy identifies communication objectives, target audiences, and the channels through which the communication is expected to occur. Finally, the plan provides for the ongoing collection of data on key placement benchmarks to document and evaluate progress and report to the Monitor and others on a monthly basis.
Assessment: Provision Met. The placement plan provides a comprehensive strategy for ensuring the appropriate placement of all members of the Youth Exit Population consistent with the Consent Decree by June 30, 2017.
3

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Attachment A Amended Joint Plan for Identifying All Members of the Youth Exit
Population
October 26, 2016
Requirement: RIDE, in consultation with ORS, BHDDH and EOHHS, will develop and submit to the Monitor for approval not later than September 30, 2016 a plan and implementation strategy for identifying all members of the Youth Exit Population. Implementation of the plan should begin not later than October 3, 2016 and provide for the identification of all members of the Youth Exit Population by November 15, 2016.
Current status: There are 259 individuals in the Consent Decree (CD) Tracker who are members of the Youth Exit Population. Seventy‐five exited in the (2013‐2014) school year and seventy–six exited in the (2014‐2015) school year. To date, 109 members of the 2015‐2016 Youth Exit group have been identified. The remaining members of the (2015‐2016) exit group may not yet have been captured in RIDE’s census data and entered into the CD Tracker. RIDE will provide this information, as more census information becomes available, no later than June 30, 2017. BHDDH and ORS will utilize existing data to continue to identify members of the 2015‐2016 Youth Exit Target population as they come into the service system. In the analysis that has been done to date on the (2013‐2014) and (2014‐2015) Youth Exit members:
 Ninety‐nine (99) are enrolled in BHDDH services.
4

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 5 of 17 PageID #: 2324
 Thirty (30) are or have been enrolled in ORS services only.  Twenty‐two (22) are not enrolled in adult services. The plan addresses the refinement of information about the 259 known individuals, the identification of additional members of the Youth Exit Target Populations, and practices to improve the identification of the future Youth Exit members.
Plan to refine information about the current census of Youth Exit members: 1. BHDDH has identified from the CD Database the 22 Youth Exit members who are not receiving services. The names of these individuals have been shared with RIDE, ORS and BHDDH to gather any information available about their status. BHDDH will then notify these individuals based on the contact information available.
2. ORS will review the 22 names and cross check with their transition counselors to determine previous referrals and determine the status of those referrals. This will be complete by October 3, 2016 and ORS will continue to track these 22 individuals separately.
3. BHDDH and ORS will send a letter to the 22 individuals, reminding them that they are members of a protected class under the Consent Decree and that they may be eligible for supported employment services per the Consent Decree. BHDDH will also attempt to contact them via phone to notify them and confirm their address prior to sending the letters.
5

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 6 of 17 PageID #: 2325
Plan to identify Additional Youth Exit members:
1. RIDE will report all youth with a disability, aged 14‐21who are categorized under IDEA as having an intellectual disability, autism, or multiple disabilities. RIDE has already been providing this information for the Consent Decree Database on students with I/DD. RIDE will provide the names of youth ages 14‐21 with autism and multihandicaps to the CD State Coordinator by November 15, 2016. This additional information will help the State determine the maximum universe for individuals we will need to identify for the Youth Exit Target Population.
2. BHDDH will develop a list of members of the (2015‐2016) exit group by reviewing the Transition Target population census in the CD Tracker and identifying those individuals who turned 21 after September 1, 2015. BHDDH will generate this list by October 30, 2016.
3. BHDDH will then determine which members of the (2015‐2016) exit group are enrolled in services with ORS and/or BHDDH and which members are not receiving any adult services by November 15, 2016.
6

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 7 of 17 PageID #: 2326
4. ORS, BHDDH and RIDE will review the names of those (2015‐2016) Youth Exit members who are not enrolled in adult services to gather any information about their status by November 15, 2016
5. BHDDH and ORS will attempt to contact these individual families via telephone to notify and confirm address, and then send a letter to those (2015‐2016) Youth Exit members informing them that they are members of a protected class under the Consent Decree and may be eligible for supported employment services.by November 15, 2016
6. BHDDH will identify all individuals new to BHDDH services since 2013 with a birth date of 1/1/92 who have not previously been identified by RIDE and add them to the Youth Exit population census by November 15, 2016.
Plan to improve the future identification of Youth Exit Population
1. As of September 2016 RIDE has tasked the Regional Transition Coordinators (RTC’s) in assisting BHDDH and ORS in the scheduling of the “Introduction to State Services” meetings with each school district. RTC’s will contact the appropriate BHDDH Social Caseworker Supervisor to invite them to the meeting at LEAs.
2. RIDE will continue its practice of providing correspondence to members of the Transition Exit Population about their eligibility as a Consent Decree member. This
7

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 8 of 17 PageID #: 2327
correspondence includes information on the Consent Decree and literature and contact information for ORS and BHDDH. Additionally, RIDE provides a model letter for the use of local school districts in communicating with former students who entered the status of the Youth Exit Population to further reinforce the availability of adult services from BHDDH and ORS. RIDE will continue to make this information available to the Transition Exit Population and local school districts
3. BHDDH will refine its information describing eligibility criteria for adult DD services in order to improve the identification of future Youth Exit members. By November 15, 2016 BHDDH will create guidance materials for the LEAs to assist in the accurate identification of individuals who will likely be eligible for BHDDH services. To ensure that this guidance is effective BHDDH will put in place an “Eligibility Determination by 17” Policy and process by establishing a referral process at age 16 and eligibility determination by age 17. Thus all individuals with disabilities enrolled in Rhode Island LEAs will be affirmatively identified as eligible for adult services long before their exit from secondary programming. LEAs will be guided to inform families that they have a right to file an application for BHDDH adult services by the age of 16 in all cases of youth with a disability, who are categorized under IDEA as having an intellectual disability, autism, or multiple disabilities, or are believed to have a developmental disability and be eligible for BHDDH services. It is solely the family’s decision whether to pursue such an application for services and guidance documents will reflect that.
8

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 9 of 17 PageID #: 2328
4. BHDDH will also update its application instructions, and accompanying materials by November 30, 2016 and will post on the BHDDH website and share this new “Eligibility Determination by 17” Policy and process with stakeholder groups, educators and the public by November 30,2016.
5. By January 15, 2017BHDDH will assign a Statewide Transition Coordinator to provide dedicated coordination of all BHDDH activities and involvement in the transition process for students exiting secondary schools. This Statewide Transition Coordinator will be dedicated to working closely with RIDE and all LEAs to facilitate the new “Eligibility by 17” process described in Section 3 above and to make continuous process improvement recommendations to the Interagency Consent Decree Implementation Team. These recommendations will focus on ongoing process improvements designed to better identify all Youth Exit Target Population members and will be coordinated and implemented in consultation with the Director of Quality Assurance and Program Improvement.
9

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 10 of 17 PageID #: 2329
Attachment B
Plan for Achieving Consent Decree Placement Outcomes For The Youth Exit Population
To come into compliance with the Consent Decree, the Court Monitor recommended in the Status Report and during the Status Hearing held by the Court on September 16, 2016 that the three state departments, BHDDH, RIDE and ORS collaborate on the development of a plan, strategy and timeline for ensuring that all individuals in the Youth Exit Populations are provided with supported employment placements by June 30, 2017.
The Youth Exit Placement Plan represents a comprehensive, intensive approach to identifying and bolstering employment‐related supports and services to members of the Youth Exit population through the coordinated efforts of BHDDH and ORS and with input from RIDE, where appropriate. While a lead staff member is identified for each component of the plan, the intent is to strengthen the interagency collaboration and team process to pursue very ambitious outcomes. Through the vehicles of the Interagency CD Advisory Team as well as monthly joint BHDDH/ORS meetings to review Data and Progress, the State agencies will work together to create a seamless transition to supported employment services and placements for the Youth Exit Target Members.
BHDDH will take the lead in the development of a Youth Exit Tracking and Quality Improvement System and work collaboratively with ORS, RIDE and the Sherlock Center to support these targeted individuals to maximize supported employment placements. There are five key components to this plan:
 Section 1: The Youth Exit Tracking System identifies each member and his or her services.
 Section 2: The financial plan prioritizes the Youth Exit Target Population Members in BHDDH’s Person‐Centered Supported Employment Program and maximizes financial participation of ORS in a braided funding arrangement where possible.
 Section 3: BHDDH and ORS will monitor progress towards employment placement. A continuous quality improvement approach will be developed and ongoing coaching and technical assistance will be available for individuals, families and providers.
 Section 4: BHDDH will partner with ORS, RIDE and EOHHS to communicate the goals and activities of the Youth Exit Placement Initiative with an array of stakeholders.
 Section 5: On a monthly basis, BHDDH will report to the Monitor on key performance benchmarks
10

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 11 of 17 PageID #: 2330
1. Description of the Youth Exit Target Population:
I. Total number and names of individuals in each of the three Youth Exit Populations (2013‐2014, 2014‐2015, and 2015‐2016)
From the CD Database, the State will identify the names and number of individuals who are members of the Youth Exit population by Exit year. They will be broken down by:
 The names and numbers of individuals enrolled in BHDDH services
 The names and numbers of individuals served by each DD provider agency.
 The names and numbers of individuals who self‐direct through a Fiscal Intermediary.
 The names and numbers of individuals enrolled in ORS only services.
 The names and numbers of individuals who are not receiving services or supports from BHDDH, ORS or RIDE, the dates they left services, and any additional information relevant to why services are not received.
II. For each Youth Exit Target Group Member the State will identify:
 The array of supported employment services an individual has received – including vocational assessments, trial work experiences, benefits counseling and outreach and education on the State’s Employment First Policy and the Consent Decree.
 The status of the individual’s career development plan and/or individual support plan with respect to the identification of employment‐related goals and individual support planning. (CDP/ISP/IPE) This data will be gathered from a review of the individual plans by BHDDH.
 For each Youth Exit Target Group Member, the Consent Decree Coordinator and Employment Specialist will provide information and education about the variance process as appropriate in order for the individual to make an informed choice about whether to pursue an integrated day services placement in lieu of supported employment.
 BHDDH will work with each Youth Exit Member, his or her family and provider to project a timeline with respect to achieving a supported employment placement.
2. Financial Plan and Rationale
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Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 12 of 17 PageID #: 2331
I. The design of the funding plan is to be person‐centered, flexible and structured to support individuals in a variety of situations.
 BHDDH authorizes a spending package based upon an individual’s residential placement and SIS Tier. Within the authorized package, the individual has the ability to allocate resources towards particular services (such as job coaching and other employment supports). In addition, a process is in place to allocate additional resources to individuals when it is determined that additional supports are needed. Under the Person‐Centered Supported Employment Services Program additional resources are made available to ensure that individuals have supported employment programs that support their individual needs.
 The service design reflects the need for additional funding for individuals with complex and challenging needs or persons in temporary crisis who need additional staffing or support for a period of time. BHDDH has an established system in place to allow for additional funding to be made available when an individual needs more supports than are available within their authorized spending package. Additional financing may be requested to support an array of activities including respite, transportation, supported employment, and other community based activities.
 Written materials will be developed by October 3rd in a format that can be easily shared with and understood by providers, families and other stakeholders to clarify the funding process.
 The Division will update materials that explain funding allocations and spending packages and ensure appropriate placement on the BHDDH website by October 15th. These materials will be designed to ensure that they will be appropriate for providers, families, and other stakeholders.
 In order to address provider’s appropriate needs for training, support and additional resources the Division will assess the needs for training, support, and additional resources for providers when changes occur with funding packages and other financial authorizations. Members of the DD team will continue to communicate on a regular basis with providers to troubleshoot issues as they arise.
3. Managing the Placement Process and Timeframe
In order to ensure that each member of the three Youth Exit Population annual cohorts is provided with an integrated supported employment or day service placement, BHDDH will take the lead in managing the placement process system‐wide. Anne LeClerc, Associate Director of Program Performance at BHDDH, will oversee this effort, with assistance from
12

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 13 of 17 PageID #: 2332
Tracey Cunningham, Associate Director of Employment Services at BHDDH and Joe Murphy, Assistant Administrator, Vocational Rehabilitation/Supported Employment at ORS. This team will work with providers, families, and individuals to address the specific placement needs and requirements of the Youth population. A targeted approach to managing the Youth Exit population placements is being implemented through the following activities.
I. Providers received a list of the individuals they are currently serving who are members of the Youth Exit group to ensure that these individuals are being prioritized and accurate data is being reported.
II. The Person‐Centered Supported Employment Services Program application sets a priority for Providers to target the Youth Exit population and build capacity specific to this population. Applications are due in October.
III. As part of the Supported Employment Services Program process goals and timelines are developed with provider agencies to project the numbers of individuals to be placed by each agency each month throughout the remainder of the fiscal year. Youth Exit population members will be prioritized in all Supported Employment Services Program agreements.
IV. BHDDH will meet with providers and ORS monthly, in coordination with the Sherlock Center, to actively manage, monitor, and evaluate the placements being made to ensure that goals and targets are met or modified as necessary to meet emerging challenges and opportunities.
V. In preparation for this meeting, Providers will be required to submit a monthly progress report (see Attachment A) for each individual and report on progress towards the goals and objectives in the individual’s career development plan. Tracey Cunningham, Employment Specialist, will be working with providers to identify and problem solve any barriers within the program.
VI. The State will work with the Conversion Institute to identify and provide needed training and technical assistance specific to the Youth Exit population, for providers, families, and the youth themselves.
VII. The State will take the following approach to assess and improve the quality of services provided through this initiative:
 Outcomes will be assessed using data gathered from the monthly progress reports and the quarterly Sherlock Center survey.
13

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 14 of 17 PageID #: 2333
 Individuals’ satisfaction with the employment services received and the job obtained will be assessed using surveys of the Youth Exit population.
 The correlation between resources used and outcomes achieved will be evaluated for each provider. This data will then be compared to the feedback from the individuals served regarding the employment services received and outcomes gained.
4. Youth Exit Placement Initiative Communications Strategy The State will develop a targeted communications strategy to communicate the purpose, goals, objectives, activities and outcomes of the Youth Exit Placement Initiative to a variety of audiences and stakeholders. This strategy will align with the objectives and key messages included in the Consent Decree Communications Plan.
I. Target audiences:  Primary: Members of the Youth Exit Population and their families  Secondary: o Developmental disability providers o Secondary education districts, special educators, teachers and staff o State employees, including social caseworkers o Community stakeholders including developmental disability service organizations o Legislators o Members of the media o General public
II. Communication objectives:  Ensure that members of the Youth Exit population and their families are aware of the supported employment services they are eligible for and the process for achieving supported employment placement.  Raise awareness of the State’s Employment First policy.  Explain the benefits and opportunities of supported employment and encourage individuals and families to seek supported employment services.  Promote success stories that validate the outcomes of supported employment services for individuals, families and employers.
14

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 15 of 17 PageID #: 2334
 Raise awareness of the variance process as appropriate to help individuals to make an informed choice of whether to pursue an integrated day services placement in lieu of supported employment.
 Raise awareness of how supported employment services are funded.
 Raise awareness of how the Youth Exit Placement Initiative aligns with the State’s work to achieve the terms of the Consent Decree and improve the quality of services for individuals living with intellectual and developmental disabilities.
 Provide clear, accurate, transparent data on progress towards achieving the goals of the Youth Exit Placement initiative.
 Provide opportunities for individuals, families and other stakeholders to provide feedback and express concerns.
IV. Communication channels and vehicles. The State will leverage the following communication channels to achieve the communication objectives outlined above.
 Members of the Youth Exit population and their families:
o Direct communication (letters, phone calls, and/or family meetings at developmental disability agencies, as appropriate)
o Employment First Task Force Meetings o Quarterly Developmental Disability Family Forums o Outreach through the Rhode Island Parent Information Network o Other community stakeholder meetings o Transition events o BHDDH Website o BHDDH Community Newsletter o State agency social media accounts o Advocates in Action Statewide Conference
 Providers:
o Outreach through the Community Provider Network of RI o Developmental Disability Provider Council Meeting
 Secondary education districts, special educators, teachers and staff
o Direct communication with:  Superintendents  Special Education Directors
15

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 16 of 17 PageID #: 2335
 State employees, including social caseworkers: o Regular staff meetings o Staff emails
 Community stakeholders o The Employment First Task Force o Other community stakeholder meetings o BHDDH Website o BHDDH Community Newsletter o State agency social media accounts
 Legislators: o Legislative briefings, as requested and appropriate
 Members of the media: o Direct engagements with reporters covering this topic area
 General public: o BHDDH Website o State agency social media accounts o Media engagements
5. Progress Documentation: In order to assess the ongoing progress of this effort, on a monthly basis BHDDH, in collaboration with RIDE, ORS, the Sherlock Center and other partners, will identify key performance benchmarks and provide summary data regarding outcomes, including but not limited to:
 The numbers of individuals receiving supported employment or other integrated services as appropriate to the needs and desires of the individual.
 The numbers of individuals requesting a variance or integrated day only services.  The extent to which provider placement goals are being met.  The quality of placements and individual satisfaction with placements.  Barriers encountered.
16

Case 1:14-cv-00175-JJM-PAS Document 50 Filed 11/01/16 Page 17 of 17 PageID #: 2336  Opportunities identified.  Job retention, reasons for job loss, and amount of time unemployed.
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J

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 4 of 48 PageID #: 2346 

(*,)!,''(!'(.1-,)/!".)(.)*,)0#.'*),,3!/#(6-/**),.(&,-"#* .)."-3-.'9(1(#),.,.!3 #,1-'*&)33 (--#!(.) /& #&&." ,(- ),'.#)( #,,)&-."-," ),."(1#0#-#)(#,.),1-/(,.%(9"  */.3,.,32*(",1),%1#."."#0#-#)(.)(-/,)(!)#(!.#0#.#- )(.#(/ )&&)1#(!."*,./,) ." ),',  #,.),(."**)#(.'(.) ."(1 #,.),6)--9  &.")/!"*,)!,--1-'#('(3,-6-0,&#'*),.(.*, ),'(("',%-,'#(.) ,"9"(/',) #(#0#/&-#(.")/."2#.,!.)*/&.#)(1")"0(*&#( -/**),.'*&)3'(."-().,",+/#,("',%-9,,0&)*'(.*&((#(! ), .,!.*)*/&.#)('',-!(,&&3)-().'.,+/#,-.(,-6#(.,'-) ."(/',-)  #(#0#/&-,#0#(!*&(-(."+/&#.3) ."*&(-.".,#(*&9
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'*,)0'(.#(#.#.#0.)*,)0#)(!)#(!----'(.) ."+/&#.3(,-*)(-#0(--)  -,0#- /,(#-"3."..#(),(1#."."#-!,'(.9-/&.-(,)''(.#)(-)  (#(*((.,0#1) ."..;-*,)!,--)('.#(!)(-(.,*,)0#-#)(-,!,#(! +/&#.3#'*,)0'(.1#&&*,)0##( /./,,*),.9  " )&&)1#(!-.#)("#!"&#!".-%3 #(#(!-1#.",-*..)."..;-*,)!,--)('.#(!." .,'-6)(#.#)(-(,+/#,'(.-) .")0,LG*, ),'(,&.("',%-#(&/ 1#."#(."0,#)/-*,)0#-#)(-) .")(-(.,9.#&-,#*.#)(-) .".#)(-.".." .."-.%(&)(!1#."#-/--#)() ,,#,-6,+/#,.#0#.#-(,)''(.#)(-, *,)0##(."#(#(!--.#)() ."#-,*),.)(*!HG9  
.#-#'*),.(..)()..".-0,&*, ),'(("',%-'-/,."..;-)(!)#(! )'*&#(1#.",+/#,.#0#.#-1#."!)&-.".'/-.'./,#(!",*),.#(!*,#)9  *.#+&'-,- 
• /(#(!9#.#)(& /(#(!1-**,)03."!#-&./,.),--)(-(., ,+/#,'(.- ),-/**),.'*&)3'(.*&'(.-(-3-.'"(!.#0#.#-/,#(! IGHN9  o 
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 o #.#)(& /(#(!#(2--) EHH6GGG6GGG1-#(&/#(."/!..)2*( --.)-/**),.'*&)3'(.-,0#-3,!.)*/&.#)('',-1#."
9  o (#.#)(&EL9H'#&&#)(@EI9L'#&&#)( ,)'!(,&,0(/-(EI9M'#&&#)(,& ."A1-*,)0#.)))-.)'*(-.#)( ),*,#0.*,)0#,#,.-/**),.-. 9
 o "..0&)**, ),'(-)(.,.#(!')&-('."))&)!#- ), #((.#0#4#(!."2*(-#)() '*&)3'(.-,0#- /,(#-"3(9



K

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 5 of 48 PageID #: 2347

 • /'(-)/,-9 .)(.")(#.),;-,)''(.#)(("-!/(.)
,---"),.!-) (2*,.#-('(!'(.*#.39 
o .1)*)-#.#)(-,#.#&.).")(-(.,.))),#(.-/**),. '*&)3'(..#0#.#--..1#(.))0,-+/&#.3#'*,)0'(.9."#,6 ,(- ),'.#)()),#(.),*)-#.#)(1-,..))0,--3-.'"(!.#0#.#-9 /,,(.&36."#-*)-#.#)(#- #&&3." (#),.,.!3 #,--#!(.)9 
o  ,--#!(2#-.#(!-. .),--)(-(.,,&..#0#.#-( -/,."--#-.() 2.,(&-/$.'..,2*,.-.)*,)0#( '#(#-.,.#02*,.#-(!/#(9
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*&'(.-'.-)(-(.,("',%- ),.""&.,),%-")*,!.)*/&.#)( (2("',%- ),."3,!.)*/&.#)(/,#(!."#-,*),.#(!*,#)9  • 3,0#-9"(/',-) #(#0#/&-*,.##*.#(!#(#(.!,.3-,0#-6-,+/#, 3.")(-(.,6#(,--&#!".&3 ,)'." #,-..)."-)(+/,.,) IGHM9  • )(0,-#)(
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L

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 6 of 48 PageID #: 2348

o "",&)%,)0#,/,03) -/**),.'*&)3'(.(3*,)!,'-,0#-( )/.)'-#-#(!'#(#-.,(,*),.+/,.,&39 
o "..;-#(.,#')(-(.,.-#-*,)0##(!,+/#,#( ),'.#)()( -,0#-(-/**),.-9 
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'./,#(!."/,,(.,*),.#(!*,#)9)(.#(/ ),.-(.)0)..)."2*(-#)( ) -/**),.'*&)3'(.-,0#-(.""#0'(.) -/**),.'*&)3'(.*&'(.- )(-#-.(.1#.")(-(.,,+/#,'(.-9  • 
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M

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N

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 8 of 48 PageID #: 2350 



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O

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 9 of 48 PageID #: 2351 

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P

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 10 of 48 PageID #: 2352 

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HG

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 11 of 48 PageID #: 2353 

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HH

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 12 of 48 PageID #: 2354 

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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 13 of 48 PageID #: 2355

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#$!%!&%(%!"&%! -/'#...).")(#.),)()0',II6 IGHM9",*),.#(.# #-(#.#)(&JLG*,0#)/-&3/(#(.# ##(#0#/&-,#(!#(!.".).& )/."2#.)*/&.#)((-/-.)**,)2#'.&3LGH*,-)(-9 J/,.,&3../-*),.)()/,.,,&'(.--'()(*.',HM6IGHM9 K)'*&#(,)!,--*),.#--/3.")(#.),)(.),JH6IGHM@)/'(.LGA9



HJ

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 14 of 48 PageID #: 2356

/(.#&/(IGHM9/,.",'),6-().#()).().FH6)(.#(/ ),.-.)#(.# 3'',-)  .")/."2#.)*/&.#)(,2*(#(!."-#4) ."#-*)*/&.#)(9(
1,&.) ,*),.)(#(#0#/&-*&/,#(!IGHL6/.."#-#( ),'.#)(1-().,)/.#(&3!.",( ,*),.39-,-/&.6#.#-/(&,1".",."..'.."(/,3H6IGHM*&'(. &#(9-().#(&H)06.).&) LN#(#0#/&-#(.""&.,),%-")* )*/&.#)(,#0#(.!,.'*&)3'(.*&'(.-3/(JG6IGHM62#(!." *&'(.("',%3-0(*,-)(-9".).&"&.,),%-")*,!.)*/&.#)( #(.# #3.")(-(.,.-#-NHK9  ,,,,&'-6*.#+&'-,-  '"&+$@2+!-().%-#('73(/,3H6IGHM6."..1#&&*,)0#/**),. '*&)3'(.&'(.-&-.IL#(#0#/&-#(."")
-&(3,!.)*/&.#)(9  --.,6/,..)(.".).&(/',) 3,!.*)*/&.#)('',-,#0#(! -/**),.'*&)3'(.*&'(.1-().!.",),,*),.3/(.#&/(IGHM9- /&3H6IGHM6.".."-*,)0#HHO*&'(.-) #(#0#/&- ,)'."3,!. )*/&.#)(#(.)#(.!,.-/**),.'*&)3'(.2#(!."("',%) IL#(#0#/&- @&HA9".).&(/',) #(#0#/&-#(."3,!.)*/&.#)(,*),.3." )(-(.,.-#-H6LGO9  ,,,,&'-6*.#+&'-,- 
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including BHDDH, ORS, and RIDE, to establish and implement a policy or policies that include
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HK

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 15 of 48 PageID #: 2357 

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HL

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 16 of 48 PageID #: 2358 

).",-.),0#1."0,#(*)&#3(**,)0&*,)--6-,#/,,(.*,.#-)(

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HM

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 17 of 48 PageID #: 2359 

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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 18 of 48 PageID #: 2360 

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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 19 of 48 PageID #: 2361

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HP

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 20 of 48 PageID #: 2362 

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IG

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 21 of 48 PageID #: 2363

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IH

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 22 of 48 PageID #: 2364

,*),.-"0#(!*,.##*.#(*,-)((.,*&((#(!*,)--(.)"0)'*&. -9  ,,,,&'-6*.#+&'-,(--9")(-(.,,+/#,-.".&&'',-) ." )/.",(-#.#)(,!.)*/&.#)("0,,0&)*'(.*&(-9"-..;-)(-(., .-,*),.-.).&) KNG#(#0#/&-#(.")/.",(-#.#)()*/&.#)(9
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II

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 23 of 48 PageID #: 2365

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IJ

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 24 of 48 PageID #: 2366 

",&)%(.,/(,'/&.#:3,!,(. ,)'(#(,-*)(-.)..&(.),--

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%!! "$! )$'$ $##

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IK

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 25 of 48 PageID #: 2367

,/,3IO6IGHN9(3)$.#0-().3.)'*&#-"'/-.)'*&.1#."#(.".-' .#'*,#)9"..1#&&*,)0#&#-.) &&#(#0#/&- ,)'".,!.!,)/*1"),(). ,#0#(!(( #.-*&((#(!-,0#-&)(!1#."*&(.)#(#.#.(-,0#-3 ,/,3IO6IGHN9  '"&+$E8(-#('%,,,,&'-,'%#!##%#-2+#-+#<

:@;8:E;7&&0).#)(& ----'(.-(0).#)(&&#!##&#.3,#.,#1#&&*,-)(:(.,6**,)*,#.&3-#!( ), #(#0#/&-1#."
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-&()/.",(-#.#)(,!.)*/&.#)(-"&&!#(3!HK(1#&&#(&/,, *&((#(!.'(--.)(###0,-,0#--**,)*,#.9".,(-#.#)(



IL

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 26 of 48 PageID #: 2368 

*&((#(!*,)--'/-.-#!(.)(-/,."."3)/."("#->", '#&3"-(#( ),' )/.6((!#0()**),./(#.#-.)2*,#(6/**),.'*&)3'(.,0#-(.,#&1),% 2*,#(-(#(.# 3'#&-.)(-#(.# ##(."#--.#)(#(&/#(!/.().&#'#..)8

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-&(-)(,3-"))&6." ),'/&.#)((((/&,----'(.) '*&)3'(.,&.,)''(.#)(-) ."
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6  (61-/*.)( )0',IK6IGHL()(/&3H6IGHM@-&)1A(**,)*,#.&3,---.".#0#.#- ,+/#,3.")(-(.,9)(-#-.(...((3,*,-(..#0-..,(-#.#)( '.#(!- ),3)/."#(.,(-#.#)("-,'#("&&(! ),(9  " /&&----'(.) .".#)(-.".."-.%(.))'#(.))'*&#(1#."." ,+/#,'(.-) ."#--.#)() .")(-(.,(,&.,+/#,'(.-) .",, #--/3.")/,.)(3HO6IGHM#-*,)0##(.")/,.)(#.),;-,0#1) ."..;- "#,()/,."../-*),.-#--/)(/&3II6IGHM(*.',P6IGHM,-*.#0&39
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IM

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 27 of 48 PageID #: 2369

.")(#.),) ." #&-) -0(#(#0#/&- ,)'.")/.",(-#.#)(,!.)*/&.#)( ,0&.".) ##&-..(K) N@LNQA,,0&)*'(.*&((#(!'.#(!-( -. *,.##*.#(L) ."N,,*&((#(!'.#(!-@NHQA9
.#-,)!(#4.".." ..#-.%#(!-.*-.)#'*,)0..(() *,.'(.,*,-(..#0-.)/.",(-#.#)( '.#(!-9  ,,,,&'-6*.#+&'-,-7".."-'.,+/#,'(.-#(.# ##(.")(-(. ,(#(.")/,.;-,,) 3HO6IGHM,!,#(!."0&)*'(.( #'*&'(..#)() .,(-#.#)(*,)-- ),.")/.",(-#.#)(,!.)*/&.#)(9
 '"&+$B9+,('8'-+++/%()&'-%'<


:A;4:E;7*,-)(:(., ,,0&)*'(.*&(-"&&*,*,3**,)*,#.&3-. ,,*&((#(!.'- )," 3)/."#(.,(-#.#)(.)#( ),'."0&)*'(.) '*&)3'(.,&.!)&-(,)''(.#)(-9
--.,8)069#(#(!-@A,,0&)*'(.&((#(!6("',%K,, 0&)*'(.&(/.)'-8)/.",(-#.#)(,!.)*/&.#)(9  ,,,,&'-6*.#+&'-,(--  '"&+$C9(-#('%,,,,&'-,<


:C;3:F;7&&3)/."#(.,(-#.#)(-"&&"0( )**),./(#.3.)2*,#()(),'),0).#)(&>-#./.#)(&----'(.-#(#(.!,. '*&)3'(.-..#(!-9  66(
6-"&&*,)"##.0).#)(&----'(.-) .,(-#.#)(: !3)/."#(-!,!.1),%-..#(!-9
--.,6
;-'*&)3'(.#,-.)&#3*,)"##.-."*,)0#-#)() 0).#)(&----'(.-#( -!,!.-..#(!-("-)''/(#.."#-*)&#3.)."-9;*)&##-(,!/&.#)(- ,+/#,&&----'(.-.))(/.#(()(:-!,!.)''/(#.3-..#(!-9   #,'- (-/**),.-."#-*,.#6/.)-()./,,(.&3 /(0).#)(&----'(.-9  ,,,,&'-6*.#+&'-,-7  '"&+$D9+#%(+$1)+#',<


:D;7 ),2#.#(!-)(,3-"))&&& .,(-#.#)(#(!3)/."-"&&"0()**),./(#.3.)2*,#(.&-..1).,#&1),%2*,#(-6 ") **,)2#'.&3MG3-#(/,.#)(6#((#(#0#/&#46#(.!,.'*&)3'(.-..#(! '.#(!." #(#.#)(-(-.(,--. ),."#(.#)(-@A:@A9
--.,6"..;-#(.,!(3!,'(.--#!(.-,-*)(-#& ),.".,#&1),% 2*,#(,+/#,'(.-(
-,-*)(-#& ),(-/,#(!."..".,#&1),%2*,#( ,+/#,'(.#-'(#(),*),.#(.)."2#-.#(!
*&((#(!*,)--9
 ,*),..".."0&/.#)() -./(.-;*,.##*.#)(#(#(.!,..,#&1),%2*,#(-, *,.) ."#-.,#.;-)(:-#.,0#1) ,,0&)*'(.*&(-(*&((#(!9
&-) ,*),..".#( ),'.#)()(.,#&1),%2*,#(*,.##*.#)(#-)/'(.#(."*#& /.#)((-/-.9
"-)(/.)(:-#.')(#.),#(! ),&&,+/#,'(.-) ." 1"#"#(&/-,0#1) 0#() -./(.;-;-1",.,#&1),%2*,#(-, )/'(.9 )10,6.)(."(/',-) .,(-#.#)(!3)/."1")"0"." )**),./(#.3.)2*,#(.&-..1).,#&1),%2*,#(-) .&-.MG3-/,.#)(#(( #(#0#/&#4#(.!,.'*&)3'(.-..#(!1-().*,)0#3
),.)." )(#.),9 



IN

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 28 of 48 PageID #: 2370

,,,,&'-6*.#+&'-(--7
"-'"(#-'- ),0&/.#(!-./(.-; *,.##*.#)(#(#(.!,..,#&1),%2*,#(-/."-().*,)0#."#-#( ),'.#)(.)." )(#.),9  (&&'-#(',8
(,,+/-..)*,)0#.).")(#.),3,/,3 IO6IGHN.)(."(/',(*,(.!) .,(-#.#)(#(!3)/."1")"0"." )**),./(#.3.)2*,#(.&-..1).,#&1),%2*,#(--,+/#,3.")(-(. ,9  '"&+$E9+/#,-(+',#-#('!(.-"<


:G;9  66(
-"&&(-/, .".."**,)*,#.-,0#-(-/**),.-,0#&&.).,(-#.#)(:!3)/."1")"))-.) 1),%#(.")''/(#.3 ),."#,IH-.#,."3,.",."(,'#(#(!#(-"))&9  1#&& /*.#.-*)&##-('#(#-.,.#0,/&-.)(&&#!#&#(#0#/&-.)--  -,0#- 3!HO91#&&/*.#.-*)&##-('#(#-.,.#0,/&-.)(&&#!#&#(#0#/&-.) --0).#)(&,"#&#..#)(-,0#-.!HM9
1#&&#--/-..1##,.#0.)&)& -"))&#-.,#.-.)!#(.".,(-#.#)(*&((#(!*,)--.!HK9  --.,6"..;-,(-#.#)(#'&#(6,0#-/(JG6IGHM6.#&-."*)&##-(*,.#- .".,'*&)33
6(.)(-/,."*,)0#-#)() -,0#-(-/**),.-.) .,(-#.#)(!3)/.")(-#-.(.1#.".",+/#,'(.-) .")(-(.,9"#'&#( -,#-."-,0#-(-/**),.-.".,0#&& ,)'
6(.",)/!")/.." .,(-#.#)(*,#)9/*.#.-*)&##-(*,)/,-.)'%#.&,.".,!. )*/&.#)('',-,&.)---,0#-.!HO3,-9
(#.#)(.).",(-#.#)( #'&#(6#( ),'.#)(,!,#(!&#!##&#.3.,'#(.#)(6)''/(#.#)(1#." '#&#-6." -"/&#(!) (----'(.-(."),!(#4.#)() )/.," ),.-,&..)), )(-(.,,+/#,'(.-#-#(&/#(;-(1&30&)*)(-(., )''/(#.#)(-&((#(."&#!##&#.3(#.*.9"-()./*.#.-*)&##- (,/&-.) #&#..),--#-.#(#0#/&-.)--0).#)(&,"#&#..#)(-,0#-.!HM 3,--,+/#,9
"-().# #-"))&#-.,#.-."..,(-#.#)(*&((#(!-"&&!#(.! HK3,-9*# #.#)(-(,-*)(-##&#.#-) -,!,#(!.".,(-#.#)(*,)--,&#-. #(.",(-#.#)(#'&#(9
)(/.-)(:-#.'*&)3'(.#,-./&#.30#1-1#."" #-.,#..)----
>.#)(-(,0#10#(.#'&#(.#0#.#-,#(! #'*&'(.-,+/#,9
"-*,)0##.#)(&.))&-@
#'&#())&-A ),#-.,#.- --#-.."'#(#'*&'(.#(!.#'&#(.#)(-9
,*),.."..";-"02*,-- )(,(()( /-#)(,!,#(!.",+/#,.#)(-/(,."-.#)() .",(-#.#)( #'&#(9  ,,,,&'-6*.#+&'-,(--7,*),.)(.",(-#.#)(#'&#((,&. )'*&#(.#0#.#-#--/3.")/,.)(#.),)(/&3II6IGHMM )/(.".."..1-#( )'*&#(1#."."#-*,)0#-#)(9
.1-().6")10,6.".-.#)(-) ."#'&#(, ,,#(!.) ."0#(.)!.",.)0,# 3."..#)(-,+/#,3.")(-(.,1,.%( (.)-.,(!."(9
#-')(#.),#(!."&#0,3) .,(-#.#)(-,0#--,+/#, /.6-().)06"-().*,)0##( ),'.#)()/'(.#(!.".&&.,(-#.#)(!3)/.", ,#0#(!)**),./(#.#-.)*,.##*.#(.1).,#&1),%2*,#(--,+/#,9 )/(-&),---#!(.)"-)(,3-"))&,')(#.),#(!."&#0,3) .,(-#.#)(-,0#- /.()*)&##-"0(-.&#-".) #&#..--.)-,0#-!#((#(!.!HM9

M*),.) .")/,.)(#.),)((#...-) ',#09..) ")
-&(-/', HK:HNL ((.-"#,../-*),.9
--//&3II6IGHM9",&-)-&36)/,.)(#.),9



IO

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 29 of 48 PageID #: 2371

"-#(.# #%3.#)(-.).%(3."#0#-#)(/,#(!.".,(-#.#)(*,)--("- -..#.-#(.(.#)(.)(',(-#.#)()),#(.),#((/,3IGHN9"#0#-#)("- 0&)*6/.().3. /&&3#'*&'(.6*,)-- ),0&/.#(!."2.(..)1"#"." .#)(-&#-.#(.",(-#.#)(#'&#(,#(!*,)0#9  ,,+2-#('6
.#-,+/-..".." )&&)1#(!*,)0#.).")/,.)(#.),3 ,/,3IO6IGHN8
• 
:#( ),'.#)()( #,'#(!.".#(#0#/&-#(.,(-#.#)(,) ,.1).,#&1),% 2*,#(-9
• ?)/'(..#)() ." /&&#'*&'(..#)() *,)--- ),0,# 3#(!.".,+/#, ().# #.#)(-(.#0#.#--,##(.",(-#.#)(#'&#("0.%(*&9
• ?)/'(..#)(.".*)&##-(>),'#(#-.,.#0.) #&#..#(#0#/&-1") ,&.)--0).#)(&,"#&#..#)(-,0#-!#((#(!.!HM"0( 1,#..((#'*&'(.9
 '"&+$F9+',#-#('.-#(''+#'#'!


:?>;7"..6#(&/#(!
6-"&& .% #,'.#0-.*-.)(-/,.".&&3)/."#(.,(-#.#)(,().2&/ ,)'."( #.-( )**),./(#.#-) .,(-#.#)('#-6().",*)-.:-)(,3*&((#(!6/.#)(6( '*&)3'(.,-)/,-#(-./(.;---#!(-"))&#-.,#. )&&)1#(!."#,2#. ,)'-"))&9
 1#&&.% #,'.#0-.*-.)&#(%."*,(.-( '#&#-) .,(-#.#)(:!3)/."1#."
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--.,6
6(  ,'%#(! ),.-.)(-/,.".&&3)/."#(.,(-#.#)(,(). 2&/ ,)'."( #.-()**),./(#.#-) .,(-#.#)('#-6().",*)-.:-)(,3 *&((#(!6/.#)(6('*&)3'(.,-)/,-#(-./(.;---#!(-"))&#-.,#. )&&)1#(! ."#,2#. ,)'-"))&9,(.-( '#&#-,,#0#(!--.)#( ),'.#)((-/**),..) -.,(!."(."#,#&#.3.)-/**),.."#, '#&3'',-1#."
/,#(!.".,(-#.#)(*,)--6 )(-#-.(.1#."."*,)0#-#)(-) .")(-(.,9
( ),'.#)("-( /,(#-".)."
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 7+#'#'!@.#)(
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:?;:@;:B;7)'*.(#-(.,#(#(!*,)!,'-1#&& -.&#-"3."-.. ),@A-"&.,1),%-")*( #&#.3-3*,)!,'-. 6@A&& '',-) ,,*&((#(!.'-6@A3)/."-,0#*,) --#)(&-6(@A  6(
 -. 9".,#(#(!*,)!,',---."0&)*'(.) 0).#)(&----'(.>*,) #&-6,, 0&)*'(.*&(-6(.,(-#.#)(*&(-6$)0&)*'(.6$))"#(!6'*&)3'(.-/**),.6 ( #.-)/(-&#(!6-/**),.'*&)3'(.(#(.!,.3-,0#-(*&'(.-6#(.%( 0).#)(&,"#&#..#)(-,0#-6(-,0#)),#(.#)(9
--.,8")'*.(3:-0&/-:-.,#(#(!*,)!,'-.(,-1,0&)*3 ."(  #()&&),.#)(1#."."'*&)3'(.#,-.-%),(**,)03 .")(#.),)(/(HP6IGHL9"/,,#/&/',+/#,-*,)0#,-.)&.)')(-.,.$) 0&)*'(.($))"#(!)'*.(#--)(:**,)060#(:-.,#(#(! -.(,- ),-/**),.'*&)3'(.9,)!,'-.(,-&&)1 ),.,#(#(!.)*,)0#



IP

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 30 of 48 PageID #: 2372

/.#&#4#(!).",/,,#/&,.# #),**,)03."..-&)(!-."/,,#/&, &. .,#(#(!-.(,-9  ,,,,&'-6*.#+&'-,-  '"&+$@9- +#'#'!<
:A;7"..(-/,-.".&&*,-)(-#(0)&0#(."#-)0,3 (----'(.*,)--6."*,*,.#)((#'*&'(..#)() ,,0&)*'(.*&(-(." *,)0#-#)() -/**),.'*&)3'(.(#(.!,.3-,0#-6(*&'(.- ),'',-)  .",!.)*/&.#)(-"0)'*&.(--,3.,#(#(!("0..#((,.#(." ,+/#,)'*.(#-9  --.,6(.,#(#(!,+/#,'(.--.)/.#(.#)(


@A) ."..;-**,)0 )'*.(3:-0&/-:-.,#(#(!*,)!,'#(&/." )&&)1#(!*,)0#-#)(-8N 
• ,)0#,!(#-'/-.)/'(.."(--,3'*&)3+/&# #.#)(-(>),"0 )'*&.."(--,3*,)!,'-9 
• ,)0#,!(#-'/-.((/&&3-/'#.-/")/'(..#)(.)  ()( ),'-*# #3."..9 
• 3*.',H6IGHM6."..)(-(.,)),#(.),;- #1#&&'#(.#(&#-. ) &&**,)0(..:(),-*,)!,'-6&#-.) &&..:**,)0 , ,-",*,)!,'-(&(,) .,#(#(!-9 
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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 31 of 48 PageID #: 2373 

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2*,#(-6#(.# 3,,#,-(#.#)(&.,#(#(!(-9),.3.",-..(." ---#)(9  ,,,,&'-6(--7,)!,--#-#(!')(."*,)0#-#)() .,#(#(!.)*,)0#,!(3 -. 9
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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 33 of 48 PageID #: 2375

*,)!,'(."#(:,")/.,"/.#)(*,)!,'9/,#(!."*-.3,6."-%),"- *,)0#(#'*),.(. ),/' ),*,)0#,-6 '#&#-60).-(*)*&1#."#-#&#.#-.) -",)(,(-(0)#."#,*,-*.#0-)(.".#)(-."..#-.%#(!.))'*&31#."." *,)0#-#)(-) .")(-(.,9  "#&'.#(!-,.%#(!*&6%3,+/#,'(.-) .")(-(.,,().#(!'.9 /,#(!."/,,(.,*),.#(!*,#)."-%),#().'.1#.".")(#.),)( +/,.,&3-#--#-,+/#,3.")(-(.,92*. ),)(#(-.(.")(#.),"- ().(,)/.#(&3#(0#..)*,.##*.#(+/,.,&3'.#(!-6"-().(*,)0#1#." -"/&)  /./,'.#(!-("-().61#.")(2*.#)(6,#0'#(/.-) ."'.#(!- ."."0.%(*&9")(#.),#,#0'#(/.- ,)'."'.#(!"&)(3HG6IGHM9 #'#&,)(,(-"0(2*,--3-..) ##&-61"),*),..".."3)().,#0 ().#) '.#(!-#(0((,().,)/.#(&3#(0#..)+/,.,&3'.#(!-9"-% ),"-().*,)0#*)&#3,)''(.#)(-6,-,"#--/-),#--'#(. #( ),'.#)(-,+/#,3.")(-(.,9..) ##&- /,.",2*,--.".."3,0,3 1#&&#(!.)*,.##*.#('.#(!--'**,)*,#.3."-%),'',-(.".6 .'#(#'/'6."31#&&..(+/,.,&3'.#(!--#!(. ),."#-*/,*)-3."-% ),9..) ##&-"02*,--(."/-#-' ),,#0#(!."*)&#3,)''(.#)(-)  ."-%),("0)''/(#..".."31)/&1&)')**),./(#.#-.)'.1#." (!#(."*,-*.#0-(,)''(.#)(-) -%),'',-9  ,,,,&'-6*.#+&'-,(--9"'*&)3'(.#,-.-%),#-().'.#(!#.- ",!-)/.&#(#(.")(-(.,9)*)&#3,)''(.#)(-),,*),.-)(."-../- ) ,,#,-.))(-(.,#'*&'(..#)("0(#--/9  "-%), /(.#)(--(#(*((.60)&/(.,3!,)/*) 0).-(-.%")&,- 1"),().#,.&3#(0)&0#(-..!(3)*,.#)(-9")(-(.,)/.&#(--"),. &#-.) ,+/#,'(.-6/.&0-#-#)(-,!,#(!&,-"#*6),!(#4.#)(6'', ,-*)(-##&#.#-()*,.#)(&*)&##-.".,(--,3.)(-/,.".."#(.# #.-%- ()&#!.#)(-,)'*&..)."-%),;-#-,.#)(9&.")/!"#.#-",!1#." ,-*)(-##&#.3 ),'%#(!*)&#3,)''(.#)(-6."!,'(.)-().-*# 3.)1")' -/",)''(.#)(-,.)'(),."(./,),#(.(.) (3,-,".))(/. ),#( ),'.#)(.)#--'#(.9-(#(*((.)36."-%),)-()."0 '#(#-.,.#0-/**),.),)0,-#!".3(3-..!(39  "-%),"-."*).(.#&.)*,)0#(#(*((.('(#(! /&,)&#(-/**),.#(! ."#&#.3) ."...))'*&#-".", ),'-#(.# #3.")(-(.,6(." #&#.3) #(#0#/&'',-) .",!.)*/&.#)(-.),#0."-,0#-(-/**),.-.) 1"#"."3,(.#.&9/."(!(-.).%*&# ."-%),#-.)"#0#.- /&& *).(.#&9  (&&'-#(',8" )&&)1#(!.#)(-,,)''(9)/--")/&#,. .)1,*,)0##(!(-.,/./,1#.")/.)'*,)'#-#(!."-*,.(#(*((.0)# ) 0).-(-.%")&,-8  H9 
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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 34 of 48 PageID #: 2376

 I9 "-%),"#,*,-)(#()&&),.#)(1#."."*/.3,.,3)  6,
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9 ,*,(((/&,*),..).")(#.),6."..( ),*/&##--'#(.#)(6.". #(.# #-,,#,-.)-/-- /&#'*&'(..#)() .")(-(.,6 ,)''(.#)(-/- /&#(,--#(!.",,#,-6-.*,.#-6(-/!!-. .#)(-.)--#-.#(#0#/&-#(.",!.)*/&.#)(--/-- /&&3.,(-#.#)(.) #(.!,.'*&)3'(.(3-..#(!-9
 "-%),"#,*,-)(#-,+/-..),*),..).")(#.),)(.")(0(#(!) ." 1),%!,)/*#-/--#(-/-.#)(I)0(."!.",#(!) *,&#'#(,3 ,)''(.#)(- ,)'."1),%!,)/*,!,#(!#'*,)0 /(.#)(#(!) ."'*&)3'(. #,-.-%),3,/,3IO6IGHN9  7+(/#+)#-2@.#)(
A  '"&+$?8/%()#'!+(/#+)#-2<
:?;3:@;7  (1#&&(-/, *,)0#,*#.3.".#--/ ##(..) /,(#-"-/**),.'*&)3'(.(#(.!,.3-,0#-.) #(#0#/&-#(.""&.,),%-")*63,)!,'()/."2#.)*/&.#)(-9  --.,6(,*),..".."/,,(.*,)0#,!(#-(#(#0#/&-,-/ ##(..) '.."#(,-(- ),-/**),.'*&)3'(.(#(.!,.3-,0#-(-/**),.- ,+/#,3.")(-(.,9/. '#&#-) #(#0#/&-1#."
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*,0(.),&33*,)0#,-1"), /-.)*.(1, ,,&-9,)0#,, /-&-**, .)#,.&3&#(%.)*3'(.,.-(,.-..#(!*,.#-9"..;-**,)0&)  #(,- /(#(! ),#(#0#/&-,#0#(!-,0#-6."#'*&'(..#)() *, ),'( -#((.#0*3'(.-3(.".#(&/#.#)(&-/**),. ),-. .,#(#(!6 (.",&-)  /(#(!.)--#-.*,)0#,-#('%#(!-.,/./,&"(!-.))(0,.-"&., 1),%-")*-((.,:-*,)!,'-.)#(.!,.&.,(.#0-,2*..)-#!(# #(.&3 ,-*,)0#,, /-&-(#(,---.)-,0#-9  ,,,,&'-6*.#+&'-(--7("0-)/!"..)#'*,)0,!.)*/&.#)( ',-;--.)*,)0#,-3#(,-#(!#(#0#/& /(#(!(-. .,#(#(!,+/#,'(.-9 &.")/!"*,.#-"0(#'*&'(.(&,*,)!,--"-('6#.#-.)),&3.) .,'#(1".",."*,)/,-(*)&##-1#&&"0."#(.(#'*.9"#-*,)0#-#)( 1#&&')(#.),.)(-/,.".."#(.()/.)'-,#(!"#0(*,)0#,-- #--/ ##(..)'..",+/#,'(.-) .")(-(.,9  (&&'-#(',6"..#-,+/-..)!.",(,*),.. ,)'*,)0#, !(#-)(."(/',-) #(#0#/&-&#!#& ),(>),-,0#-1")1,(# -,0#-/,#(!."*,#)-8/&3H6IGHM.",)/!"',JH6IGHM7(/,3H6IGHN.",)/!" ,"JH6IGHN7(*,#&H6IGHN.",)/!"/(JG6IGHN9",*),.-")/&#(.# 3."-,0# *,)0#,6.",-)(- ),-,0#, /-&),&36."&(!.") ."&36(,)''(.#)(- ),#'*,)0#(!--.)-,0#-9
.#-,+/-..".." #,-.,*),.)0,#(!/&3H6IGHM: ',JH6IGHM*,)0#.).")(#.),3,/,3IO6IGHN9  '"&+$@9',.+#'!- )#-2<
:@;7  (1#&&(-/,*,)0#, ),!(#4.#)(-"0-/ ##(.*#.31#.",-*..).,#(-. 6-. -/*,0#-#)(6**,)*,#. *)&##-(*,)/,-(+/&#.3#'*,)0'(.*,)!,'-.)&#0,-,0#-(-/**),.- ,+/#,3.")(-(.,9  --.,8(,.%#(!.#)(-.)/#&."*#.3) *,)0#,!(#-.)..,.( ,.#(.,#(-. 6*,)0#+/.(/',-) -. (-. -/*,0#-#)(6(&#0, -,0#-)(-#-.(.1#.".")(-(.,9"..;-**,)0&) #(,- /(#(! ), #(#0#/&-,#0#(!  -,0#-6."#'*&'(..#)() *, ),'(-#((.#0 *3'(.-(.",&-)  /(#(!3.")(0,-#)(,/-./(.)--#-.*,)0#,-#( '%#(!-.,/./,&"(!-.))(0,.-"&.,1),%-")*-((.,:-*,)!,'-.) #(.!,.&.,(.#0-,2*..)#(,--. *#.3(*#&#.39"..&-) *,)0# /(#(!.)#(,-."-&,#-) #,.-/**),.*,)0#,-. ($))"-9  ,,,,&'-6*.#+&'-(--9"..6#(&/#(!(6"0.%((/', ) .#)(-.)#(,-."(/',-) .,#(-. 6#(,-1!-) 2#-.#(!-. 62*(( #'*,)0.,#(#(!(/#&*,)0#,-. *#.39(  "0)."0&)* *, ),'(-'*&)3'(.*,)!,'-9;*, ),'(-*,)!,'1),%-1#." -0(!(#-.)#(,-*#.3.)-/**),.'*&)3'(.-,0#-.",)/!"'*&)3'(. .'-9("0!,.)1),%1#.").",-..-.)&,(")1.".1)*, ),'( -'*&)3'(.*,)!,'-(-.1),%#()($/(.#)(.)-/**),.."'2#'/'(/',)  #(#0#/&-#(."')-. .#0139&,*,)!,--"-('#(."#-,/.#.((). 3.-#.".*,)0#,!(#-"0." /&&,,3.,#(-. (.)(-/,." *,)0#-#)() -,0#-(-/**),.-,+/#,3.")(-(.,9  '"&+$A9+(/#++*.%# #-#('*.#+&'-,<
:A;73*.',H6IGHK6." ..1#&&-.&#-"6#'*&'(.(( ),*,:+/&# #.#)(,+/#,'(.- ),&&-/**),.



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6 '#&#-6-,0#*,)0#,-6)''/(#.3),!(#4.#)(-().",-9  --.,8".."-#'*&'(.*, ),'(:- #((#&#((.#0-.)-.#'/&. *,)0#,),!(#4.#)(-.)#(,-."(/',) #(#0#/&-,#0#(!-/**),.'*&)3'(. -,0#-.",)/!".",-)(:(.,/**),.'*&)3'(.,)!,'.)."(9 #.#)(&"(!-.)*)&##-(*,.#-"0(#'*&'(..),/),&#'#(. ,,#,-.)."2*(-#)() -/**),.'*&)3'(.(#(.!,.3-,0#-9 )10,6 -*# ##((.#0--#!(.)()/,!.".,(-#.#)() -,0#-(-/**),.-.)#(.!,. '*&)3'(.(3-,0#&.,(.#0-"0().(0&)*.",)/!"*/&#:*,#0. *,.(,-"#*--,+/#,3."-*,)0#-#)(-9
.#-#'*),.(..)()..".6  6." *,.'(.) ),(,#(#(!@A6(.")0,(),;-),% ),),"0!/( #(#.#&)&&),.#)(.)1,."-(-(,()11),%#(!.)!.",)(,!/&,-#-.) -.#'/&.*/&#:*,#0.*,.(,-"#*-9,&32'*&-) *,)!,--#(&/'.#(!-1#." '*&)3,-#(&/#(!,)0#("',) )'',,% -.'.#(!.)-", #( ),'.#)()(."0&/) ."-*/&#:*,#0.*,.(,-"#*- ),#(#0#/&-1#."#-#&#.#-9 "#-$)#(.#(#.#.#036  6()0,(),;-),% ),),1-&/("#(." -/'',) IGHM9  ,,,,&'-6*.#+&'-(--9#!(# #(.*,)!,--#-#(!')(."#-,+/#,'(. /.-*# ##(#.#.#0-"0().3.(#'*&'(.9  '"&+$C9('#-(+#'!4/+,#!"-'"'#%,,#,-'<
:C;9"..1#&&*,)0# ')(#.),#(!6)0,-#!".6(."(#&--#-.(.)(-/,-/**),.'*&)3'(.*,)0#,-/- 0#(#( ),''*&)3'(.*,.#-6"0+/.-. #(!6),!(#4.#)(&-/**),.( -/*,0#-#)(6(/- .#0/-#(--')&-.)'.."!)&-()/.)'-) ."#-)(-(. ,9"..1#&&0&)*(*/&##4#.-)0,-#!".*,)---(*,)0#'"(#-'- ), #(#0#/&-1#."
6."#, '#&#-6-,0#*,)0#,-6(0).-.) #&)'*&#(.-1"#"1#&& ,--3."..#(.#'&3 -"#)(9 



JM

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 37 of 48 PageID #: 2379

--.,6.#)(/&#.3
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( ).",#-#&#.#-,#0#(!*/&#-/**),.96(--*)#(.
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(-/,()'*(3-*,.(,-#(."*,)$.9 #.#)(&0(.-,-"/&.),#(!.)!.",-..!(#-6*,)0#,-(*,#0.#(/-.,3 .)*,)').)''/(#.3-#(.!,.'*&)3'(.-." #,-.)*.#)( ),*)*&1#." #-#&#.#-#(."-..9  ,,,,&'-6*.#+&'-,-7"(.)*,)')./**),.'*&)3'(.&'(.-#( *,#0.#(/-.,3(1#."#(-..( ,&!(#-#-()(!)#(!)$.#0) .")(-(. ,.".-")/&2*((, #()0,.#'1#."."!)&) 0&)*#(!&)(!.,' ,&.#)(-"#*-1#."%3*,#0.#(/-.,3&,-6&)&"',-) )'',6().",-..6 &)&( ,&!(#-9  '"&+$E9/%()&'-( +(.+,-(,,#,-
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-&(-"&.,1),%-")*-..#(!-( #&#.3: -3-..#(!-.)/**),.'*&)3'(.,0#-(&'(.-9"*,)/,-1#&& *,)0##((.#0-(-/**),..)+/&# #*,)0#,-) -"&.,1),%-")*-,0#-/*)(."  .#0.) ."#-)(-(.,.)!#(.))(0,.."#,'*&)3'(.*,)!,'-.)/**),. '*&)3'(.,0#--).".."*,)0#,-;-,0#-,)(0,.*,#',#&3.)/**),. '*&)3'(.,0#-)(.".,'-()(#.#)(-) ."#-)(-(.,,'.6.." 2*#,.#)() ."#-)(-(.,9  --.,6;-(1&3#'*&'(.,-)((.,/**),.'*&)3'(.,)!,'*,)0#- /(#(!#((.#0-.)+/&# #-/**),.'*&)3'(.*,)0#,-."., &.).".,#(#(!( *, ),'(2*..#)(-@.#)(9/(#(!&)1A9
(#.#)(.) ;-*,)!,'6"-0&)*(#(.,)/(1*, ),'(--,0#*#&).1#." -0(!(#-.)"&*1#."#(,-#(!*#.3.)."*,)0#,-.)*,)0#-/**),. '*&)3'(.-,0#-.",)/!"'*&)3'(..'-(#('((,.".."<')(3 )&&)1-." *,-)(9=("0!,.)1),%1#.").",..-.).,'#(")1.".1) *,)!,'-(-.1),%#()($/(.#)(.)-/**),.."'2#'/'(/',) &#(.-#(."')-.  .#0139#.#)(&#((.#0- ),*,)0#,-1),%#(!.))(0,.-"&.,1),%-")*( #&#.3:--,0#-.)-/**),.'*&)3'(.,/#&.#(.)."-/**),.-,#03 *,)0#,-."."0**&# ),(,#0#.#)(& /(#(! ,)'.")(0,-#)(
(-.#./.9 
.#-#'*),.(..)().6")10,6."."-().3.) , #((#&#((.#0-#-.#(. ,)' .",-)(:(.,'*&)3'(.,0#-#((.#0-.)*,)0#,!(#-."."0().



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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 38 of 48 PageID #: 2380

2*,--(#(.,-.#(*,.##*.#(!#(.",-)(:(.,/**),.'*&)3'(. #(#(! *,)!,'6(),.)*,)0#,!(#-."."0().,#0 /(#(! ,)'.")(0,-#)(,/-. /(.)-"# .-,0#&#0,3.)#(.!,.3('*&)3'(.-..#(!-9  ,,,,&'-6*.#+&'-,-7".."-.%(#'*),.(.-.*-.),--."#- *,)0#-#)(9,)!,--)(--#-.#(!#(#0#/&-;.,(-#.#)(.)#(.!,.-..#(!-1#&&2'#( (0&/.#(-/-+/(.,*),.-9  '"&+$F9,-%#,""%-+(+$,"()('/+,#('
',-#-.-<
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(-.#./.9  --.,6")(0,-#)(
(-.#./.;--.,/./,6 #((#(!6()*,.#)(&*,#(#*&-1, -.&#-"#(.),IGHK.),,3)/.-#2%3 /(.#)(-#(&/#(!8@A#( ),'.#)( #--'#(.#)(7@A.,#(#(!7@A."-.&#-"'(.) )/-,)/*-.).,'#(."(-)  *,)0#,!(#-7@A,.#)() (**&#.#)((*,)-- ),."#-.,#/.#)() ,/-./( )&&,-7@A*,)0#-#)() .,!..,#(#(!6."(#&--#-.(6)"#(!('(.),#(!7(@ A .)&&.#)((,*),.#(!9,#(#(!(."(#&--#-.("-(*,)0#.)."(#( !(#-#(0)&0#(."
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7--'-"+!'2-#(',@.#)(

A  '"&+$?9.+#'!"'#%,,#,-'<

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JO

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 39 of 48 PageID #: 2381

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A  '"&+$?8&(+'.&( !+&'-<


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JP

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 40 of 48 PageID #: 2382

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--.,8/(#(! ),-,0#-(."0&)*'(.) *, ),'(-6#((.#0- )(.,.-#-,--#(."..;-#,-.6)(6"#,()/,."../-*),.- #&1#." .")/,.#(,-*)(-.).")/,.;-,,-#--/)(,"J6IGHM(3HO6IGHM9  
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@LA(@MA) .")(-(.,9,)0#,- '3,+/-."(!-#((#(#0#/&;- /(#(!&&).#)(.".,(--,3.)+/.&3 /( -,0#--)(."#(#0#/&;-#(.# #(-9  "-#'*,)0#.-#&#.3.),-*)( .)-/",+/-.-#(.#'&3'((,&.")/!")(.#(/ ),.-(.)*&)(,-*)(#(! .),+/-.- ), /(#(!"(!-),("('(.-#(.#'&3'((,9
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O),#.#)(&#( ),'.#)(-..) "))'*&#(../-*),.@#,-.../-*),.A9 -H8HK:0:GGHNL::9)/'(.HM9#&K>H>HM9 P),#.#)(&#( ),'.#)(-*),.) .")/,.)(#.),)(." ((.-"#,../-*),.9 -H8HK:0:GGHNL::9)/'(.JO9#&N>II>HM9



KG

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 41 of 48 PageID #: 2383

-. ,.# #.#)((#&#.3.)#&& ),-/**),.'*&)3'(.-,0#-.."*)#(.)  (,)&&'(.) &#(.-#(."*,)!,'9"#-#--/1#&&&)-&3')(#.),/,#(!." )&&)1#(! ')(."-9  '"&+$@9+ (+&',('-+-,<
:B;3:D;73(/,3H6IGHL6."..-"&& 0&)*(#'*&'(.*, ),'(:-)(.,.- ),/**),.'*&)3'(.,0#-.) #(#0#/&-#(.",!.)*/&.#)(-6&#(%#(! /(#(!.)."*,)0#,;-"#0'(.) (/',#& .,!.-(#'*&'(..#)(.#'&#(-9
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KH

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 42 of 48 PageID #: 2384

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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 43 of 48 PageID #: 2385

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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 44 of 48 PageID #: 2386

/(IGHM6) ##&-,*),..".**,)2#'.&3-#2-. 1,#(0)&0#(.",0#1 *,)--(**,)2#'.&3.",.) )/,!(#-1,,0#1"3,9.."#-,.#.1)/& .%**,)2#'.&3(#(3,-.),0#1&&JM!(#-9#.#)(&#( ),'.#)()(*,)0#, !(3*, ),'(#-!.",3 #&-. (,0#13'#(#-.,.),-)(( )(!)#(!-#-9)/(-&),-,--#!(.)&##-)(1#."*,)0#,!(#-6'.#(!)( ')(."&3-#-.),0#1'#(#-.,.#0.#0#.#-6#-/--#(#0#/&(-3-.'#,,#,-6 -,0#+/&#.3()(-(.,,&..#0#.#-9
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Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 45 of 48 PageID #: 2387

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(,-*)(-6.".. #&.1)



KL

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 46 of 48 PageID #: 2388

*,)!,---../-,*),.-1#.".")/,..".#(&/6 ),." #,-..#'6."#(#0#/&.)( .")(-(.,;-.,!.*)*/&.#)(-9HH  "",&)%/,03"-(2*(#(-)*( ,+/(3) '#(#-.,.#)(.)*./, .)(."'$),#.3) ."#.'-#(.# ##(.#)(
@:,A9-/'',3,*),.)(-,0#- *,)0#/,#(!." #,-.+/,.,6(/,3H6IGHM?,"JG6IGHM1-#--/#(/&3IGHM9 ")(/,.,.*),.)0,#(!."*,#)*,#&H6IGHM.",)/!"/(JG6IGHM1- #--/)(.),HN6IGHM9  &.")/!",+/#,#( ),'.#)(#-#(!)&&.(,*),.)(."'$),#.3) ." )'*)((.-) .#)(
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>,)--")
-&(6(1")*,.##*.)( '*&)3'(..'-7  @*A"(/',) +/&# #(.,#(#(#0#/&- ),".!),3) -/**),. '*&)3'(.*,) --#)(&-6#(&/#(!$))"-6$)0&)*,-6'*&)3'(. -*#&#-.-6(( #.-)/(-&),-*,)0##(!-,0#-.).",!.)*/&.#)(7  @+A"(/',) +/&# #(.,#(0).#)(&)/(-&),-1")----(--#-. *,-)(-1#."
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-&(7(  @,A"(/',) #(:,"6)/.:,"6(/.#)(*,)!,'-( ),.-) ,.) .",!.)*/&.#)(@-A9  ,,,,&'-6*.#+&'-,(--7#!(# #(.(-/-.(.#0*,)!,--"-('#( ."#-,6-)/'(.#(.",*),.----#(!)'*&#(1#.".")/,.,,-9.)(&& /. )/,) ."'-/,-&#-./(,.#)(
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6(  9 /,.,&3,*),.-,#(!#--/3."..)(."(/',-) #(#0#/&-#(.",!. )*/&.#)(-1"),'*&)3#(#(.!,.-/**),.'*&)3'(.(."(/',-) 
 HH..) ")
-&()'*&#(../-*),.)(*,#&H6IGHM@)/'(.HMA6(."  ((.-)(../-*),. #&)(*,#&IP6IGHM@)/'(.IMA9



KM

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 47 of 48 PageID #: 2389 

#(#0#/&-,*,.##*.#(!#(#(.!,.3.#0#.#-9#.#)(&-,0#,&.#( ),'.#)(

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,0#1-((&34-."#( ),'.#)(.".#.!.",-)(."-,0#-(-/**),.-.".#.

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KN

Case 1:14-cv-00175-JJM-PAS Document 53 Filed 01/25/17 Page 48 of 48 PageID #: 2390

-/**),.'*&)3'(.*&'(.!)&-,"#0 ),&&'',-) .".,!. *)*/&.#)(-7  I9 /&#.3
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KO

 
 Case 1:14-cv-00175-JJM-PAS Document 55 Filed 03/03/17 Page 1 of 3 PageID #: 2434


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QUARTERLY STATUS REPORT ON COURT ORDERED PLACEMENTS

 

.+(-+,0
 
##%)"-(-+,1  "# #'
**#$"$ %"$ $ " 
  " %*e Order issued by the U.S. District Court District of Rhode Island on May 18,

2016 requires the Monitor to file with the Court regular reports of supported employment

placements made by the State to assist in measuring compliance with the Consent Decree. This

report summarizes supported employment placement and related data for the quarter July 1, 2016

to September 30, 2016 and includes information on the State’s performance during previous

quarters ending on March 30, 2016 and June 30, 2016. Data was drawn from the State’s Consent

Decree Database. The Database aggregates employment related information on the services and

outcomes received by Target Population members drawn from primary source data gathered and

reported by DDD, ORS, RIDE, and the Sherlock Survey on individuals receiving supports from

each provider organization.

The attached Consent Decree Data Report was prepared by DDD and documents the extent to which the State is achieving the benchmarks and performance outcomes required by the Consent Decree across the four Target Populations. Key findings for the quarter ending September 30, 2016 include the following:

Case 1:14-cv-00175-JJM-PAS Document 55 Filed 03/03/17 Page 2 of 3 PageID #: 2435

,* "$ !%$ #%#*##$!%$"!""$#"

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 Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 1 of 10 PageID #: 2628
Career Development Plannin&: Outcomes and Practices ORS/RIDE
Benchmark 4 - Career Development Plan Outcomes: Youth Transition Target Population §IV(3); §VIII(7). The State will engage in an annual person centered planning process with all individuals in the Youth Transition Target Population mandated by state law to begin at age 14 resulting in a career development plan for each transition age student that consolidates the recommendations of school personnel, ORS and DDD representatives. The plan will be developed by the employment team and inform employment related goals and recommendations of the Individual Support Plan (ISP), the Individual Education Plan (IEP), the Individual Plan for Employment (IPE), Individual Learning Plan (ILP) and individuals' Summary of Performance (SOP).
Status: RIDE works in collaboration with the LEAs to implement the requirements of the Consent Decree for transition age students with ID and DD beginning at age 14. In July, RIDE identified 462 individuals with ID in the Youth Transition Target Population. Eighty-percent (80%) of these individuals (368) have a Career Development Plan in their records as verified by the Special Education Census as well as by on-site Employment First Quality Reviews (See Section L below). An additional209 individuals with developmental disabilities andjor intellectual disabilities as a secondary or tertiary diagnosis were identified by the census and 22 reported as having participated in a person centered planning process and to have completed CDPs.
Assessment: Requirements Not Met. The Consent Decree requires that all members of the Youth Transition Target Population have career development plans. The state's Consent Decree Database reports a total of 470 individuals in the Youth Transition Population. RIDE reports a total of 462 individuals in the Transition
1

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 2 of 10 PageID #: 2629
Target Population with intellectual disabilities, 368 of whom (80%) have career development plans in place. While the State has demonstrated progress in this area, the requirement that all members of the Transition Target population have CDPs has not yet been achieved.
Recommended Actions: RIDE and ORS report that they have implemented monitoring and quality improvement strategies to identify noncompliance with this requirement and determine the need for additional training or oversight to improve career development planning. However, numbers of individuals continue to be without needed CDPs. RIDE and ORS are requested to review and improve their current policies and practices for ensuring that CDPs are provided in a timely fashion to all individuals who have been determined to need one, and to provide a report to the Court Monitor on the steps they are taking to comply with this provision not later than February 28, 2017.
Response:
RIDE conveys the requirements for the CDP through the RIDE Employment First Policy, which promotes the development of a career planning team, the use of the career development plan and its conjunction with the IEP process through person centered planning techniques. In addition, RIDE promotes the use of the RI Transition Timeline as a guiding document holding the RIDE/LEA responsible for particular tasks related to CD requirements.
Noted in the timeline between the ages of 14-15 are the promotion of career development teams, person centered planning and the development of a career development plan. The career development plan is specifically noted in the Evidence column for accountability measures during on-site reviews.
2

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 3 of 10 PageID #: 2630
This school year (2016-2017) is the first year in which RIDE began to collect the "CDP Date" for the CD database. This collection was on a "move- forward" basis which may not register the most accurate data until after June 30, 2017. Youth who recently turned the age of 14 or who had their IEP review conducted in grade 8 may not show up on the special education census with a CDP until June 2017. Many districts have utilized the fall months to conduct person centered planning, transition assessments and school-based preparatory experiences to support the development of the CDP and IEP, which typically occurs in the later part of the school year. In addition to these continued efforts RIDE will also implement the following actions to support the Monitor's recommendations:
1. Send reminder notification to all Special Education Directors noting the requirements of the CDP accompanied by the Employment First Policy and RI Transition Timeline.
2. RIDE, in collaboration with the Regional Transition Coordinators, will followup with Special Education Directors regarding the current status of those youth reported on the special education census that are reported to be missing a CDP.
3. RIDE will begin disaggregating the data for individuals with CDPs to ascertain the numbers of individuals who have CDPs by grade, since 14 year olds may not have had person centered planning before the 8th grade. Since a through person centered planning process precedes the development of the CDP, school districts may be on schedule for completing the CDP during the student's 14th year as required, however the counts may not be arriving in the RIDE census data until after the age 14 data is reported to RIDE. By disaggregating by age, RIDE can demonstrate whether individuals without a CDP are in fact 14 year olds that are beginning or actively engaged in the person centered planning process and thus moving toward the development of a CDP.
For students in Transition, ORS will assess current expectations and actual practice with LEAs, Regional Vocational Assessment Centers, Transition Coordinators and
3

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 4 of 10 PageID #: 2631 VR Transition Coordinators. These findings will assist in the improvement of tracking systems to ensure implementation and better coordination for CDPs between ORS and LEAs. ORS will continue to track CDPs in their quarterly reporting to the Monitor and ensure that Counselors will follow up with LEAs when CDPs may be missing or out of date. ORS has increased service provision to students not enrolled in ORS services due to WIOA legislation and ORS staffs are active members of the CDP/IEP teams at schools. ORS, RIDE and LEAs, with assistance from the RVACs, will develop and provide professional development around career planning. ORS does not delay the initiation of services to members of the Transition Target Population based on the lack of a current CDP.
4

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 5 of 10 PageID #: 2632
Plan for Increasing the Number of Hours Worked by Consent Decree Target Population Members
The State of Rhode Island and Providence Plantations Department of Behavioral Healthcare, Developmental Disabilities and Hospitals Division of Developmental Disabilities Submitted to: Charles Moseley, Court Monitor Date:2/28/2017 Updated:3/24/17

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 6 of 10 PageID #: 2633
Plan for Increasing the Number of Hours Worked by Consent Decree Targei Population Members
und
In the Report of the Court Monitor on Rhode Island Consent Decree Compliance, the following assessment was made regarding target population hours worked:
Benchmark 4- Youth Exit Target Population Hours Worked §V(J). By May 16, 2016 and thereafter all individuals in the RI Youth Exit Target Population who receive a Supported Employment Placement shall average, as determined by a pointin-time survey, work in an integrated employment setting for at least 20 hours per week.
Status: RIDE identified the following numbers of individuals in the three Youth Exit Populations based on the June 30, 2014 census:
2013-14:84 2014-15:64 2015-16: 121
The RI Statewide DO Employment and Day Activity Outcome Survey is conducted quarterly by the Rhode Island College Sherlock Center on Disabilities (Sherlock Survey) and provides data on outcomes achieved by all Consent Decree Target Populations. The Sherlock Survey Quarter 2 Progress Report for the period ending June 30, 2016 provides information on 95 individuals including 40 members of the 2013-14 Youth Exit Target Population, 38 members of the 2014- 15 Youth Target population and 17 members of the 2015-16 target population. The total of 95 individuals represents approximately 63% of the 151 individuals identified as members of the Youth Exit Population. Of the 95 participants, 11 (12%) were reported as being employed in employer paid jobs in integrated settings. As a group these individuals averaged 95 hours per week or 8.6 hours per person per week This represents a decrease in the average hours worked per week as compared to the previous quarter's average of 12.33 hours per person per week
Assessment: Requirement Not Met. Individuals of theYouth Exit Target population who are working in employer paid integrated employment average 8.6 hours per week or approximately 43% of the 20 hours per week required by the Consent Decree.
Recommended Actions: The State is requested to develop, in collaboration with IDD provider agencies, a plan and strategy for increasing the average hours worked per week across all individuals in the Youth Exit, Sheltered Workshop and Day Target populations. The plan should be submitted to the Monitor by February 28, 2017 and implementation begun on March 1, 2017.
This plan was developed as recommended to outline the steps to be taken to address the need to increase the average hours worked across all target populations, first focusing on the Youth Exit population.
2!2.81'17

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 7 of 10 PageID #: 2634
Plan for Increasing the Number of Hours Worked by Consent Decree Targei Population Members

J.

tify Needs and Barriers lncreasina \tVork

'-"

The Division of Developmental Disabilities (DDD) has surveyed all providers to develop a list of all individuals currently receiving Supported Employment services, what services they are receiving, who are currently employed, and the hours currently worked, and wages.

From this comprehensive list, DDD will work with the provider agencies to identify which of the following groups individuals fall into by May 31, 2017.

1) Those working less than 20 hours per week by choice. For these individuals, DDD and the provider agencies will: • Ensure that the decision to work fewer hours is based on an informed choice of the individual. o If found to not be an informed choice by the individual, these individuals will be prioritized to update their person-centered ISP goals and career development plan. o If an individual decides at any point to pursue an increase in hours, DDD will work with the provider to determine a plan of action, and DDD will monitor the progress of these individuals monthly or bimonthly. • Ensure that ongoing annual career development plans address the question of desired hours.

2) Those working at least 20 hours per week and satisfied with their hours. For these individuals, DDD and the provider agencies will: • Ensure that job retention services are available to help the individuals maintain their employment levels and make any changes required/desired in the future.

3) Those working who consider themselves underemployed (i.e. would like more hours). For these individuals, DDD and the provider agencies will: • Follow up with individuals to discuss current job satisfaction and whether there is opportunity for additional hours at current employer. • Review/revise or complete a career development plan for all underemployed individuals to include strategies for increasing hours or securing new employment that offers more hours.
• Providers will identify obstacles and solutions towards the goal of increased hours, and determine how to implement these changes into an agency specific strategic plan.

2/2.8/17

2

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 8 of 10 PageID #: 2635
Plan for Increasing ihe Number of Hours Worked by Consent Decree Target Populotion Members

4) Those who are self employed. A challenge in addressing hours of self-employed individuals is that the Division lacks a definition of and standards for self-employment. Currently, the data for these individuals is combined with employer-paid individuals in the Sherlock survey data provided to DDD, so it is difficult to determine what the specific needs of the selfemployed group are. See Section 2 for more on data collection.
DDD, in conjunction with ORS, will define self-employment standards and educate individuals, families, and providers, and work with stakeholder groups and subject matter experts around developing sustainable self-employment opportunities. The standards will be defined and training will begin by April 30th.
As part of ongoing oversight, DDD and the provider agencies will ensure that each individual's next career development plan addresses hours of employment and strategies to obtain the desired number of hours.

Q

nd

One challenge to increasing the average hours worked is the method and quality of data collection. Steps to improve this include:
a. Separate self-employment data from competitive employment data in the reporting of the next quarterly Sherlock survey.
b. Establish a method of follow up to the Sherlock survey with those reporting employment but not providing data on hours and wages in the next quarter.
c. Validate data collected in the next quarter that does not meet set standards, such as too few hours (e.g. one hour or less per week), or hours paid at less than minimum wage.
• Establish follow up training with the agencies and with self-directed individuals regarding the expected standards for integrated competitive employment that will begin in the next quarter and continue as needed afterwards.
d. Through the Person-Centered Supported Employment Program, incorporate the collection of data related to hours worked.
e. Explore additional ways to collect data on hours worked in a more timely fashion than the quarterly reports so that potential quality issues can be addressed earlier and to ensure employment standards are being met within the Individualized Support Plans, Career Development Plans, and in provided services.

2./2.81'11

3

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 9 of 10 PageID #: 2636
Plan for Increasing the Number of Hours Worked by Consent Decree Target Population Members

3.

vvith

Gro

Because agencies participating in the Person-Centered Supported Employment Program either have well-established employment programs or are focusing on developing more robust employment programs, these agencies are the core ones that DDD will initially work with to develop strategies to increase the hours worked for all target populations. Throughout the year-long pilot program, the Associate Director of Employment and the Associate Director of Program Performance will work with the PCSEP agencies on strategies to increase hours worked. Lessons learned from this group will be shared with other agencies through the Associate Director of Employment's regular meetings with each provider, and through written materials and group meetings.

The monthly strategy meeting was held with these agencies on February 26, and included a discussion of strategies to increase hours worked, listed in the next section. During this discussion, some barriers to increasing hours were raised, including:

• Myths regarding benefits, including incorrect information given out by non-DD agencies such as the Social Security office.
• The inability of employers to offer more hours. Several agencies reported that employers have told them they are planning to cut hours, especially if the minimum wage is increased.
• Lack of coordinated job search and job development resources. Many of the agencies are approaching the same businesses, which puts off the business owners/managers.
• Transportation, especially for those working more than one job.
Over the next quarter and continuing thereafter, DDD will also work with stakeholder groups such as the Supported Employment Leadership Network, the Employment First Task Force, the DO Supported Employment Council, families, and other subject matter experts to identify additional strategies to improve work outcomes and to provide better education around work and benefits.

4.

Ho Worked

The following are strategies to increase hours worked discussed by providers: • Ongoing discussion with the employer regarding their satisfaction, the employee's progress, interests, and satisfaction, and the possibility of increase hours or responsibility. • Regional shared contacts or business liaisons to coordinate search and job opening efforts among multiple provider agencies.
2/28/17

Case 1:14-cv-00175-JJM-PAS Document 59 Filed 04/19/17 Page 10 of 10 PageID #: 2637
Plan increasing the Number of Hours Worked by Consent Decree Target Populotion Members
• Work with individuals to look for a second or third job opportunity.
• Restructure day activities to focus on discovery activities, such as volunteering, to lead individuals to make better informed decisions about work.
• Look at the State as a model employer, and State set-asides for contracts with people with disabilities.
DOD will pursue the following strategies to assist providers in increasing hours:
• Provide ongoing individualized provider-specific technical assistance through the Associate Director of Employment and the Conversion Institute.
• Promote and facilitate a forum, such as a job developers group, among providers to share ideas, successful practices/strategies, and questions/challenges they are having in moving people towards employment. Have representatives of this group coordinate with the Employment First Task Force and the Ocean State Employer Services Network.
• Continue to have monthly strategy meetings and regular individual continuous improvement meetings with providers.
• Continue to provide training and resources on supported employment, customized employment, and best practices.
• Promote benefits counseling and provide information that counters the myths around work and impact on benefits, through a contract with the Sherlock Center and DOD's written materials.
• Add an Employment First page to DOD's website.
• ODD's Associate Director of Employment is coordinating with the Department of Labor and Training around collaborating efforts to increase employment outcomes for the DD population.
• ODD and RIPTA are collaborating on transportation options, including a joint approach to Uber and Lyft and other alternative methods.

2128/17

5

 
 Case 1:14-cv-00175-JJM-PAS Document 62 Filed 06/14/17 Page 1 of 10 PageID #: 2876

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA Plaintiff
v.
STATE OF RHODE ISLAND Defendant

C.A. No 14-175

QUARTERLY STATUS REPORT ON COURT ORDERED PLACEMENTS:
OCTOBER 1, 2016 THROUGH DECEMBER 31, 2016
Issued: June 13, 2017   
Background. This report summarizes supported employment placement and related data for the fourth quarter, October 1, 2016 through December 31, 2016. Data was drawn from the State’s Consent Decree Database, which provides information on the employment services received and outcomes achieved by members of the four Consent Decree Target Populations.1 The Database aggregates primary source data gathered and reported by the Division of Developmental Disabilities (DDD), the Office of Rehabilitative Services (ORS), the Rhode Island Department of Education (RIDE), and the survey of provider agencies conducted by the Sherlock Center on Disabilities at Rhode Island College (Sherlock Survey).
The attached Consent Decree Data Report, prepared by DDD and reviewed by the Court Monitor, documents the extent to which the State is achieving the benchmarks and performance outcomes required by the Consent Decree across the four Target Populations. The total number of Target Population members engaged in integrated employment increased during each calendar quarter in 2016 from 204 individuals on March 31, 2016 to 482 individuals on December 31, 2016. Integrated employment became a reality for 278 individuals during this nine-month period including: 106 members of the Youth Exit Target Population, 56 members of

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Case 1:14-cv-00175-JJM-PAS Document 62 Filed 06/14/17 Page 2 of 10 PageID #: 2877  
the Sheltered Workshop Target Population, and 116 members of the Day Target Population (See Appendix, Report 2). Key findings for the quarter ending December 31, 2016 include the following:

1. Target Population Census. The total unduplicated number of individuals in the Consent Decree’s four Target Populations was 3,443 on December 31, 2016:2 Each of these persons is required to receive a Career Development Plan, updated annually, and Benefits Planning during the year that they obtain a supported employment placement or, for members of the Youth Transition Target Population, not later than the year prior to exiting secondary school. The total number of individuals required to be placed in integrated supported employment is 2,686. This number does not include members of the Transition Target Population or individuals who were employed during 2012, the based year for Consent Decree calculations. The total number of individuals to be placed by target population is: a. Sheltered Workshop Target Population – 658 b. Day Target Population – 1,532 c. Youth Exit Target Population – 496

2. Individual Employer Paid Employment.3 The number of Youth Exit Target Population

members who received a supported employment placement increased throughout the year

from 26 individuals on March 31, 2016 to 135 individuals on December 31, 2016. While

positive gains were made in every quarter during 2016, the total number of placements represents only 27.2% of the Consent Decree benchmark of 496 individuals in this

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population (See Table 1).


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Case 1:14-cv-00175-JJM-PAS Document 62 Filed 06/14/17 Page 3 of 10 PageID #: 2878  
By December 31, 2016, a total of 113 members of the Sheltered Workshop Target Population had received a supported employment placement, exceeding the Consent Decree benchmark of 100 individuals employed (Table 1).

The number of individuals in the Day Target Population who received a supported employment placement by December 31, 2016 was 234, far surpassing the Consent Decree benchmark of 50 individuals.

The average number of hours worked per week by members of the three target populations

changed little during 2016 and is below the required benchmark of 20 hours per week. On

December 31, 2016, members of the Youth Exit Population worked on average 13.7 hours

per week; members of the Sheltered Workshop Target Population averaged 11.6 hours per week; and members of the Day Target Population averaged 10.6 hours per week (see Attachment, Report 4). 3. Career Development Planning (See Table 2). Overall, the

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number of individuals with Career Development Plans more than doubled from 714 on

March 31, 2016 to 1,983 on December 31, 2016. While progress has been made, the

percentage of target population members with Career Development Plans continues to fall

below the required benchmarks across each target population (See Attachment, Report 3a).

4. Benefits Planning. The number of Target Population members with benefits plans should be roughly equal to the number of individuals who are employed. On December 31, 2016 the number of individuals with Benefits Plans fell short of the

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Case 1:14-cv-00175-JJM-PAS Document 62 Filed 06/14/17 Page 4 of 10 PageID #: 2879  
Consent Decree requirements for the Youth Exit, Sheltered Workshop and Day Target Populations (See Attachment Report 3b).
Summary DDD, in collaboration with ORS and RIDE, has significantly improved its ability and capacity to gather, aggregate and analyze the outcome and system performance data that are required by the Consent Decree. Continued efforts need to be placed on expanding the integrated employment placements among the Youth Exit Target Population. The attached Consent Decree Data Report details the State’s progress on meeting key benchmarks and activities.
 
Respectfully Submitted,
Charles Moseley EdD U.S. District Court Monitor



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 Case 1:14-cv-00175-JJM-PAS Document 63 Filed 07/19/17 Page 1 of 9 PageID #: 2886

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA Plaintiff
v.
STATE OF RHODE ISLAND Defendant

C.A. No 14-175

QUARTERLY STATUS REPORT ON COURT ORDERED PLACEMENTS:
JANUARY 1, 2017 THROUGH MARCH 31, 2017
Issued: July 19, 2017  
Background. This report summarizes supported employment placement and related data for the first quarter, January 1, 2017 through March 31, 2017. Data was drawn from the State’s Consent Decree Database for the quarter ending March 31, 2017. The Database and related report aggregates primary source data gathered by the Division of Developmental Disabilities (DDD), the Office of Rehabilitative Services (ORS), the Rhode Island Department of Education (RIDE), and the survey of provider agencies conducted by the Sherlock Center on Disabilities at Rhode Island College (Sherlock Survey).

The attached Consent Decree Data Report, issued July 6, 2017, was prepared by DDD and reviewed by the Court Monitor. The report documents the State’s progress on achieving the benchmarks and performance outcomes required by the Consent Decree across the four Target Populations through March 31, 2017. 1 During this period, 62 additional individuals received supported employment, increasing the total number of Target Population members who have received a supported employment placement in an integrated competitive employment setting to 544. Placement data for each target population is measured against Consent Decree benchmarks that must be achieved by January 1, 2018 for the Sheltered Workshop and Day Target Populations. Additional benchmarks occur in subsequent years. The placement

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Case 1:14-cv-00175-JJM-PAS Document 63 Filed 07/19/17 Page 2 of 9 PageID #: 2887

benchmark for all members of the Youth Exit Population was July 1, 2016. The total number of individuals placed during this reporting period (62) fell below the average achieved over the three previous quarters of approximately 85 individuals per quarter. Key findings for the quarter ending March 31, 2017 include the following: 2

1. Target Population Census. The total unduplicated number of individuals in the Consent Decree’s four Target Populations was 3,621 on March 31, 2017. Each of these persons is required to receive a Career Development Plan, updated annually, and Benefits Planning consultations during the year that they obtain a supported employment placement or, for members of the Youth Transition Target Population, not later than the year prior to exiting secondary school. The total number of individuals required to be placed in integrated supported employment is 2,696. This number does not include members of the Transition Target Population or individuals who were employed during 2012, the base year for Consent Decree calculations. The total number of individuals to be placed by target population is: a. Sheltered Workshop Target Population – 658 b. Day Target Population – 1,541 c. Youth Exit Target Population – 497 Differences in the Quarter 1 census data as compared with previous quarters reflect the continuing efforts by the State to identify members of the Consent Decree’s four target populations and account for individuals who may have voluntarily left or refused services, or who may have become deceased.

2. Individual Employer Paid Employment By Target Population (Table 1).3 The number of Youth Exit Target Population members who received a supported employment placement increased by 25 individuals during the first quarter, from 135 on December 31, 2016 to 160 persons on March 31, 2017. The total number of placements represents only 32% of the Consent Decree benchmark of 497 individuals for this population.

By March 31, 2017, a total of 122 members of the Sheltered Workshop Target Population had
received a supported employment placement, an increase of 9 individual placements. The

'
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Case 1:14-cv-00175-JJM-PAS Document 63 Filed 07/19/17 Page 3 of 9 PageID #: 2888

Consent Decree benchmark requires a total of 150 members of the Sheltered Workshop

Target Population to be placed by January 1, 2018.

The number of individuals in the Day Target Population who

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received a supported employment placement by March 31, 2016 was 262. This exceeds the

Consent Decree requirement that placements be provided to 100 individuals from this target

population by January 1, 2018.

Average Hours Worked Per Week. The average number of hours worked per week by

members of the three target populations during the first quarter of 2017 did not differ

significantly from the previous reporting period and remains below the 20 hours per week

benchmark. On March 31, 2017, members of the Youth Exit Population worked on average

14.9 hours per week; members of the Sheltered Workshop Target Population averaged 12.2

hours per week; and members of the Day Target Population averaged 10.3 hours per week.

The percentages of target population members working more than 20 hours per week

dropped slightly across all three target populations as compared to the prior reporting

quarter (see Attachment, Report 4).


3. Career Development Planning (Table 2). Overall, the number of individuals with Career

Development Plans grew from 1,983 on December 31, 2016 to 2,290 on March 31, 2017, an increase of 307 individuals. Although

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progress has been made, the percentage of target population members with Career

Development Plans continues to fall below the required benchmarks across each target

population averaging 63% for the four groups combined (See Attachment, Report 3a).


4. Benefits Planning (Table 3). The number of Target Population members with benefits plans

should be roughly equal to the number of individuals who are employed. A total of 367



(

Case 1:14-cv-00175-JJM-PAS Document 63 Filed 07/19/17 Page 4 of 9 PageID #: 2889

target population members were reported to have benefits plans in place on March 31, 2017.

This represents an increase of 50 individuals over the previous reporting quarter and

approximately 67% of the benchmark requirement. A summary of performance by target

population is provided in Table 3 and, with greater detail in the Attachment, Report 3b.

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Summary. The number of individuals who received supported employment placements

consistent with Consent Decree requirements continued to increase during the quarter ending

March 31, 2017. Although greater numbers of individuals have received placements, progress

has been uneven across the three target populations. As noted above, the State has exceeded the

January 1, 2018 placement benchmark for the Day Target Population and has reached 81% of

the benchmark for the Sheltered Workshop Population. By contrast, more than 67% of Youth

Exit Population members were awaiting supported employment placements on March 31, 2017.

Based on the first quarter data, 365 additional individuals need to be placed by January 1, 2018:

28 persons from the Sheltered Workshop Target Population, zero from the Day Target

Population and 337 individuals from the Youth Exit Target Population.

 
Respectfully Submitted,

Charles Moseley EdD

U.S. District Court Monitor








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.

 
 Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 1 of 13 PageID #: 2985

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA Plaintiff
v.
STATE OF RHODE ISLAND Defendant

C.A. No 14-175

QUARTERLY STATUS REPORT ON COURT ORDERED PLACEMENTS:
APRIL 1, 2017 THROUGH SEPTEMBER 30, 2017
Filed: January 19, 2018  
Introduction - Changes in Reporting Periods and Formats.
During the past year the State and the Court Monitor reviewed the methodology and format of the quarterly placement data reports to improve the accuracy and validity of the information being reported. Additional steps were taken to identify Consent Decree target population members who are not engaged in supported employment or are not receiving employment related services. These efforts resulted in the development of new reporting categories to improve documentation of individuals who: have deceased, have voluntarily left services, are not attending or engaged, have not applied and those who are not eligible or who have withdrawn their applications (See Attachment, Report 1, Total Individuals).
The joint review made additional modifications in the timing and format of the State’s quarterly status reports on supported employment placements and related services. These summary reports aggregate data drawn from four different sources: the Sherlock Center Quarterly Provider Survey (Sherlock Survey), Office of Rehabilitation Services (ORS) case files, Division of Developmental Disabilities (DDD) caseload information, and the Rhode Island Department of Education (RIDE) annual census to create a single non-duplicated dataset that is used to track progress on a quarter-by-quarter basis. The aggregated data is composed of information that is

Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 2 of 13 PageID #: 2986

gathered at different times during the quarter. ORS and DDD routinely collect and report caseload status and related information on a quarterly basis. The analysis of data from the comprehensive Sherlock Survey, however, takes approximately three months to complete creating a significant time lag between data collection and reporting.

To improve the timeliness of the quarterly reports the State supplements the Sherlock data with more recent numbers reflecting caseload changes that take place during the intervening months of data analysis. For example, the quarterly report filed on July 19, 2017 includes Sherlock Survey data for the period ending March 31, 2017 updated with caseload information gathered in April, May and June. In the past, the review period identified for this report was based on the timing of the Sherlock Survey, January 1 – March 31, 2017. On close examination it was realized that linking the review period to the timing of the Sherlock data ignores the additional updates that are routinely included. It was determined that a more appropriate approach is to identify the period of review on the quarterly reports to reflect the most recent data being reported by ORS and DDD. It is important to note that these modifications do not change the value of the data being gathered nor do they have an impact on the documentation of the State’s performance relative to achievement of key Consent Decree performance benchmarks.

The aforementioned formatting changes are reflected in this report presenting data for the quarter ending September 30, 2017. It includes: Sherlock Survey data covering the period April through June 2017 (reported in September); caseload information from ORS and DDD collected during July, August and September; and data from RIDE’s annual census conducted in July 2017. The data tables and charts in the attached quarterly review have been adjusted to reflect the revised realignment of reporting periods. It should be noted that the active census of individuals in each of the Consent Decree Target Populations can be expected to vary slightly from quarter to quarter depending on individual circumstances.

Findings

The attached Consent Decree Data Report, issued October 31, 2017, was prepared by DDD and reviewed by the Court Monitor. The report documents the State’s progress on achieving the January 1, 2018 benchmarks and performance outcomes required by the Consent Decree across



*





Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 3 of 13 PageID #: 2987

the four target populations1 for the period ending September 30, 2017. During this quarter, the

total number of target population members who received a supported employment placement

in an integrated competitive employment setting increased from 544 on June 30, 2017 to 573 on

September 30, 2017, a gain of 29 individuals. This represents the lowest quarter-to-quarter expansion over the past year (Table 1). However, increased numbers of placements achieved during the prior 12 months resulted in an expansion of the total number of target population members receiving supported employment placements by 305 individuals, from 268 in September 2016 to 573 in September 2017. During this time period the State averaged approximately 76 placements per quarter.

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The Consent Decree requires the State to meet performance benchmarks regarding the numbers of target population members placed in supported employment according to a set schedule. Although the vast majority of individuals covered by the Agreement who received a placement in the past continue to be employed, a small number no longer receive State employment services or have deceased. The aforementioned data review process identified an additional 16 individuals across the Youth Exit (6), Sheltered Workshop (2) and Day Target (8) Populations who received supported employment placements following the signing of the Consent Decree in July 2014. The current quarterly Consent Decree Data Report lists these numbers separately and does not include them in the data analysis. These additional individuals should be considered when determining the State’s progress on meeting Consent Decree placement requirements. Adding these individuals to the count raises the total number of placements achieved to date from 305 individuals to 321 individuals. The impact of these individuals on meeting the placement benchmarks for each target population is described below in Section 2 and in Table 2.

Placement data for each target population is measured against Consent Decree benchmarks that must be achieved by January 1, 2018 for the Sheltered Workshop and Day Target Populations.



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Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 4 of 13 PageID #: 2988

Additional benchmarks occur in subsequent years. The benchmark date by which time all members of the Youth Exit Population were to have been placed was July 1, 2016. Key findings for the quarter ending September 30, 2017 include the following:2

1. Target Population Census. The total unduplicated number of individuals in the Consent Decree’s four Target Populations was 3,418 on September 30, 2017. This number represents a decrease of 203 individuals as compared with the previous period. These differences reflect improvements by the State in identifying and documenting target population members who are not involved in the developmental disabilities system for a number of reasons including: deceased individuals as well as those who: are not attending or participating in services, have not applied for services, have rescinded their applications, are not eligible or who voluntarily left services.3 Each target population member is required to receive a Career Development Plan, updated annually, and Benefits Planning consultations during the year that they obtain a supported employment placement or, for members of the Youth Transition Target Population, not later than the year prior to exiting secondary school. The State is required to provide supported employment placements for 2,501 members of the Sheltered Workshop, Youth Exit and Day Target populations. This number does not include members of the Transition Target Population4 or individuals who were employed during 2012, the base year for Consent Decree calculations. The total number of individuals to be placed by target population (updated) is: a. Sheltered Workshop Target Population – 617 b. Day Target Population – 1,442 c. Youth Exit Target Population – 442 It is important to note that the active census of individuals in each of the Consent Decree Target Populations varies slightly from quarter to quarter depending on individual circumstances and improved methods of identifying and tracking target population members.



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3 See Attachment Report 1 Current Census

,The Consent Decree does not require the State to place individuals in the Youth Transition

Target Population. 



,





Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 5 of 13 PageID #: 2989

2. Individual Employer Paid Employment By Target Population (Table 2).5

Youth Exit Population. Progress on securing supported employment for members of the

Youth Exit Population has continued to fall below expectations, increasing by only 6

individuals over the previous reporting period from 160 persons on June 30, 2017 to 166

individuals on September 30, 2017. The total number of placements represents only 37.6% of

the July 1, 2016 Consent Decree benchmark of 442 individuals for this population. When

these figures are adjusted to reflect prior year placements of 6 individuals who are no longer

receiving State services the total number of placements increases to 172, 39% of the

benchmark for this target population. Placement data shown in Table 2 includes individuals

placed in prior years as described above. Although this rate is less than that achieved for the

other target populations, it is important to note that the number of individuals in the Youth

Exit Population has significantly increased over the past two years as a result of expanded

State outreach efforts to identify and contact all members of this group. The initial

assessment of this population identified 151 members with intellectual disabilities in need of

placement. The Court ordered the placement of this group by June 30, 2016. Further efforts

on the part of the State located additional numbers of individuals with developmental

disabilities who previously were not included in the Youth Exit Population and individuals

in this population who had never applied for and were not engaged in DD services. This

resulted in the overall expansion of the population to approximately 442 individuals. The

state developed an implementation plan and schedule to ensure the placement of all remaining

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Youth Exit Population Members who choose competitive employment according to the

following schedule: 50% will receive a supported employment placement by April 30, 2018,

and 100% by September 30, 2018. Youth Exit Population members who do not wish to

pursue competitive employment will be identified through the variance process by

February 28, 2018.



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Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 6 of 13 PageID #: 2990

Sheltered Workshop Target Population. Supported employment placements among members of the Sheltered Workshop Target Population were similarly low during this quarter, the total number growing by only 8 individuals over the previous reporting period to a total of 130 individuals. This number represents 86.7% of the Consent Decree benchmark that requires 150 members of the Sheltered Workshop Target Population to be placed by January 1, 2018. Adjusting these data to reflect the prior year placement of two individuals who are no longer receiving State services increases the total number of placements 132 or 88% of the benchmark for this target population.

Day Target Population. The number of individuals in the Day Target Population who received a supported employment placement by September 30, 2017 was 277. Eight individuals were placed during prior years bringing the total number of individuals who have received a supported employment placement to 285, more than double the Consent Decree requirement that placements be provided to 100 individuals from this target population by January 1, 2018.

Average Hours Worked Per Week. The average number of hours worked per week by members of the three target populations during the quarter ending September 30, 2017 was largely unchanged from the previous reporting period and remains below the 20 hours per week benchmark. On September 30, 2017, members of the Youth Exit Population worked on average 14.5 hours per week; members of the Sheltered Workshop Target Population averaged 12.4 hours per week; and members of the Day Target Population averaged 11 hours per week. The percentages of target population members working more than 20 hours per week did not significantly improve across the three target populations as compared to the prior reporting quarter (see Attachment, Report 4). The State prepared and is implementing a plan to identify workers’ preferences and increase the weekly hours worked among individuals receiving supported employment.

3. Career Development Planning (Table 3). Overall, the total number of target population members with Career Development Plans grew from 2,290 on June 30, 2017 to 3,253 on September 30, 2017, an increase of 963 individuals. Significant progress was made in this area across all populations. The required benchmark was met at the 99% level for the Youth



.





Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 7 of 13 PageID #: 2991

Exit, Sheltered Workshop and the Day Target populations, and at the 83% level for members

of the Youth Transition Target Population. An analysis of the status of the 136 individuals

who had not received a career development plan by September 30th revealed that 121 individuals were on

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the active rolls but had not yet received a plan, 14 individuals had a plan pending, and one

person refused to participate in the planning process. An additional 29 individuals were

receiving DD services, such as homemaking, respite or home health, that do not require a

career development plan to be prepared (See Attachment, Report 3a).

4. Benefits Planning (Table 4). All individuals in the Youth Exit, Sheltered Workshop and Day

Target Populations are required to receive benefits planning and information no later than

the year in which the person is scheduled to transition to a supported employment

placement. The number of Target Population members with

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benefits plans should be roughly equal to the number of individuals who are employed. A

total of 392 target population members were reported to have benefits plans in place on

September 30, 2017. This represents an increase of 25 individuals over the previous

reporting quarter and approximately 68% of the benchmark requirement. A summary of

performance by target population is provided in Table 4 and, with greater detail in the

Attachment, Report 3b.

Summary. The State has continued to refine and improve its format and methodology for gathering and reporting data on the number of target population members who receive supported employment placements and related services. The number of individuals receiving supported employment placements increased during the quarter ending September 30, 2017. Data on quarter-to-quarter performance over the past year indicates that 305 target population



/





Case 1:14-cv-00175-JJM-PAS Document 69 Filed 01/19/18 Page 8 of 13 PageID #: 2992
members received a supported employment placement between September 30, 2016 and September 30, 2017 (See Attached, Report 2). The inclusion of data on prior placements of individuals who are no longer receiving services brings the total to 321. Although these data are encouraging it is important to note that the quarterly placement rate has dropped from 119 individuals for the quarter ending March 31, 2017 to 63 individuals for the quarter ending June 30, 2017, to 29 individuals during the current reporting period, the lowest quarterly increase over the past six quarters. It is important to note that placement rates vary from one quarter to another and are influenced by a number of different factors. DDD and ORS are using placement data to inform related decisions regarding the delivery and oversight of supported employment services.
As noted above, as of September 30, 2017 the State significantly exceeded the January 1, 2018 placement benchmark for the Day Target Population and reached 88% of the benchmark for the Sheltered Workshop Population. DDD and ORS are aware of the need to increase placements among the members of this population. As noted above, the two state agencies are implementing a plan to place all remaining Youth Exit Population members who have expressed an interest in employment by September 2018. In addition, DDD is incorporating new incentives in its Person-Centered Supported Employment Program to enhance provider capacity to develop integrated supported employment opportunities for target population members.
Respectfully Submitted,
Charles Moseley Ed.D. Court Monitor January 18, 2017



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Case 1:14-cv-00175-JJM-PAS Document69Filed01 /19/18 Page 9 of 13 PageID #: 2993



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 Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 1 of 41 PageID #: 3006

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA Plaintiff

v.

C.A. No 14-175

STATE OF RHODE ISLAND Defendant

REPORT OF THE COURT MONITOR ON RHODE ISLAND’S CONSENT DECREE COMPLIANCE
Review Period: August 1, 2017 - December 31, 2017.
Issued: April 6, 2018

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 2 of 41 PageID #: 3007

Table of Contents

I. Introduction

3

A. Target Populations

4

B. Assessing Progress

5

II. Findings: Review of Progress

7

A. Supported Employment Services and Placements

7

B. Integrated Day Services and Placements

12

C. Career Developmental Planning and Benefits Planning

17

D. Transition Planning for Youth

20

E. Provider Capacity

22

F. Funding

23

G. Quality Improvement

25

Attachment 1

Consent Decree Quarterly Data Report

33

Attachment 2

DDD Quality Improvement Plan

38

2

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 3 of 41 PageID #: 3008
I. Introduction
The Consent Decree in U.S. v. State of Rhode Island, Case No. CA14-175 resolves the United States’ findings of violations by the State of Rhode Island of Title II of the Americans with Disabilities Act of 1990 (ADA), 42 U.S.C. § 12131, et seq., as interpreted by the United States Supreme Court in Olmstead v. L.C., 527 U.S. 581 (1999), through its administration and operation of its day activity service system, including employment, vocational, and day services, 46-1-14 R.I. Code R. § 43.0, for individuals with intellectual and developmental disabilities (IDD).
The Consent Decree was entered by the Court four years ago on April 9, 2014, launching the State of Rhode Island on a ten-year initiative to end its over-reliance on sheltered workshops and segregated facility-based day services by ensuring individuals with intellectual and developmental disabilities (IDD) receive employment and day services in the most integrated community settings, working alongside co-workers without disabilities earning minimum wage, or better, and receiving the support they need to fully participate in community groups and activities. During the past four years, the State has made needed and appropriate adjustments in the funding allocation process for individuals receiving support and has instituted performance-based payment systems to incentivize supported employment placements. Actions by the Governor and the State Legislature have provided long overdue pay increases to job coaches, job developers and direct support professionals. The State has increased opportunities for training and technical assistance to service providers and has developed and distributed clear program standards to guide the design and delivery of integrated employment and day services. Placement goals included in the Consent Decree have been met for the Sheltered Workshop Target Population and exceeded for the Day Target Population. A plan developed by the State to increase placements among members of the Youth Exit Population was implemented and has met its first placement benchmark. Data in this report documents the progress that is being made in meeting supported employment placement benchmarks as well as other key goals.
The Consent Decree includes additional provisions calling for changes in the nature and structure of day services, shifting from segregated facility-based programs to supporting people in an array of integrated community activities of their own choosing. Although more work needs to be done in this area, changes are being made as provider organizations begin to consider the steps that need to take to move to new person-centered approaches that enable people receiving support to take the lead in deciding the nature of the services and supports they will receive.
Progress is being made, but continued resources need to be provided and efforts need to take place to build the capacity of the State to assure and improve service quality, document performance, and support and sustain necessary system and provider infrastructure.
3

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 4 of 41 PageID #: 3009
This report documents the State of Rhode Island’s progress on meeting the terms and conditions of the Consent Decree during the period, August 1, 2017 through December 31, 2017. Additional updated information is provided to mark progress on some provisions covering the period January 1, 2018 to February 28, 2018. Emphasis is placed on assessing the efforts the State made during this period to carry out the requirements of the Consent Decree and to implement the recommendations included in the Consent Decree Compliance Report issued on January 25, 2017, the Addendum to the Consent Decree Report issued on February 10, 2017 and the Consent Decree Compliance Report issued on July 27, 2017.
During the past several months the Court Monitor and the State have worked to institute a quarterly reporting process for documenting the State’s progress on completing compliance related actions recommended by the Monitor and ongoing Consent Decree requirements. The State continues to work within existing fiscal and personnel constraints to carry out the policy and procedural changes that are required by the Consent Decree. As noted in the Monitor’s July 27, 2017 Consent Decree report, the Division of Developmental Disabilities (DDD) has taken steps to increase staffing in some areas to provide needed direction, oversight and management but additional personnel continue to be needed by the Division to carry out key Consent Decree requirements in the area of Quality Improvement. The State Consent Decree Coordinator resigned her position in August 2017. This role was filled on a temporary basis by the Executive Office of Health & Human Services (EOHHS) Chief Strategy Officer until a replacement was found. The new Consent Decree Coordinator was hired in January 2018. The State kept the Monitor and the Parties fully informed of the recruitment process. The transition of responsibilities during this period took place without disruption of the monitoring process and compliance related activities were completed as scheduled.
Report Organization. This report provides a targeted review of the State’s progress on achieving and maintaining compliance with requirements related to seven key provisions of the Consent Decree listed above in the Table of Contents. This Introduction (Section I) provides basic information on the Consent Decree summarizing its background, scope and target populations, as well as the means used to gather information and evaluate performance, compliance and outcomes. The Findings Section (Section II) reports on the extent to which the actions taken by the State fully address the required performance benchmarks, policy revisions and operational changes. Also included are recommended actions that should be taken to comply with Consent Decree requirements.
A. Target Populations
Individuals belonging to the following target populations are eligible for Supported Employment Services, Integrated Day Services, and/or transition services under the Consent Decree (See CD Section III):
4

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 5 of 41 PageID #: 3010
1. Rhode Island Sheltered Workshop Target Population. Individuals with IDD who receive day activity services in settings where they perform sheltered workshop tasks or have received day activity services in such settings during the year before the Consent Decree went into effect.
2. Rhode Island Day Target Population. Individuals with IDD who receive day activity services in facility-based day program settings or have received such services during the year before the Consent Decree went into effect.
3. Rhode Island Youth Transition Target Population. Individuals with IDD who are transitionage youth according to current Rhode Island law and who are currently attending a Rhode Island secondary school.
4. Rhode Island Youth Exit Target Population. Individuals with IDD who have exited a Rhode Island secondary school during the 2013-2014, 2014-2015, or 2015-2016 school years.
B. Assessing Progress
This report is based on information gathered by and reported to the Monitor from a number of sources during the reporting period including information gathered over the course of four onsite visits to the state and ongoing weekly contact with the RI State Consent Decree Coordinator and the Department of Justice (DOJ). Additional calls and meetings were held on a bi-weekly basis with the Parties to discuss progress, issues and concerns. Scheduled and unscheduled meetings and calls were held with state policymakers including the Deputy Secretary of EOHHS, as well as the directors and staff of BHDDH - DDD, RIDE and ORS, and the Sherlock Center at Rhode Island College. Additional meetings and discussions were held with provider agency directors and staff during site visits and via conference calls.
Information on State activities and compliance used in the preparation of this progress report was gathered through a number of different sources, methods and strategies including:
• An in-depth review of data and descriptive information provided in the State’s Consent Decree and Interim Settlement Agreement Quarterly Report for the period ending December 31, 2017.
• Survey data on the services received and outcomes achieved by members of the four Consent Decree target populations as reported by the Sherlock Survey, the State Database and independently by DDD, ORS and RIDE.
• Reports on individual and system outcomes prepared by each of the three State agencies and provided in monthly and quarterly updates and reports.
5

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 6 of 41 PageID #: 3011
• Meeting with the Secretary of EOHHS and multiple in-depth interviews and discussions with the directors and key staff of EOHHS, DDD, RIDE, and ORS.
• Meetings and discussions with provider agency directors regarding the impact of new program standards and guidelines for supported employment and integrated day services, quality improvement, the operation of the PCSEP program, the organization of integrated day services other Consent Decree related activities.
• Meeting with the directors of DDD, ORS and RIDE on: the implementation of personcentered practices, planning and service delivery; funding and resource allocation methodologies that ensure the flexibility needed for person centered practices, quality improvement, and the implementation of integrated day services.
• Meeting with IDD provider agency directors addressing: the implementation of personcentered practices, planning and service delivery; funding and resource allocation methodologies that ensure the flexibility needed for person centered practices, quality improvement, and the implementation of integrated day services.
• Meeting with one provider agency for an in-depth discussion of the approach and strategies used by the organization support individuals in integrated community settings and activities of their choosing.
• Visits to six (6) developmental disabilities services provider organizations across the state, visits with people with IDD receiving support and interviews of program directors and key staff. Services provided by one provider agency were reviewed on three occasions.
• Multiple visits with individuals receiving integrated day services and employment services.
• Meetings with the leadership of provider agencies to learn about and understand the barriers and challenges they face in implementing the Consent Decree.
• Participation in two meetings of the Employment First Task Force discussing barriers to Consent Decree implementation and effective strategies for moving forward with systems change.
• Review and analysis of state data, records and documentation of services and supports furnished to members of the Target Groups conducted by a subject matter expert in collaboration with the Monitor and key state agency officials.
6

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 7 of 41 PageID #: 3012
• Conducted with the assistance of an independent reviewer, an assessment of ten individuals, including records and services, provided by Community Work Services in October 2017 covering both Consent Decree and ISA requirements.
II. Findings: Review of Progress on Meeting Consent Decree Requirements
A. Supported Employment Services and Placements (Consent Decree §IV and §V)
Benchmark 1 – Supported Employment Placements §IV(8)(a)-(d) & 9(a) - The State will provide Supported Employment Placements and Integrated Day Services as detailed in Sections V-VI of the Consent Decree for individuals in the Rhode Island Youth Exit and the Rhode Island Sheltered Workshop Target Populations (§IV[8][a]-[d]) and for individuals in the Day Target Population (§IV[9][a]) according to the schedules in this section.
Current Status and Progress Made. The Consent Decree includes performance benchmarks regarding the numbers of additional target population members that must be placed in supported employment according to a set schedule. Individuals who leave their positions after placement and subsequently return to the same job, secure a new position, or are employed by a different company are not counted as additional placements under the Consent Decree (see §V[H]). Supported employment placements of individuals who subsequently leave state services or are deceased continue to be counted toward the State’s total placement requirement.
The total census of individuals in the Consent Decree’s four target populations is 4,002 for the quarter ending December 31, 2017 (see Attachment I, Consent Decree Data Reports for the Quarter Ending December 31, 2017, Report 1). Adjusting this figure by the numbers of individuals across the target populations who have died since 2013, voluntarily left state services, are on the rolls but attend sporadically, have not applied for services, or have been determined to be ineligible reduces this number to an active census of 3,324 individuals. Adjusting the active census by the number of individuals who were: employed when the Consent Decree was signed, are members of the Transition Target Population, have received a variance, or have elected to retire reveals a total of 2,418 persons who are required to be offered supported employment placements under the terms of the Consent Decree.
Across all target populations, the number of individuals receiving supported employment placements by the State on December 31, 2017 was 617, an increase of 44 individuals over the previous quarter. Adjusting this number to reflect additional prior year placements of individuals who are longer receiving State services brings the total number of placements to 649 (Attachment I, Report 2). The number of individuals actively engaged in supported employment during the 2017 calendar year grew by a total of 254 individuals from 363 on December 31, 2016 to 617 on December 31, 2018.
7

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 8 of 41 PageID #: 3013

Placement data for the Sheltered Workshop and Day Target Populations is measured against annual benchmarks that increase on January 1st of each year during the term of the of the Consent Decree. All members of the Youth Exit Population were required to have received a supported employment placement by July 1, 2016. It is noted that the State was not able to fully identify this population until late 2016. Furthermore, the total number of individuals in this group fluctuates somewhat as a result of expanded State outreach efforts to identify and contact all members of this target population and decreases related to individuals who have terminated State services for the reasons indicated above.

Status of Employer Paid Employment by Target Population


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Table 1 identifies for each target population the annual target number of individuals to receive a supported employment placement, the aggregated year over year total, and the number of placements made by January 1st of each year. The adjusted total includes individuals placed during prior years who have since terminated services.

Youth Exit Population. Placements among members of the Youth Exit Target Population increased by 11 individuals over the previous quarter bringing the total number of active placements for the year ending December 31, 2017 to 177 persons. Adjusting this number to include prior year placements of individuals who no longer receive employment services raises the total to 199, approximately 48% of the Consent Decree requirement (see Table 2).

8

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 9 of 41 PageID #: 3014

As noted in the Quarterly Status Report on Court Ordered Placements issued on January 19, 2018, the number of individuals in the Youth Exit Population increased during the past two years as a result of expanded State efforts to identify and contact all members of this group. Initial


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assessments of this population identified 151 members with intellectual disabilities in need of

placement. The Court ordered the placement of this group by June 30, 2016. Ongoing efforts by

the State to identify additional members of this target group who are interested in actively

seeking employment expanded the count to include eligible individuals with developmental

disabilities who do not have intellectual disabilities diagnoses. This increased the number of

individuals in this target population to 413 as of December 31, 2017. It is important to note that

the total numbers of persons reported in each of the Consent Decree’s four Target Populations

may vary from quarter to quarter as a result of continuing efforts on the part of the State to

identify and review individuals in each target population.

Progress on Meeting the Youth Exit Target Population Placement Plan. DDD and ORS are implementing their previously submitted and approved plan to ensure the placement of all remaining Youth Exit Population Members who choose competitive employment (413). According to the plan’s placement schedule: 50% will receive a supported employment placement by April 30, 2018, and 100% by September 30, 2018. Progress is being made on achieving these benchmarks. As indicated in Table 2 above, 48% of the members of the Youth Exit Population received a supported employment placement by December 31, 2017. The Youth Exit Placement Plan DDD identified 60 members of this population who were not active with DDD or ORS. Contact with this group revealed that 39 were determined to have never applied for services and the remaining 21 individuals were found to be eligible for ORS services but had not applied to DDD. The Division sent letters on September 29, 2017 to this group to inform them of DDD services, eligibility and community resources. DDD continues to follow up on the status of these individuals. The placement process continues for the approximately 277 individuals who are receiving supported employment services but are not yet employed.

DDD requested provider agencies serving members of the Youth Exit Target Population to confirm the accuracy of the provider’s current roster of Youth Exit members receiving support, the services provided and the person’s interest in employment by February 28, 2017. This action has been broadened to collect information on all individuals receiving services. The expansion of the request to provide data on all service populations caused the Division to extend the response deadline and the provider data is still being gathered. Advocates in Action, a selfadvocacy organization of individuals with intellectual disabilities, continues its work on the development of an employment services satisfaction survey to gather consumer input. The

9

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 10 of 41 PageID #: 3015
Placement Plan includes provisions for identifying Youth Exit Population members who do not wish to pursue competitive employment. One variance to receive an integrated day only placement was approved on March 2, 2018. No additional employment related variance requests have been received.
Sheltered Workshop Target Population. Forty-four (44) members of the Sheltered Workshop Target Population received supported employment placements during the quarter ending December 31, 2018 (Table 2). Adjusting these data to reflect the prior year placement of two individuals who are no longer receiving state services increases the total number of placements among this population to 170. This is 113% of the benchmark of 150 persons who needed to receive supported employment placements by January 1, 2018.
Day Target Population. The number of individuals in the Day Target Population who received a supported employment placement by December 31, 2017 was 272. Eight individuals were placed during prior years bringing the total number of individuals who have received a supported employment placement to 280. This represents more than double the Consent Decree requirement that placements be provided to 100 individuals from this target population by January 1, 2018. The total number of individual placements of Day Target Population members reported by the State for this quarter appears to show a decline as compared with the number reported to have been placed during the previous quarter, 285. DDD reports that this apparent discrepancy does not reflect fewer placements, but rather the re-characterization of a number of individuals were incorrectly identified as members of the Day Target Population. These individuals are now being correctly counted as members of the Sheltered Workshop Target Population.
Activities Across Target Populations. A decline in the rate of supported employment placements across all target populations has been recorded in the Monitor’s previously issued Quarterly Status Report on Court Ordered Placements (issued January 19, 2018). DDD, ORS and provider agencies are in general agreement that this decline reflects a focus of early placement efforts on individuals who were already receiving supported employment services and were ready to participate in integrated supported employment.
During the past year DDD and ORS implemented incentive-based payment methodologies to stimulate providers’ efforts to move target population members into integrated supported employment. The two programs promote the same goals and are coordinating their provision of technical assistance to provider agencies. During calendar year 2017 22 providers participated in DDD’s Person Centered Supported Employment Program (PCSEP) and achieved 169 job placements out of 448 individuals enrolled, an employment rate of 38%. DDD is closely tracking the performance of this program, collecting and reporting data on average weekly hours worked (10.2 hours), the percentage of individuals who remain working after 90 days (93.9%), 180 days (91%) and post-180 days (91.4%), staff certification, and other benchmarks. In late 2017, DDD issued a second opportunity for providers to participate in the PCSEP program, PCSEP
10

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 11 of 41 PageID #: 3016
2.0, that included higher incentive payments for placements of members of the Youth Exit Population and other program refinements. While this payment approach has not yet been embraced by all provider agencies, the incentives based contracting process aligns funding with the desired placement outcomes and has been re-tooled to better address provider concerns regarding payments and funding. During the second year of the program the total number of participating providers increased to 26. DDD is meeting monthly with provider agencies to review and discuss the PCSEP initiative.
ORS, in coordination with DDD, has developed and is implementing its own incentive-based payment pilot program for individuals with IDD. Currently, 45 Consent Decree Target Population members are participating in the pilot across seven DD provider agencies. Of this number, 9 individuals received placements in integrated supported employment, four individuals indicated that they did not want to work, and 32 persons are awaiting placement. In October 2017, ORS was informed that the federal Rehabilitation Services Administration (RSA) was severely decreasing the amount of federal funding it was providing to Rhode Island, dropping its allocation from approximately $3.6 million to $532,000. This reduction in funding has forced ORS to institute a waiting list for services (see below, Section E Funding). DDD is streamlining its intake process to ensure target population members receive immediate access to employment and other related services as required by the Consent Decree and the Interim Settlement Agreement (ISA). Additional information is needed to fully monitor and assess the impact of this cut on the services individuals receive (see below).
The RI Department of Labor and Training, in coordination with RIDE, DDD, ORS and the Sherlock Center, was awarded a Disability Employment Initiative Grant in the amount of $2,250,000 over three years. The funds will be used to support four disability resource coordinator positions and the implementation of activities designed to assist individuals with IDD transition from sheltered workshops and segregated day services into competitive employment.
Assessment: The State has met the placement requirements for the Sheltered Workshop Target Population (Consent Decree §IV[8][c, e, & f]) and for the Day Target Population (Consent Decree §IV[9][a-c]). The State has not met the placement requirements for the Youth Exit Population (Consent Decree §IV[8][a, b, & d]). Notable progress has been made in this area, however. Provider agencies have documented the impact of meaningful work on the lives of individuals with IDD receiving support in Rhode Island. For example, see https://vimeo.com/81024947 and https://www.youtube.com/watch?v=PBcfHqLB2QU&feature=youtu.be
As noted above, DDD and ORS currently are implementing a plan to ensure the placement of all remaining Youth Exit Population Members who choose competitive employment by September 30, 2018 and is on track to meet the first placement benchmark on March 23, 2018. In addition, DDD has incorporated new incentives in its PCSEP initiative to enhance provider
11

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 12 of 41 PageID #: 3017
capacity to develop integrated supported employment opportunities for Youth Exit Target Population members.
Recommended Actions: Currently, 30 Consent Decree target population members are on ORS’ waitlist for services. ORS is requested to institute a mechanism for identifying, tracking and reporting to the Monitor on the status of every Consent Decree or ISA Target Population member who is placed on ORS’ waiting list for services. The tracking mechanism should be designed in coordination with DDD and should indicate: (a) the name or identifier of each Target Population member placed on the ORS wait list, (b) the date that the individual was placed on the ORS wait list, (c) the date the individual was referred to DDD for services and the date that DDD services commenced. It is further requested that this information be provided monthly to the Monitor for the months of January, February, and March and in a quarterly summary thereafter as a part of the State’s quarterly reporting process.
B. Integrated Day Services and Placements (Consent Decree §VI)
Benchmark 1 – Integrated Day Service Availability and Characteristics §VI(B)(1-6). Integrated day services will be provided to all individuals in the Sheltered Workshop, Youth Exit and Day Target populations who receive a supported employment placement for the remainder of all time set forth in an individual’s ISP during a 40-hour work week in which the person is not in school or supported employment. Integrated day services and activities should have the following characteristics:
• Be individualized, flexible, purposeful and productive to fit the needs and desired of the individual receiving support.
• Offer individuals with IDD the same opportunities as non-disabled individuals to engage in non-work activities at times and frequencies of the person’s choosing.
• Be selected and designed by the individual through a person-centered process.
• Complement and support an individual’s integrated employment outcomes.
• Allow individuals with disabilities to interact with persons without disabilities to the fullest extent desired and practical for the individual.
• Facilitate meaningful choice between group and non-group, structured and unstructured activities.
Current Status and Progress Made. A review of integrated day services was completed by the Monitor and an Independent Reviewer in December 2016. The assessment involved an in-depth examination of the integrated day services furnished to a sample of 21 individuals by 11
12

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 13 of 41 PageID #: 3018
separate provider agencies. Findings of the review and related recommendations were included in the Addendum to the Consent Decree Compliance Report issued by the Monitor on February 10, 2017. The report concluded that the State was not in compliance with this provision of the Consent Decree. Recommendations emphasized the State’s need to make significant improvements in person centered practices, planning and service delivery by: (a) supporting self-direction, (b) improving staff training, oversight and program standards, (c) reviewing and modifying current resource methodologies, (d) developing a clear linkage between personcentered planning and resource allocation (e) beginning implementation of the above recommendations with PCSEP program participants. A subsequent report, issued by the Monitor six months later on July 27, 2017 found the State was not yet in compliance with this provision, concluding that although progress had been made in some areas, in the majority of cases integrated day services did not reflect the characteristics outlined in Section VI(B)(1-6) of the Consent Decree. It was again recommended that the State work with service providers to facilitate the development of person-centered integrated day services for individuals participating in the PCSEP program as a way to move forward in this area.
Context. The Sherlock Survey report1 provides information on the numbers of individuals in each Consent Decree Target Population who receive Community Based Non-Work supports (CBNW). This category includes all services that are delivered in the community, rather than in a facility, that are not directly employment related. The definition of CBNW is broader than the criteria for integrated day services detailed in the Consent Decree. The Sherlock Survey data on CBNW services participation is offered here to describe the context within which communitybased day services are provided, the extent of individual participation and the general nature of activities involved. Accurate data on the numbers of Consent Decree target population members who are engaged in integrated community-based activities, as described by Consent Decree section VI(B)(1-6), is not yet available.
The Sherlock Survey gathers and reports detailed data on the activities being chosen, the community settings being used and the length of time or tenure that individuals are engaged community activities. Data for the Quarter ending September 30, 2017, the most recent available, indicates that 2,008 target population members (86% of the total) participated in integrated day services during the quarter ending September 30, 2017: 502 from the Sheltered Workshop Population; 1,233 from the Day Target Population; and 273 from the Youth Exit Population. Data indicated target population members typically receive integrated day services and supports in a variety of community settings and venues. The majority, 97%, take place in public venues such as libraries while approximately 24% occur in business or employer settings, almost 15% take place in member-based organizations such as the YMCA, a little over 4% occur in senior centers, and almost 3% utilize a school or training facility.2 The majority of individuals
1 Progress Report to DOJ and Court Monitor Q 2017-3, Issued 12/15/17. Sherlock Center on Disability, Rhode Island College 2 Percentages reflect the frequency of use. Individuals may participate in activities in more than one setting.
13

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 14 of 41 PageID #: 3019
participating in community based non-work activities are reported to average approximately 12.35 hours per week in one or more settings.
The number of target population members engaged in integrated day services (2,008) is more than three times greater than the number of individuals receiving supported employment services (638). The Consent Decree requires the development of integrated community day services and opportunities for target population members, just as it requires the expansion of supported employment placements and employment opportunities. The State has made progress on improving access to employment services, strengthening funding through the PCSEP initiative and expanding technical assistance and oversight of supported employment services and placements. Similar concentrated efforts need to be devoted to assisting providers in making the transition to integrated and self-directed day services.
Training. Training and direct technical assistance continues to be provided by the Sherlock Center, the Conversion Institute and the Division addressing items a - d identified above. These include instruction to providers on self-direction and self-determination as an essential component of person-centered practices and ongoing training opportunities led by experts in the field on: Developing Community Connections and Supports (Carter and Amado, November 2728, 2017); Establishing a Framework for Investing in People (Patti Scott and David Hasbury October 24, 2017); and Building a Person-Centered Infrastructure (Patti Scott and David Hasbury, October 23, 2017). Principles and Standards for Integrated Day Supports were released by DDD in September 2017 and are being implemented. The new standards set the expectation that individuals with IDD receiving state supports, “…should receive the supports they need to pursue meaningful and productive lives and achieve full integration and inclusion in society through relationships and work, in an individualized manner, consistent with the unique strengths, resources, priorities, concerns, and abilities of each individual.” The guidance provides an overview of the nature and purpose of integrated day services, a description of the four key principles guiding service delivery and program standards clarifying the State’s expectations regarding the services provided and outcomes to be achieved. DDD is developing quality improvement processes to assess and improve providers’ adherence to these standards (see Section F below).
Funding. DDD’s SIS based resource allocation system generates a level of funding for each individual based on a standardized assessment of the person’s support needs. The personcentered planning process identifies the services the individual will receive that reflect his/her/their needs and preferences. The extent of support that a person can access is limited not only by the total amount of the allocation, but also by the type, nature and costs (billing rates) of the services selected. Several providers report that additional limitations imposed by the State’s billing and reimbursement rules for day services make it virtually impossible for them to estimate future billings and receipts with confidence. As a result, they hesitate to deviate from traditional facility-based and group-based patterns of day service organization. This situation appears to be exacerbated by the State’s quarterly authorization and cost reconciliation process which limits providers’ ability to absorb financial risk by managing
14

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 15 of 41 PageID #: 3020
expenditures due to unanticipated changes in participants’ service needs or cyclical costs that may occur over the course of the fiscal year.
While many providers express frustration with DDD’s billing and reimbursement process, several appear to be managing the payment process effectively, indicating that they are routinely able to draw down most of their allocations. DDD has revamped the funding process for supported employment services through the PCSEP program. A similar analysis needs to be performed regarding the strengths and weaknesses of the current funding model and documentation requirements with respect to the delivery of integrated day services.
Visits to provider agencies and reviews of services conducted by the Monitor during the latter half of 2017 up to and including the most recent site visit conducted on February 26-28, 2018 identified trends in the provision of non-work integrated day services, as well as promising practices throughout the DD service delivery system. As noted in previous progress reports, integrated day services are provided in a variety of configurations. Increasingly, providers are relying less on facility-based day activities and shifting towards supports to individuals in relatively small groups of 3 to 8 persons. Typically, individuals take part in a relatively narrow range of activities that are selected from pre-set lists or menus that vary by the day, week or month. Although these activities take place in the community in the presence of individuals without disabilities, they generally are non-participatory; people attend a community event, visit the zoo, walk through or have lunch in a park, go to a restaurant for coffee, spend time in the local library or in stores in the mall. These visits may improve individuals’ knowledge of community options, but they do not expand the person’s social network or engage the individual in a meaningful and productive involvement with people without disabilities. A comprehensive assessment of the extent to which integrated day services, as described in the Consent Decree, are being furnished to target population members by providers statewide has not yet been completed. The evidence from individual program reviews that have been conducted to date, however, strongly suggests that in the majority of cases community-based activities are not designed and selected by the individual through a person-centered planning process and the community day services being offered do not reflect all of the integrated day services characteristics required by the Consent Decree.
While integrated day services need to be improved generally, it is important to note that individualized, productive and integrated day supports that do meet Consent Decree requirements are being furnished by several agencies across the state. Many of these providers offer day services only in integrated settings and have taken steps to ensure that individuals receiving support are fully engaged in decisions regarding the activities that they will participate in during the day. Some individuals are living self-determined lives and, with support from staff when needed, are volunteering in local agencies or joining community organizations. Many engage in both individual and group activities of their own choosing over the course of the week and are supported in determining what it is that they do every day and what role the service provider will play in their lives.
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While the goal is yet to be fully realized, several DD agencies throughout the State are making progress in their efforts to support individuals in truly integrated and meaningful day activities. As noted above, the Conversion Institute, is bringing in national thought leaders to provide training to providers on the design and delivery of integrated day supports. This very important activity needs to continue, but it is essential that the State also highlight and disseminate information on the innovative and promising practices that are taking place within provider agencies across the State.
Assessment: Requirement Not Met. Integrated day services are not yet meeting the requirements of the Consent Decree. Key areas that need to be addressed include the expansion of person-centered practices and planning, the resolution of day service related financial barriers associated with billing and reimbursement, and the identification and sharing of information on promising practices currently being used by provider agencies.
Recommended Actions: It is recommended that DDD, in collaboration with relative State agencies, take the following actions to achieve further progress in this area:
1. Fully implement person-centered practices in individual service planning, career development planning and throughout the delivery of integrated day and employment services (see Section C below);
2. Perform an analysis of the strengths and weaknesses of the current funding model and documentation requirements with respect to the delivery of integrated day services. Assist service providers in developing effective methods and strategies for planning, managing and predicting day services costs and reimbursements;
3. Collaborate with the Conversion Institute, in the development of implementation strategies for provider agencies that result in day services that reflect the day service characteristics outlined in the Consent Decree.
4. Identify and publicize promising practices that are currently being employed by RI provider agencies.
5. Fully address the recommendations made in each of the two previous Monitor’s Consent Decree progress reports issued on February 10, 2017 and on July 27, 2017 to implement the changes and activities identified in 1-4 above on a pilot basis with individuals who are receiving employment services through the PCSEP program beginning April 1, 2018. DDD is further requested to report to the Monitor quarterly on the development of the pilot and the progress made on each item.
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C. Career Development Planning and Benefits Planning (Consent Decree §VII)
Benchmark 1 - Person-Centered Planning. Person-Centered Planning (PCP) is described by the Consent Decree as, “the formal process that organizes services and supports around a selfdirected, self-determined and goal directed future…” (§IIA[8]). It is the foundation on which target population members and their teams identify each individual’s strengths, needs and preferences and the focus and direction of the services to be provided and received. Personcentered planning forms the basis for the development of the Career Development Plan, the Individual Support Plan and the Individual Education Plan (CD §IV[1]&[3]; §VII[5]). It guides the selection and design of integrated day services (CD §VI[4]), the use of vocational assessments and eligibility (CD §VII[2]), and school to adult service transition planning (CD §VII[7]).
Current Status and Progress Made. DDD has expressed its commitment to establishing personcentered planning and person-centered practices as the foundation of service delivery across state and community partners. Working in collaboration with the Sherlock Center and Advocates in Action, DDD held 16 community forums from April 2017 through August 2017 to assist people in understanding the core values of person-centered practices, and to gather input from community members. These meetings, along with additional research on person-centered practices by the Sherlock Center, statewide trainings organized by the Conversion Institute, and a series of five statewide workshops led to the development of a draft Person-Centered Thinking Guide. The Guide reflects the involvement of key stakeholders including the RI Developmental Disabilities Council, Advocates in Action, families, the Community Provider Network of Rhode Island, independent providers and the Employment First Task Force. It is designed to be used by providers and families to better understand and participate in the person-centered planning process. DDD plans to establish a training program for personcentered planning facilitators and to provide opportunities to test and refine the personcentered thinking process.
The Division developed a standardized Career Development Plan Quality Rubric to guide its assessment of person-centered career development plans and planning activities taking place in provider agencies across the state. DDD reports that the tool will be used to review the alignment of individuals’ goals across their ISPs and CDPs, to evaluate quality and to provide a basis for quantitative measurement. The Rubric additionally will provide the basis for training and feedback to providers and plan writers.
DDD is engaging with consumers, families and stakeholders to promote a full understanding of the nature and importance of person-centered planning and practices. A recent report to the Monitor from the Employment First Task Force (EFTF) noted although people recognize the benefits and importance of person-centered practices some resistance exists from individuals receiving services and families who see the activity as another layer of bureaucracy that could take funding away from needed services. Others expressed concern that providers may not be
17

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 18 of 41 PageID #: 3023
able to furnish all of the supports identified through the planning process. The Task Force made several recommendations, some of which are already being addressed by DDD. Among these recommendations are: (a) continuation of the Sherlock Centers’ Person-centered Thinking training series that is available to individuals with disabilities, families and stakeholders, (b) the dissemination of a clear and direct communication strategy informing people of the changes taking place and timelines for implementation including the roll out of “conflict free” person directed planning, (c) making person-centered planning tools and training widely available, (d) identifying a new funding stream for person-centered planning activities, and (e) enlisting community groups such as Advocates in Action, the Cross Disability Coalition, Rhode Island Parent Information Network (RIPIN) and Rhode Island Families Organized for Reform, Change and Empowerment (RI-FORCE) a new parent advocacy group. The State is meeting regularly with the EFTF to discuss and respond to these and other recommendations.
Assessment: Requirements Not Met. The use of person-centered planning is expanding but is not yet the norm throughout the service system. DDD is making substantive progress in accomplishing this outcome though ongoing training and the establishment of a Rubric to guide the evaluation of person-centered planning. Working in collaboration with the Sherlock Center Conversion Institute, the Division is involving people with disabilities, families, advocates and providers in the development of a broad understanding of the principles of person-centered thinking and the application of person-centered practices and planning tools in the design and delivery of services.
Benchmark 2 – Career Development Plan Outcomes. Person-centered Career Development Planning (CDP) is required to be provided to each member of Youth Exit, Sheltered Workshop, Youth Transition and Day Target Populations consistent with the requirements of the Consent Decree (§VII) and the Youth Transition Target Population (§VIII).
Current Status and Progress Made. The State continued to increase both the numbers and percentages of target population members with Career Development Plans (see Table 3). The total number of target population members with Career Development Plans grew significantly during the past year from 1,983 individuals on December 31, 2016 to 3,248 individuals on December 31, 2017, an increase of approximately 64%. The Consent Decree benchmark was fully met for all members of the Youth Exit, Sheltered Workshop and Day Target populations. CDPs were in place for 89% of the Youth Transition Population. The 71 Transition Population members without CDPs are primarily new students who will receive their CDPs during the school year as well as a number of individuals who left the state after engaging in services. Documentation of the status of CDPs for Youth Transition Target Population members is filed at the end of each school year and generally is not available until in July. RIDE provided data on the total number of Transition Target Population members with completed plans and identified the 71 members of this population whose plans will be complete at the end of the school year or are not included for other reasons. If plans are completed as scheduled the benchmark for this population will be met.
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Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 19 of 41 PageID #: 3024

Assessment: This requirement was met for the Youth Exit, Sheltered Workshop and Day Target Populations. The requirement is provisionally met for the Youth Transition Target Population pending confirmation by RIDE in July 2018.

The lag in reporting data on the status of career development plans for Youth Transition Population members is a structural barrier that reoccurs every year. RIDE does not receive the data from the various school


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districts until the end of the school year in June. The Department identifies new students

entering, and leaving, its system each year and their receipt of required career development

planning. RIDE is requested to provide the Monitor with an accurate count of the number of

individuals with CDPs by July 31, 2018.

Compliance reviews conducted in subsequent months will focus on: (a) the quality of Career Development Plans, (b) the extent to which the goals and provisions of Career Development Plans align with the goals and provisions included in Individual Support Plans, and (c) the extent to which individuals’ personal goals, objectives and service preferences are reflected in the supports and services they receive.

Benchmark 3 - Benefits Planning. Youth Exit, Sheltered Workshop and Day Target Population members are required to receive benefits planning and information no later than the year in which the person is scheduled to transition to a supported employment placement. The number of Target Population members with benefits plans should be roughly equal to the number of individuals who are employed.

Current Status and Progress Made. Benefits Plans were reported to be in place for 423 target population members as of December 31, 2017, an increase of approximately 33 individuals over the previous quarter ending September 30, 2017. The total number of individuals with Benefits Plans represents 69% of the benchmark for all three target populations combined (See Table 4).

19

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 20 of 41 PageID #: 3025

Approximately 255 individuals with benefits plans were reported to be working in a supported employment placement. As indicated in Table 4, 137 of the Youth Exit Target Population members (77% of the benchmark) have a benefits plan in place. A benefits plan has been prepared for 136 members of the Sheltered Workshop Target Population (81% of the benchmark), and for 150 members of the Day Target Population (55% of the benchmark).

In response to the Court’s Order issued June 23, 2017 regarding the Interim Settlement Agreement (ISA) DDD increased the amount of its contract with the Rhode Island College Sherlock Center by up to $100,000 to expand the availability of Benefits Counseling to approximately 275 individuals. These funds support an additional 5 part-time benefits planners, each providing up to 19 additional hours per week. These services augment benefits planning services provided by ORS.

As noted above, 423 of 617 individuals have benefits plans on file. Of the remaining 194 individuals approximately 143 were referred to the Sherlock program for benefits counseling. As of December 31, 2017, plans have been completed for 14 individuals with another 61 in process. DDD reports that steps are being taken to centralize the referral and tracking process and better coordinate activities with ORS and with the Department of Human Services (DHS). Requests to DHS for confirmation of the state benefits received by Consent Decree target population members were delayed in prior months, causing further delays in the completion of individual’s benefits plans. DDD reports that its efforts to resolve the bottlenecks have been successful and further processing and reporting problems are not anticipated.

Assessment: Requirement Not Met. The numbers of individuals in each Consent Decree Target

Population without needed benefits plans and counseling continues to fall short of the required

benchmarks. The State is making progress in this area, however. With funding from DDD and a

federal grant from the U.S. Department of Social Security’s Work Incentives Planning and

Assistance (WIPA) initiative, the Sherlock Center is actively working to reduce the backlog of

referrals in DD provider


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This provision of the Consent Decree outlines essential activities and requirements that are designed to create a bridge to facilitate the passing of Target Population members from school to employment, adult services and a meaningful life in the community. Benchmarks require

20

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 21 of 41 PageID #: 3026

RIDE to develop and implement an Employment First Policy making work in integrated community settings the first and priority service option for transition age youth interested in employment and vocational activities (§VIII[1]). Additional provisions call for the establishment of interagency agreements between RIDE, ORS and DDD (VIII[2]), the involvement of the three State agencies in career planning teams (VIII[3]), a transition process beginning at age 14 years (VIII[4]), person-centered career development planning, vocational assessments in integrated settings and others.

Current Status and Progress Made. A complete assessment of this section will occur in

subsequent reports. During the current reporting period DDD, RIDE and ORS have

strengthened their collaboration across a number of areas, expanding involvement and

communication with schools and the school system, state agencies, community organizations,

advocates, and with families and individuals receiving supports. As noted in previous reports

of the Court Monitor, in 2016 DDD instituted an “Eligibility by 17 Policy” in response to

Consent Decree provisions requiring that students receive a comprehensive introduction to or

enrollment in State services by age 16 years (VIII[4][a]) and facilitate eligible individuals to

access State services, including supported employment services, by age 18 years (VIII[9]). DDD

entered into contracts with the

Rhode Island Parenting

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policy and reports that the family to family contacts are resulting in an earlier engagement with

DDD. This data, as reported by DDD in Figure 1, suggests that families and individuals with

IDD are applying for DD services at a younger age. The chart shows the percentage of eligibility

applications received by DDD between January 2017 through January 2018 for 316 individuals,

spread across in each of five age groupings, 16 through 20 years of age. In summary, the data

over the three time periods show increasing numbers of applications being received from

younger individuals aged 16, 17 and 18 years and decreases in the number of applications

received for individuals 20 years of age. This is a positive trend that should result in a more

21

Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 22 of 41 PageID #: 3027
predictable transition for students with disabilities and their families from school to the adult system.
DDD, ORS and RIDE are collaborating in the provision of training and technical assistance across the three systems. DDD provides an introduction to adult services with the Local Education Authorities (LEA) each year along with ORS representatives. ORS RIDE and DDD representatives including RIPIN participate in RIDE’s Transition Advisory Councils including the State Council, Regional Councils and Local Councils.
Assessment Deferred. The State has continued to make progress in the development and implementation of effective and responsive services for Youth in Transition. Progress on this provision will be address in future Consent Decree reports.
E. Provider Capacity (Consent Decree XI)
Benchmark 1 – Ensuring Provider Capacity. The State, including BHDDH and ORS, will ensure that it supports and maintains a sufficient capacity to deliver Supported Employment and Integrated Day Services to individuals in the Rhode Island Sheltered Workshop, Rhode Island Day Program, and Rhode Island Youth Exit Target Populations, including qualified supported employment providers and integrated day providers, consistent with the terms of this Consent Decree (CD §XI[1]).
Current Status and Progress Made. DDD issued a report on July 19, 2017 summarizing the four actions the Division was taking to address provider capacity issues: (a) improve the understanding of what and where capacity is needed, (b) provide a vision for the IDD system of services in terms of person-centeredness, integration, and community-based supports, (c) determine providers’ needs for developing capacity and transitioning to fully integrated, community-based services, and (d) address institutional barriers within DDD that affect both provider capacity and consumer access to supports. The Division has made progress on addressing the policy and practice related issues and challenges outlined in items (b), (c) and (d).
The Division has not, however, developed data collection strategies and formats for producing regular reports on the current capacity of provider agencies and the extent to which the provider system will be able to serve increasing numbers of individuals in the years ahead. Families and advocates report that many provider agencies turn down individuals’ applications for services or are unable to respond in a timely manner, citing barriers related to insufficient funding, inability to serve individuals with complex or challenging conditions, workforce shortages - inability of the provider agency to recruit and maintain needed staff, internal limitations on the size of the organization or the number of individuals served, or other reasons.
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DDD has gathered and reported to the Monitor information from state social caseworkers on the number of referrals made to a group of provider organization, the number of individuals who have been accepted, the number of individuals refused by providers, the reasons for the refusal and other data. But the caseworkers experience generally is limited to only the individuals with whom they have been directly involved. Also, individuals and families typically apply to several agencies and may or may not follow up with each making it difficult to avoid duplicate counts. For a number of legitimate reasons, the data that has been gathered is, for the most part, incomplete and unreliable.
Assessment: Requirements Not Met.
Recommended Actions. DDD is requested to collaborate with provider agencies in the development of a format and methodology for gathering and reporting on a quarterly basis provider or systems level data on the capacity of providers to accept supported employment and integrated day services referrals. It is recommended that the following data be gathered for each of the two services: (a) the number of referrals received, (b) the number of referrals accepted, (c) the number refused, and (d) the reasons for refusals. Ideally, this information would be provided by each provider agency but systems level information on provider capacity may also suffice. DDD is requested to prepare and submit a plan to the Monitor on the databased approach it proposes to use to determine and regularly review provider capacity by April 30, 2017.
F. Funding (Consent Decree §XIV)
The State shall timely fund the services and supports necessary to comply with the Consent Decree for the eligible members of the Sheltered Workshop, Day, Youth Transition and Youth Exit Target Populations according to the standards and timelines set forth in the Consent Decree (CD §XIV(3).
Current Status and Progress Made. Funding furnished by the State to support DD services and Consent Decree compliance during the current FY2018 fiscal year resulted in marked progress being made across several key outcome areas (see above). Data from the RI Office of Management and Budget3 indicates that additions to the enacted total budget for DD services of $256,907,760 (State + Federal Funds) resulted in a revised FY2018 budget amount of $272,207,664, an increase of $15,299,904 dollars. The level of financial commitment for DD services in FY 2018, however, was not maintained in the Governor’s proposed budget for FY 2019. Recommended funding for DD services and supports for FY 2019 dropped to $250,808,432, approximately $6 million dollars less than the enacted 2018 DD budget and a
3 State of Rhode Island and Providence Plantations Department of Administration Office of Management and Budget FY 2019 Budget Technical Appendix, Health and Human Services Department of Behavioral Healthcare, Developmental Disabilities and Hospitals p. 174.
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reduction of $21,399,232 from the final revised budget reflecting the Division’s level of expenditures in FY 2018.
DD funding reductions in the proposed DD services budget are significant. The State’s FY 2019 budgeting process is not yet complete and changes in departments’ final funding allocations are likely to be made in the months ahead. It must be clearly understood, however, that the FY 2019 recommended budget raises the potential of serious underfunding for developmental disabilities services and that such underfunding will have a significant impact on the State’s ability to comply with the requirements of the Consent Decree and the ISA.
The effect of the proposed budget reductions on individuals receiving support was addressed by BHDDS and DDD staff during a quarterly community forum providing held on February 26, 2017. At this meeting Becky Boss, BHDDH director, is reported to have acknowledged the potential impact of such a large cut and offered assurances that the Executive Office of Health and Human Services and BHDDH were committed to ensuring that funding for DD services would meet the needs of the individuals receiving support and that the State has no intention to cut services or reduce rates to service providers. These assurances will be closely monitored in the weeks ahead.
Additional funding barriers and restrictions that are having an impact on Consent Decree target population members come from ORS. In October 2017, ORS was informed that the federal Rehabilitation Services Administration (RSA) was severely decreasing the amount of federal funding it was providing to Rhode Island, dropping its allocation from approximately $3.6 million to $532,000. ORS reports that it does not expect that RSA will restore the lost funding during in FT 2019. This reduction in funding forced ORS to institute a waiting list for services. Currently 30 members of the Consent Decree target populations have been waitlisted for services out of the total of approximately 399 waiting list members. DDD is streamlining its intake process to ensure target population members, including all waitlisted individuals receive immediate access to employment and other related services as required by the Consent Decree and the Interim Settlement Agreement (ISA). At this point in time it does not appear that target population members are being denied access to the services and supports necessary to comply with the Consent Decree.
The loss of approximately $3 million in total ORS funding, combined with the potential of significant cuts in the State’s 2019 budget for DD services of up to $21.4 million (revised DD 2018 budget vs. recommended 2019 budget) will, if enacted, seriously erode the State’s efforts to comply with Consent Decree and ISA requirements. The Court Monitor will closely follow the State’s legislative budgeting process and will keep the Court and the Department of Justice apprised of financial actions that have the likelihood of effecting the State’s ability to continue to meet its obligation to “timely fund” the services and supports necessary to comply with the Consent Decree and the ISA.
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Assessment: Requirements Met. To date the State has met the provisions of Consent Decree Section XIV for the current reporting period. The State has taken steps to increase and better target funding provided through the performance based PCSEP funding initiative for supported employment services. Overall, current funding appears adequate to achieve Consent Decree performance requirements related to the expansion of supported employment services and the achievement of supported employment placement benchmarks for three of the four target populations. The adequacy of funding for individualized integrated day services is less clear. As noted above, integrated day services typically are provided in groups of 3 to 8 individuals who engage in community activities or visit a variety of local businesses over the course of the week. The majority of providers additionally offer individualized person-centered and self-directed services to a relatively limited number of individuals to assist them in engaging in community activities. The general consensus among provider agencies appears to be that the current funding structure and billing methodology limits their capacity to transition away from group models, convert existing programs and expand access to fully communitybased alternatives. This issue will be examined in more detail in future progress reports.
Recommended Actions
The Monitor intends to closely follow the progress of the State budget for DD services through the budget development process and will file regular reports with the Court regarding the funding decisions being made and their anticipated impact on services provided to Consent Decree target population members. The State Consent Decree Coordinator is requested to collaborate with the Monitor on the development of an effective strategy for completing this activity.
G. Quality Improvement (Consent Decree § XV)
Benchmarks 1-3. The Consent Decree requires the State to develop and implement a statewide quality improvement initiative to ensure supported employment services and placements, and integrated day services are developed in accordance with Consent Decree Sections V-VI, to evaluate the quality and quantity of employment and day services provided, and to ensure members of the target populations receive supported employment placements and day services that are adequate and sufficient to achieve integration, increased independence and increased economic self-sufficiency. To accomplish these objectives, Consent Decree Section XV identifies three broad requirements regarding Quality Improvement (QI): (a) the development and implementation of a statewide quality improvement initiative (§XV[1]), (b) the establishment of detailed program standards (§XV[2]), and (c) the implementation of a plan to ensure the provision of regular on-site reviews, reports and follow-up reviews (§XV[3-5]). The Consent Decree required the statewide quality improvement initiative to have been developed and implemented by November 1, 2014.
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Current Status and Progress Made. The Consent Decree Compliance Report issued on July 27, 2017 identified a number of actions DDD is taking to establish needed infrastructure, write program standards and guidelines, and to build its capacity to monitor and improve service quality. The following is a summary of activities that have taken place through December 31, 2017.
DDD
1. Establishment of an organizational structure to support a DDD Quality Program within BHDDH.
DDD prepared a Quality Improvement Plan with near and long-term goals and objectives to guide and track its development of the required quality improvement initiative or program. The Plan identifies the actions that will be taken by the Division as well as a timeline for completion by mid-2019. Included action steps address goals related to the development of an organizational structure for DDD and BHDDH quality improvement activities; the establishment of a quality review program for DD provider agencies; the finalization of quality related regulations, policies and standards; the need to improve data collection and reporting; and the need to strengthen communications, increase transparency and improve the availability of information to the public (Attachment 2). DDD’s adherence to these benchmarks will be assessed in future reports.
a. Organization – DDD established an internal Quality Improvement Committee to guide planning, recommendations and improvements in communication across the department. The group meets with the Department’s Regulations Review Workgroup to coordinate activities and policy related decisions. According to DDD’s Quality Improvement Plan (QI Plan), clear areas of staff responsibility as well as procedures for BHDDH functions in QI licensing and DD quality assurance will be completed by June 30, 2018 as a part of an ongoing process to identify improvements in licensing, certification and program reviews. The final coordinated process for licensing, certification and program reviews will be completed by July 1, 2018 (see QI Plan Goal 1, Objectives 1S-A, 1S-D, and 1L-D). These projected timelines for completion are appropriate. It is noted, however, that the QI Plan does not provide for the determination of the need and feasibility of a quality improvement entity or unit responsible for assuring the quality of DD services until June 30, 2019 (Goal 1, 1L-A), nor does it describe the duties and responsibilities of that entity. The current need for clear direction in this area is significant and should not be delayed. DDD/BHDDH are requested to review this completion deadline for this objective and to move it forward to not later than September 30, 2018.
b. Staffing – DDD’s lack of sufficient staff to carry out required QI development and oversight activities was identified as a critical issue in previous Consent Decree and
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ISA compliance reports. Insufficient staff resources continue to be a major barrier to meeting the requirements of this provision. The Associate Director for Program Performance has responsibility for the management of QI activities, along with several other responsibilities for data collection and reporting, training and other duties (1 FTE - Full Time Equivalent position). During the current reporting period one BHDDH position was temporarily assigned to DDD to assist in program analytics and program management (.5 FTE). An additional part time assistance is being provided by the Office of Health and Human Services (OHHS) to assist with data analysis (.25 FTE). The total number of staff assigned to participate in quality improvement activities is 1.75 FTE, far short of the number needed to carry out this function as required by the Consent Decree and the Interim Settlement Agreement (ISA).
QI Plan goal 1S-C states that DDD will identify a minimum of two BHDDH positions in FY 18 to expand quality management related to provider and system performance by June 30, 2018. The temporary assignment of staff who have other competing responsibilities will assist DDD in accomplishing some of its QI related activities but is not sufficient to meet the operational requirements of the Consent Decree and ISA. As noted in previous reports, Section XV requires the State to regularly conduct onsite reviews of integrated employment and day programs to evaluate the services provided against the program standards under the Agreement. At a practical level, accomplishing a full review of each of the approximately 38 DD provider agencies on a regular basis at a minimum of once every two years would require that one to two DD provider organizations would need to be reviewed and reported on each month. The required in-depth assessment of the quality of programs, services and individual outcomes cannot be accomplished at current staffing levels. Additional personnel resources need to be devoted to this activity.
2. Establish a quality review program for DD providers.
a. QI Reviews. DDD is participating in quality reviews being conducted by ORS. DDD reports that the Division’s Associate Directors for Program Performance and Employment joined ORS staff in two reviews conducted during the current reporting period. This information varies from that reported by ORS which indicates that BHDDH and ORS collaborated on reviews of six agencies: CWS, Work Opportunities Unlimited, RHD, Fogarty Center, LIFE Inc., and Access Point RI and that quality improvement plans were developed for five agencies with one in progress. Copies of reviews were not furnished to the Monitor as requested on January 24, 2018 but have since been provided. No information was provided on the numbers of Consent Decree target population members interviewed or the numbers of records that were reviewed. No information was provided on any corrective actions or follow-up assessments that might have been required. DDD notes that
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structured oversight and technical assistance are provided by DDD as a part of the Division’s PCSEP program but did not furnish reports of the meetings, review findings or details on the technical assistance provided. Information on provider reviews DDD has completed, and other related QI activities needs to be provided to the Monitor in the Division’s quarterly reports (see below).
b. Establishing a QI Program. DDD developed and is implementing a Rubric or assessment tool to evaluate the quality of person-centered planning in provider agencies. The Division also prepared separate Self-Employment Standards to guide the delivery of employment services to individuals engaged in self-employment activities. DDD also entered into a contract with Gail Grossman, a national expert on quality improvement in DD services to provide technical assistance to the Division on the development of its quality improvement program. Under the contract Ms. Grossman provides advice to DDD on the development of a new structure for quality improvement including reporting, identifying data needs and use, and the development of policies, procedures and standards linked to licensing and regulation. The consultant also will assist DDD in developing a quality review process for day and employment services as well as establishing stakeholder advisory councils and consumer satisfaction surveys.
The involvement of the national expert provides needed expertise to the Division in its efforts to build the required quality improvement system. The Division’s QI Plan outlines a wide scope of activities that need to be accomplished but furnishes little information on the intended design of the program model within which the various policies and practices will operate, nor does it indicate the individuals or entities responsible for carrying out each function. This program model would provide the essential framework within which the Division carries out its coordinated processes for licensing, certification and program reviews (Goal 1L-D – July 1, 2018), develops and monitors plans of correction (Goal 2L-C), and utilizes assessment tools for monitoring reviews (2L-B; 2S-E and 2S-F).
The QI Plan states that DDD will complete development of its monitoring tool by August 1, 2018 (Goal 2L-B) and will establish procedures for the development and monitoring of provider plans of correction by August 1, 2018. The Division then plans to begin conducting consultative reviews with provider agencies on September 1, 2018 during the year following the promulgation of regulations to give time for provider agencies to become familiar with the process (Goal 2L-D; September 1, 2018 -September 1, 2019). DDD proposes that formal provider reviews commence on July 1, 2019.
3. Finalize QI regulations, policies and standards.
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DDD developed and distributed guidelines and standards for integrated day services. A regulations workgroup within BHDDH produced and distributed updated draft regulations in January 2018 with promulgation slated for early 2018. A certification workgroup was launched in December 2017. Provider certification criteria based on the standards are under development. The standards will be used as the basis of a provider self-assessment DDD will be conducting to gain baseline information on the current nature and status of integrated day services. The Division’s Quality Improvement Plan sets benchmark dates regarding key activities in this area including developing and promulgating new regulations establishing clear standards and foundational principles (Goal 3S-B, February 2, 2017), developing a policies and procedures manual (Goal 3L-A, (July 1, 2018), and revising day program and employment standards to reflect final regulations and policies (Goals 3LA & B, July 1, 2018).
4. Improve Data Collection, quality and reporting.
In December 2017, BHDDH awarded a contract to Therap Inc. for the development and implementation of a comprehensive IT system including case management documentation, the gathering, reporting and tracking of individual and systems performance data, and the establishment of a quality management information (QMIS). BHDDH hired two project managers/business analysts to support this effort. Completion of the project is anticipated in 2019.
5. Improve communication and the quality, transparency and availability of information for stakeholders.
DDD has met monthly with the Quality Advisory Council including key stakeholders with the goal of improving and expanding communication and access to information. The Council will assist in developing standards for the individual service plan that align with person-centered planning guidelines currently under development by the Sherlock Center.
ORS
ORS’ internal Continuous Quality Improvement committee (CQI) reviews quality with respect to provider agencies’ policies, practices and service delivery. A subcommittee of this group monitors vendor performance including staff competencies, practices, reporting, service delivery and overall capacity. Future plans for the subcommittee are to include in the review process provider credentialing and, in collaboration with DDD and RIDE, career development plans to ensure that person-centered planning methods are being utilized.
ORS reports that six provider reviews were conducted with DDD between October and December 2017 (see above). CQI reviews were completed on all sites and quality improvement plans were prepared for five of the six programs. As noted above, conflicting data have been
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presented by DDD and ORS on the number of provider quality reviews that have been jointly conducted by the two state agencies. An explanation for this discrepancy has been requested but not yet received. ORS Counselor Liaisons meet with provider agencies on a quarterly basis using a reporting format that is similar to the one used by DDD to asses PCSEP programs. The ORS Assistant Administrator for Supported Employment attends DDD’s monthly PCSEP strategy meetings with providers to evaluate progress on goals, placements, obstacles to service delivery, service planning, best practices, fiscal concerns and related topics. ORS does not provide discreet reports of reviews of provider agencies that clearly identify essential activities related to the discovery of deficiencies, the actions that agencies are required to take to come into compliance and further remediative steps that may need to be taken by the provider agency.
RIDE
Working in collaboration with the Regional Transition Centers (RTC’s), RIDE continues to conduct on-site quality reviews on an annual basis using the RI Employment First Quality Review Checklist to assist in identifying barriers, deficiencies, gaps and additional training and technical assistance needs. As mentioned in the June 2017 Quarterly report, RIDE in collaboration with the RTC’s, conducted a TLS Member Needs survey to assist in Employment First Planning for the 2017-2018 school year. This survey resulted in the identification of training needs and the provision of training in five key areas:
1. Continued TA for students with the most significant disabilities (sub-TLS) 2. Linking the IEP, CDP, IPE 3. Improving connections between LEAs and adult vendors 4. Continued Job Coaching and Job Development training 5. Continued job coaching and job development training
RIDE reports that the Career Development Planning Rubric has become an effective tool for districts to evaluate and improve upon the quality of student’s CDPs as well as for professional development. The RTC’s, in collaboration with ORS Transition Administrator, conducted the first training on ‘Alignment of the CDP, IEP and IPE’. A repeat of this session occurred January 2018 and the RTC’s provided written invitations to providers to become part of the Regional Transition Advisory Committees that meet six times per year.
Assessment: Requirements Not Met. ORS has a quality review team with protocols in place to ensure regular quality improvement visits take place with employment services providers. ORS is not, however, producing regular published reports of their quality improvement visits, identifying deficiencies, determining the need for plans of correction, and describing the actions that the program must take to come into compliance, as required by the Consent Decree. DDD developed a Quality Improvement Plan and is actively engaged in completing several specific
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goals and activities relative to the development of the capacity to provide quality improvement as described in the Consent Decree and Interim Settlement Agreement. DDD is not routinely conducting quality reviews and quality improvement reports as required by Section XVI. RIDE continues to meet Consent Decree requirements regarding the development and implementation of the department’s Quality Improvement Initiative.
Recommended Actions
1. DDD’s Quality Improvement Plan does not provide for the determination of a quality improvement entity or unit responsible for assuring the quality of DD services until June 30, 2019 (Goal 1, 1L-A), nor does it describe the duties and responsibilities of that entity. Similarly, the Plan provides little information intended design of the program model within which the various policies and practices will operate, nor does it indicate the individuals or entities responsible for carrying out each function. The current need for clear direction in this area is significant and should not be delayed.
DDD/BHDDH are requested to (a) identify and describe the composition, structure, duties and responsibilities of the quality improvement unit or entity by June 30, 2018; (b) advance the deadline for establishing the QI unit or entity forward to a date not later than September 30, 2018. It is further requested that the status of these activities be reported to the Monitor when complete and summarized in the Division’s quarterly report for the period ending June 30, 2018.
2. The development and appropriate vetting of regulations, standards, policies and guidelines takes time, but the efforts devoted to these activities do not take the place of the State’s obligation to ensure the quality of the services provided target population members in the meantime. As noted above, DDD has no routine or standardized procedures in place for conducting regular quality reviews of individual’s service plans, career development plans, services received, or outcomes achieved, as required by Consent Decree Sections V, VI, and VII. The Division plans to prepare all necessary policies and procedures, develop guidance on the new review process for providers on August 1, 2018 and begin consultative reviews of provider agencies by September 9, 2018. The severe lack of adequate staffing in this area raises serious questions regarding the Division’s ability to complete consultative reviews of all DD provider agencies and services within identified timeframe, as described in QI Plan Goal 2L-D, and then fully implement formal on-site reviews (Goal 2L-E) as scheduled.
DDD has 1.75 FTE staff positions devoted to quality improvement activities. This level of staffing is not sufficient to fully comply with the quality improvement requirements of the Consent Decree and the ISA as described in §XV(1-5). Additional personnel resources must be devoted to DD quality improvement to meet the requirements of this section of the Consent Decree and ISA.
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It is strongly recommended that the State take immediate steps to increase the number of personnel assigned to conduct DD quality improvement activities outlined in §XV(1-5) by a minimum of four full time equivalent positions. 3. DDD and ORS are requested to revisit their respective records of provider quality improvement reviews and report to the Monitor on the number of reviews that have been conducted jointly by the two State agencies since August 1, 2017, the names of the agencies that were reviewed, the numbers of individuals reviewed, in each agency, the review findings, recommendations and any remediative or quality improvement actions that were required. 4. DDD is requested to provide information on the reviews it has conducted of provider agencies participating in the PCSEP program. Information should include the agencies reviewed, the number of individuals reviewed, as well as any findings and recommendations that were made. This information needs to be provided to the Monitor in the Division’s quarterly reports. 5. DDD’s Quality Improvement Plan details a coherent process for establishing the quality improvement initiative required by Section XV of the Consent Decree and the ISA and sets realistic benchmarks and timelines for moving forward. DDD is requested to take the necessary steps and secure the personnel and resources needed to ensure that that each benchmark is fully met on schedule. DDD, in collaboration with ORS are requested to provide timely reports to the Monitor documenting the accomplishment of each benchmark and goal included in the Quality Improvement Plan from April 10, 2017 forward. These reports should additionally indicate any identified quality improvement objectives that were not accomplished, the reasons, and future actions to be taken to address the goal.
Respectfully Submitted,
Charles Moseley EdD Court Monitor April 6, 2018
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Case 1:14-cv-00175-JJM-PAS Document 72 Filed 04/06/18 Page 38 of 41 PageID #: 3043 Attachment 2
Quality Improvement Plan RI Division of Developmental Disabilities
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 Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 1 of 13 PageID #: 3161

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA Plaintiff

v.

C.A. No 14-175

STATE OF RHODE ISLAND Defendant

QUARTERLY REPORT OF THE COURT MONITOR ON THE STATUS OF COURT ORDERED PLACEMENTS
JANUARY 1, 2018 THROUGH MARCH 31, 2018
July 13, 2018 
Background This report reviews the State’s progress on achieving supported employment placement and performance outcomes required by the Consent Decree and Interim Settlement Agreement across all Target Populations for the calendar quarter, January 1, 2018 through March 31, 2018. The assessment is based on the Consent Decree data report issued by the State on a quarterly basis (see Attachment).1 The State’s report aggregates data drawn from four sources: the Sherlock Center Quarterly Provider Survey (Sherlock Survey), Office of Rehabilitation Services (ORS) case files, Division of Developmental Disabilities (DDD) caseload information, and the Rhode Island Department of Education (RIDE) annual census creating a single non-duplicated dataset that is used to track progress on a quarter-by-quarter basis. The dataset is composed of information that is gathered at different times during the quarter. Data from the comprehensive Sherlock Survey requires approximately three months to analyze and report. This information is updated quarterly by ORS and DDD caseload numbers.
Supported Employment Placement Status The attached Consent Decree Data Report, dated April 30, 2018, was prepared by DDD and

1 Consent Decree Data Reports Data for Quarter Ending March 31, 2018.

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 2 of 13 PageID #: 3162

reviewed by the Court Monitor. The report documents the State’s progress on achieving the

January 1, 2019 benchmarks and performance outcomes required by the Consent Decree across

the four target populations2 for the period ending March 31, 2018. The total number of target

population members who received a supported employment placement in an integrated competitive employment setting increased from 617 on December 31, 2017 to 744 on March 31, 2018, a gain of 127 individuals for the quarter. Additional supported employment placements achieved during the prior 12 months expanded the total number of target population members who are working by 262 individuals, from 482 on March 31, 2017 to 744 on March 31, 2018.


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! #! %

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

  

 )2016



268

)2016

95

363

)2017

119

482

!)2017

62

544

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29

573

)2017

44

617

)2018 127

744

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During this period the State averaged approximately 66 placements per quarter. Table 1

summarizes the number of individuals receiving supported employment placements by

quarter. Please note that the numbers in Table 1 do not include 11 individuals across the Youth

Exit (0) Sheltered Workshop (1) and Day Program target populations (10) who no longer

participate in State funded employment services or have died. These numbers are counted

when assessing Consent Decree compliance and are reflected in Table 2 below. The numbers of

past placements are not included in the quarterly analysis of placement data, however.

Placement data for each target population is measured against Consent Decree benchmarks that must be achieved by January 1, 2019 for the Sheltered Workshop and Day Target Populations. Additional benchmarks occur in subsequent years. The benchmark date by which time all members of the Youth Exit Population were to have been placed was July 1, 2016. The State is implementing a plan to place these individuals by September 2018.

Target Population Census The total unduplicated number of individuals in the Consent Decree’s four Target Populations was 3,324 on March 31, 2018, roughly the same total reported for the previous quarter. Adjusting the census figures to reflect the numbers of individuals who are not or are no longer
 2Consent Decree Target Populations: Sheltered Workshop Target Population, Day Target Population, Youth Exit Target population and Youth Transition Target Population.



2

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involved with developmental disabilities services yields a total of 2,416 individuals across the four target populations who must be provided with the opportunity to receive a supported employment placement.3 This number does not include members of the Transition Target Population4 nor individuals who were employed during 2012, the base year for Consent Decree calculations. The number of individuals to be placed by target population (updated) is as follows:
a. Sheltered Workshop Target Population – 629 b. Day Target Population – 1,362 c. Youth Exit Target Population – 425 The active census of individuals in each of the Consent Decree Target Populations varies slightly from quarter to quarter depending on individual circumstances and the State’s continuing efforts to identify and track target population members.

The Consent Decree and the ISA require the State to meet numerical benchmarks regarding the number of target population members who must receive a supported employment placement during the pendency of the two agreements. A placement is counted only once for each individual. Placements achieved by target population members who subsequently leave or suspend their services, or terminate their employment, are considered to be inactive but continue to be credited against the State’s overall placement requirements. Previously placed individuals who are “re-employed” (see Consent Decree §V[H]) are returned to the “active” category.

The total number of supported employment placements is calculated by combining the number
of individuals who are actively engaged in supported employment with the number of target
population members who received a placement in the past and have since terminated their
employment for personal reasons.5 These individuals are considered to be in the inactive group
and are classified, “past placements.”

3 See Attachment, Report 1 Current Consent Decree Population. 4The Consent Decree does not require the State to place individuals in the Youth Transition Target Population.  5 Individuals in the inactive category include target population members who are hospitalized for several months, who are recovering from surgery or injury in a rehabilitation center or with home health services, those who winter in Florida or who leave the country for several months, and those choose to stop receiving services for a period of time for other personal reasons.



3

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 4 of 13 PageID #: 3164

Employer Paid Employment by Target Population The Consent Decree sets annual benchmarks for the placement of members of the Sheltered Workshop and Day Program Target Populations that increase on January 1st of each year. All members of the Youth Exit Population were required to have received a supported employment placement by July 1, 2016. The State was not able to fully identify all of the members of this population until late 2016. Continued outreach efforts are being made by the State to locate, contact and track all members of this population.

Table 2 identifies for each Consent Decree population the annual number of individuals required to receive a supported employment placement, the aggregated year-over-year total, and the number of placements made by January 1st of each year. The number of individuals in the “Placed to Date” column is revised quarterly. The adjusted total includes individuals placed during prior years who have since terminated services.

+

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2016

50

50

57

25

25

118 413

29

2017

50

100

87

25

50

167 413

109

2018

50

150

201

50

100

310 413

233

2019

50

200



50

150



413



2020 100

300



75

225



413



2021 100

400



100

325



413



2022 100

500



200

525



413



2023 100

600



200

725



413



2024 100

700



225

950



413



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4

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 5 of 13 PageID #: 3165

Youth Exit Population. The number of individuals in the Youth Exit Population has increased each quarter during the past two years as a result of the State’s continuing actions to contact all members of this group and determine their interest in receiving supported employment services and placements. DDD identified a total of 425 Youth Exit Target Population members for the quarter ending March 31, 2018, an increase of 12 individuals over the 413 individuals reported during the previous quarter. The number of Youth Exit Population members working in individual employer paid employment on March 31, 2018 was 233, an increase of 56 persons over the previous quarter and approximately 55% of the benchmark for this population (see Table 3).

DDD and ORS are implementing their previously submitted and approved plan to provide supported employment placements for all remaining Youth Exit Population Members who choose competitive employment (425). The plan calls for the placement of 50% of the Target Population by April 30, 2018, and 100% by September 30, 2018. As noted in the Attachment, 233 Youth Exit Target Population members had received a supported employment placement by March 31, 2018, approximately 55% of the total. The plan calls for the remaining 192 individuals to be placed in supported employment by September 30, 2018.

The last quarterly data report indicated that DDD had identified 60 Youth Exit Target Population members who were not receiving services from DDD or ORS.

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An examination of the group revealed that 39 had never applied for State services. The

remaining 21 individuals were found to be eligible for ORS services but had not applied to

DDD. The Division sent letters to this group on September 29, 2017 to inform them of DDD

service eligibility and community resources that may be available to assist them. DDD reports

that it is continuing to follow up on the status of these individuals. This action will likely

decrease the total number of Youth Exit Target Population members who are ready and

interested in receiving supported employment services and placements. The status of the

individuals in this group will be noted in future reports. The placement process continues for



5

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 6 of 13 PageID #: 3166

the approximately 192 individuals who are receiving supported employment services but are not yet employed.
Sheltered Workshop Target Population. Thirty-three (33) Sheltered Workshop Target Population members received supported employment placements during the quarter ending March 31, 2018 bringing the total number of placements during this reporting quarter to 201 (Table 2). Adjusting these data to reflect the prior year placement of one individual who is no longer receiving state services increases the total number of placements among this population to 202, slightly exceeding the benchmark of 200 persons who needed to receive supported employment placements by January 1, 2019.
Day Target Population. The number of individuals in the Day Target Population who received a supported employment placement by March 31, 2018 was 310, an increase of 38 individuals over the previous quarter. Ten individuals were placed during prior years bringing the total number of individuals who have received a supported employment placement to 320. This represents more than double the Consent Decree requirement that placements be provided to 150 individuals from this target population by January 1, 2019.
Average Hours Worked Per Week. The average number of hours worked per week by members of the three target populations during the quarter ending March 31, 2018 was 12.48 hours. This is largely unchanged from the weekly hours worked reported during previous quarters and remains below the 20 hours per week benchmark. On March 31, 2018, 128 members of the Youth Exit Population worked on average 14.5 hours per week; 92 members of the Sheltered Workshop Target Population averaged 13.1 hours per week; and 113 members of the Day Target Population averaged 9.7 hours per week. The average hourly wage earned individuals across all target populations was $10.19, a slight increase from the prior quarter. Finally, the percentages of target population members working more than 20 hours per week improved for each target population as compared to the prior reporting quarter (see Attachment, Report 4). This suggests that the State’s efforts to increase the weekly hours worked among individuals receiving supported employment is having an impact.
Career Development Planning



6

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 7 of 13 PageID #: 3167

Each target population member is required to receive a Career Development Plan, updated

annually and Benefits Planning consultations during the year that they obtain a supported

employment placement or, for members of the Youth Transition Target Population, not later

than the year prior to exiting secondary school. Information on the status of career

development planning is reported by the State and can be found in the Attachment, Report 3a in the table, titled Career Development Plan Exists. Data reported in this table combines the number of individuals who have completed plans with the numbers of individuals whose CDPs are incomplete (pending) and

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individuals who have refused to participate in the planning process. To clarify the status of

career development planning, Table 4 on the right separates the data on the numbers of

individuals with completed CDPs, from information on individuals with incomplete or pending

plans and persons who have refused to participate in the CDP planning process. Overall, the

numbers and percentages of individuals with CDPs during the current reporting quarter are

basically unchanged from the previous quarter ending December 31, 2017. As noted in previous

reports, the 71 members of the Transition Target Population who were identified as not having

a CDP are primarily new students who will receive their CDPs during the school year. The

status of CDPs for Youth Transition Target Population members is reported twice each year in

December and June and is filed in RIDE’s quarterly reports and will be available in July 2018.

RIDE will provide additional information on this group during the next two quarters. If plans

are completed as scheduled the benchmark for this population will be met.

Benefits Planning The State continues to demonstrate solid progress on increasing the number of Consent Decree target population members with benefits plans. As shown in Attachment Report 3b, across all target populations the unduplicated total number of individuals with benefits plans increased by 163 individuals from 367 on June 30, 2017 to 586 on March 31, 2018. Table 5 provides a



7

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 8 of 13 PageID #: 3168

breakdown of the status of benefits planning for each target population as well as the percentage of the benchmark that is required to be met under the Consent Decree.

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369

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An individual benefits plan is required for each individual who has received a supported

employment placement. Benefits plans are in place for 369 of 695 or 53% of target population

members working in supported employment Table 5).

Summary The total number of Consent Decree target population members who received a supported employment placement by March 31, 2018 is 755. During this quarter an additional 127 individuals became actively employed across all three target populations. The number of placements to date exceeds the benchmark requirements for the Sheltered Workshop and Day Program target populations and represents approximately 55% of the Youth Exit target population benchmark of 425 individuals (Table 3).

As noted in previous reports,6 DDD and ORS are implementing a plan to ensure all members of the Youth Exit Target Population who choose to receive a supported employment placement become employed by September 30, 2018. The State met its first placement goal on March 23, 2018 and appears to be on track for meeting upcoming targets at the end of June and September 2018.

Respectfully Submitted,

Charles Moseley EdD Court Monitor July 13, 2018
 6Report of the Court Monitor on Rhode Island Consent Decree Compliance Issued April 6, 2018 ECF Document 72.



8

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 9 of 13 PageID #: 3169 ATTACHMENT



9

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 10 of 13 PageID #: 3170



10

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 11 of 13 PageID #: 3171



11

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 12 of 13 PageID #: 3172



12

Case 1:14-cv-00175-JJM-PAS Document 81 Filed 07/13/18 Page 13 of 13 PageID #: 3173



13

 
 Case 1:14-cv-00175-JJM-PAS Document 82 Filed 09/04/18 Page 1 of 6 PageID #: 3174

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA Plaintiff

v.

C.A. No 14-175

STATE OF RHODE ISLAND Defendant

QUARTERLY REPORT OF THE COURT MONITOR ON THE STATUS OF COURT ORDERED PLACEMENTS
APRIL 1, 2018 THROUGH JUNE 30, 2018
SEPTEMBER 4, 2018
Background This report reviews the State’s progress on achieving supported employment placement and performance outcomes required by the Consent Decree and Interim Settlement Agreement across all Target Populations for the calendar quarter, April 1, 2018 through June 30, 2018. The assessment is based on the State’s quarterly Consent Decree data report (see Attachment).1 Progress is measured against placement benchmarks to be achieved by January 1, 2019.
Target Population Census The total unduplicated number of individuals in the Consent Decree’s four Target Populations was 3,498 on June 30, 2018, slightly higher than the total reported for the previous quarter. Adjusting the census figures to reflect the numbers of individuals who are no longer involved with developmental disabilities services yields a total of 2,414 individuals across the four target populations who must be provided with the opportunity to receive a supported employment placement.2 This number does not include the 838 members of the Transition Target Population3

1 Consent Decree Data Reports Data for Quarter Ending June 30, 2018. 2 See Attachment, Report 1 Current Consent Decree Population, Target for Employment. 3 The Consent Decree does not include placement targets for members of the Youth Transition Target Population.

Case 1:14-cv-00175-JJM-PAS Document 82 Filed 09/04/18 Page 2 of 6 PageID #: 3175

nor individuals who were employed during 2012, the base year for Consent Decree calculations. The number of individuals to be placed by target population (updated) is as follows:

a. Sheltered Workshop Target Population – 693 b. Day Target Population – 1,541 c. Youth Exit Target Population – 426

The active census of individuals in each of the Consent Decree Target Populations varies slightly from quarter to quarter depending on individual circumstances and the State’s continuing efforts to identify and track target population members.

Supported Employment Placements The Consent Decree and the ISA require the State to meet numerical benchmarks regarding the number of target population members who must receive a supported employment placement during the pendency of the two agreements. A placement is counted only once for each individual. Placements achieved by target population members who subsequently leave, suspend or terminate their employment are considered to be inactive but continue to be credited against the State’s overall placement requirements.

The total number of target population members who received a supported employment placement in an integrated competitive employment setting including individuals previously classified as closed placements increased from 744 on March 31, 2018 to 786 on June 30, 2018, a gain of 42 individuals for the quarter (see Table 1).
The Consent Decree sets annual benchmarks for the placement of members of the Sheltered Workshop and Day Program Target Populations that increase on January 1st of

Table 1

Quarterly Placement Summary

September 2016 - June 2018

Quarterly Number Total

Report

Placed Employed

Sept 2016

268

Dec 2016

95

363

Mar 2017

119

482

June 2017

62

544

Sept 2017

29

573

Dec 2017

44

617

Mar 2018

127

744

June 2018

42

786

each year. All members of the Youth Exit Population were required to have received a

supported employment placement by July 1, 2016. The State was not able to fully identify all of

2

Case 1:14-cv-00175-JJM-PAS Document 82 Filed 09/04/18 Page 3 of 6 PageID #: 3176

the members of this population until late 2016. Continued outreach efforts are being made by the State to locate, contact and track all members of this population.

Table 2 identifies for each Consent Decree population the annual target number of individuals required to receive a supported employment placement, the aggregated year-over-year total, and the number of placements made by January 1st of each year. The number of individuals in the “Placed to Date” column is revised quarterly.

Year
Jan 1 of:
2016 2017 2018 2019 2020 2021 2022 2023 2024

Table 2

Consent Decree Placement Benchmarks and State Performance

Through June 30, 2018

Sheltered Workshop

Youth Exit

Population

Day Target Population

Population

Placed

Placed

Annual Aggregate to Annual Aggregate to

Placed

Target Target

Date Target Target Date Target to Date

50

50

57

25

25

118 413

29

50

100

87

25

50

167

413

109

50

150

205

50

100

346

426

235

50

200

50

150

413

100

300

75

225

413

100

400

100

325

413

100

500

100

600

200

525

413

200

725

413

100

700

225

950

413

Youth Exit Population. The number of individuals in the Youth Exit Population has increased each quarter during the past two years as a result of the State’s continuing efforts to contact all members of this group and determine their interest in receiving supported employment services and placements. DDD identified a total of 426 Youth Exit Target Population members for the quarter ending June 30, 2018, an increase of 1 individual over the 425 persons reported during the previous quarter. The number of active Youth Exit Population members reported to have received a supported employment placement as of June 30, 2018 was 235 representing approximately 55% of the placement benchmark for this population (see Table 3). DDD and ORS are implementing their previously submitted and approved plan to provide supported employment placements for all remaining Youth Exit Population Members who choose competitive employment (426). The plan calls for the placement of 50% of the Target

3

Case 1:14-cv-00175-JJM-PAS Document 82 Filed 09/04/18 Page 4 of 6 PageID #: 3177

Population by April 30, 2018, and 100% by September 30, 2018. All remaining individuals (191) are to receive a supported employment placement by September 30, 2018.

Sheltered Workshop Target Population. Placements were recorded for four (4) Sheltered Workshop Target Population members during the quarter ending June 30, 2018, bringing

Table 3 Supported Employment Placements for Quarter Ending June 30, 2018

Target

Placement

Total

Benchmark

%

Population

This Qtr. Placements

Benchmark

Youth Exit

2

235

426

55%

Sheltered

4

205

200

103%

Workshop

Day Target

36

346

150

231%

the total number of active placements achieved to date to 205 for this target population, slightly

exceeding the benchmark of 200 persons who needed to receive supported employment

placements by January 1, 2019 (Table 3).

Day Target Population. The total number of individuals in the Day Target Population who received a supported employment placement by June 30, 2018 was 346, an increase of 36 individuals over the previous quarter. This represents more than double the Consent Decree requirement that placements be provided to 150 individuals from this target population by January 1, 2019.

Average Weekly Hours and Earnings (see Attachment Report 4). The average number of hours worked per week by members of the three target populations during the quarter ending June 30, 2018 was approximately 11.26 hours, a decline of a little over one hour per week as compared to the previous quarter. On June 30, 2018, 94 members of the Youth Exit Population were reported to have worked on average 14.2 hours per week; 185 members of the Sheltered Workshop Target Population averaged 11.8 hours per week; and 298 members of the Day Target Population averaged 10 hours per week. The average hourly wage earned individuals across all target populations was $10.86, a slight increase from the prior quarter. The percentages of target population members working more than 20 hours per week decreased slightly for the Day and Sheltered Workshop Target Populations but improved for the Youth Exit Target Population.

4

Case 1:14-cv-00175-JJM-PAS Document 82 Filed 09/04/18 Page 5 of 6 PageID #: 3178

Career Development Planning

Data reported by the State on the numbers of individuals with career development plans

includes individuals whose plans are in process and expected to be completed in

Table 4 Career Development Planning for the
Quarter Ending June 30, 2018

the near future (see Attachment Report Target

Individuals Benchmark

%

3a). As shown in Table 4, career development plans are in place for all

Population Youth Transition Youth Exit

w/ CDP 834 426

Benchmark

838

99.5%

426

100%

members of the Youth Exit, Sheltered Workshop and Day Target Populations and for 99.5% of the Youth in Transition

Sheltered Workshop Day Target

693 1,541

693 1,541

100% 100%

Population.

Benefits Planning

The percentage of individuals with benefits plans increased in the Sheltered Workshop Target Population increased from 88% to 98%. The percentage of individuals with benefits plans in the Youth Exit and Day Target Populations, however, remained roughly the same at 74% and 75% respectively. Although the numbers of individuals with benefits plans who are

Table 5 Status of Benefits Planning for the Quarter Ending June 30,

2018

Target Population Individuals Benchmark

%

w/ BPs

Benchmark

Youth Transition

NA

NA

Youth Exit

170

231

74%

Sheltered

184

203

91%

Workshop

Day Target

252

334

75%

Total

606

768

79%

Total Employed

387

768

50%

w/ B Plans

employed in competitive jobs increased by 18 persons, the overall percentage of working

individuals with plans decreased to approximately 50% (see Table 5).

Summary The numbers of individuals who received a supported employment placement during the first and second calendar quarters of the year exceed the Consent Decree benchmarks that must be met by January 1, 2019 for the Sheltered Workshop and Day Target Populations. The total number of Youth Exit Population placements to date are meeting 55% of the January 1, 2019 requirement.

5

Case 1:14-cv-00175-JJM-PAS Document 82 Filed 09/04/18 Page 6 of 6 PageID #: 3179
The average number of hours worked per week has remined virtually unchanged during the past four quarters at 10 to 14 hours per week depending on the population (see above). On March 24, 2017 DDD submitted to the Monitor a Plan for Increasing the Number of Hours Worked by Consent Decree Target Population Members. The plan was well designed, initially focusing on the Youth Exit Population, identifying system needs and barriers, laying out the steps to ensure data quality and collection, and strengthening collaboration with DD providers. A list of implementation strategies to be used to accomplish the intended outcomes was also included. Although the plan was well constructed the intended objective does not appear to have been reached. A comparison of the weekly hours worked for the quarter ending June 30, 2018 with the weekly hours worked for the quarter ending March 31, 2017 reveals no progress on achieving this goal during the past 15 months.
DDD is requested to review the current Plan in consultation with ORS, the Sherlock Center Conversion Institute, provider organizations and others as determined by the Division to consider revisions to the plan that might be warranted and to identify additional steps to take to increase the hours worked among employed members of the target populations. The State notes that additional information currently is being gathered on the status and preferences of Consent Decree Target Population members working in supported employment placements with respect to the hours they are working each week. The State intends to include this information in its analysis and revision of the current plan for increasing hours worked. A copy of the revised plan and implementation strategy is to be submitted to the Monitor as an appendix to the State’s Quarterly Report for the period ending December 31, 2018. The Consent Decree Coordinator is requested to regularly inform the Monitor on the progress of the plan’s revision and to submit a brief summary update as a part of the State’s Quarterly Report for the period ending September 30, 2018.
Respectfully Submitted,
Charles Moseley EdD Court Monitor September 4, 2018
6

 
 Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 1 of 27 PageID #: 3195 

UNITED STATES DISTRICT COURT DISTRICT OF RHODE ISLAND

UNITED STATES OF AMERICA Plaintiff
v.
STATE OF RHODE ISLAND and CITY OF PROVIDENCE
Defendants

C.A. Nos. 14-175; 13-442

COURT MONITOR’S FOURTH REPORT ON THE STATE OF RHODE ISLAND’S

RESPONSE TO THE ORDER OF COMPLIANCE WITH OUTSTANDING INTERIM

SETTLEMENT AGREEMENT REQUIREMENTS FILED JUNE 23, 2017

I. Introduction

Issued: October 29, 2018

This fourth report examines the State of Rhode Island’s progress on meeting the performance requirements specified by the Court’s Order issued on June 23, 2017 and relevant sections of the Interim Settlement Agreement (ISA) and Consent Decree. This report updates the Court Monitor’s Third Review of State Activities in Response to the Order of Compliance with Outstanding Interim Settlement Agreement Requirements issued by the Monitor on April 6, 2018. It reviews and evaluates the progress made by the State and the City of Providence Public Schools relative to the completion of actions and activities included in previous compliance reports issued by the Court Monitor relative to the Court’s Order issued on June 23, 2017.

Information on the State’s compliance with key ISA provisions and benchmarks was gathered through regularly scheduled conference calls with the State’s Consent Decree Coordinator and staff from the Division of Developmental Disabilities (DDD) and the Department of Behavioral Health Developmental Disabilities and Hospitals (BHDDH), the Office of Rehabilitative Services (ORS), the Rhode Island Department of Education (RIDE), the City of Providence Public Schools Department (PPSD) and the U.S. Department of Justice (DOJ). Data and materials were received from the Quarterly Progress Reports submitted by the State for the calendar quarter ending June 30, 2018 and by the City of Providence Public Schools for the



Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 2 of 27 PageID #: 3196 
quarter ending August 30, 2018. Additional information was drawn from direct conversations with DDD and ORS staff and email correspondence with State and City of Providence officials regarding progress on meeting the provisions of the Court’s Order. The Court Monitor additionally gathered information through two site visits. The first included meetings with state agency department heads and the executive directors and key staff of 16 provider agency to discuss systems change relative to the organization and delivery of integrated day services consistent with the requirements of the Consent Decree and the ISA. The second site visit, held during October 2-3, 2018 reviewed career development planning and the services received by a sample of TTP and Birch Target Population members and related documentation. The assessment of progress also reviewed documentation provided by DDD in advance of the State’s upcoming quarterly report to the Monitor for the period ending September 30, 2018 which will be submitted on October 31, 2018.
II. Progress Review
The State has made significant progress on achieving ISA and Consent Decree related provisions and benchmarks during the past two calendar quarters. In addition to the specific accomplishments outlined below, DDD, in collaboration with the Sherlock Center’s Conversion Institute (CI), ORS, and providers who offered sheltered workshop placements, have successfully transitioned all sheltered workshops programs to alternative services or closure. The last sheltered workshop was successfully closed during the reporting quarter ending June 30, 2018.
The State also is demonstrating its commitment to integrated employment through its collaboration with the Department of Labor and Training in the significant expansion of a Pathways Partnership including five projects that will enroll 127 Rhode Islanders with intellectual and/or developmental disabilities leading to competitive employment for a minimum of 77 Rhode Islanders with IDD. The partnership will involve up to 11 service provider partners and two IDD stakeholder organization partners (RI Developmental Disabilities Council and the Sherlock Center on Disabilities at Rhode Island College). The five projects will establish a CVS training center, a self- employment incubator, expanded access to supported employment through a provider collaboration, a partnership between a RI-based



=

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 3 of 27 PageID #: 3197 
small manufacturing business and a I/DD service provider, and enhanced technical assistance from the RI-based Business Innovation Factory

The City of Providence Public Schools continues to meet performance benchmarks and requirements across virtually all provisions of the Interim Settlement Agreement, establishing effective and appropriate mechanisms for achieving and maintaining ongoing compliance in key areas of the Agreement relative to person-centered career development planning, transition planning for youth, supported employment services, trial work experiences, the provision of professional development and in other areas of the Agreement.

A. Interim Settlement Agreement Provisions Applicable to Both the State and Providence Public Schools

1. Career Development Planning. Ref: ISA §VII(4)&(5)(a)-(c); Court Order §I(2).

a. PPSD-Birch. During the past year, the Providence Public School District (PPSD) has made significant progress on ensuring that all members of the Birch Target Population annually receive a career development plan based on a person-centered asset-based assessment model such as MAPS or PATH. Data reported by PPSD and reviewed by the

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Monitor for the quarters ending November 2017, February, 2018, June, 2018 and August 2018 reveal that PPSD has met the requirements for career development planning set forth in ISA §VII(5)(a)-(c) on an ongoing basis since November 2017. Furthermore, PPSD has met the requirements for the use of a MAPS style asset-based planning tool since February 2018 (See Table 1). A review of a sample of academic files of Birch Transition



>

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 4 of 27 PageID #: 3198 
Target Population members conducted by the Monitor in October 2018 found that career development plans were person-centered and met the requirements outlined by ISA §VII.
Assessment: Requirement Met
b. State - DDD and ORS. Career development planning for members of the Birch Look Back Target Population and the TTP Target Population has significantly improved over the past year. DDD and ORS have worked with provider agencies to ensure that career development plans are complete and up to date for ISA target population members. Both state agencies have reviewed provider organization career development planning processes on site and are providing ongoing technical assistance and training to improve the number and quality of the plans that are developed and implemented. DDD contracted with the Sherlock Center at Rhode Island College to develop an excellent Person-Centered Thinking Guide which is being used to provide detailed personcentered training, technical assistance and support to provider organizations serving this population. During the past quarter, DDD has furnished oversight and technical assistance to ESRI/CWS and other agencies to improve the alignment of plans with the services being received and to rewrite plans that are determined to be inadequate. This quarter was focused on strengthening State-provided guidance and tools that providers are using in order to ensure quality and to effect system change in this area. As a result, improvements are evident in both the numbers of career development plans being written and the quality of those plans.
Numbers of Plans. The Court Monitor’s report filed on September 7, 2017, for example, noted that career development plans were in place for only 37 of 89 (42%) members of the TTP Target Population. Data reported by DDD on the status of career development planning for this population as of June 30, 2018 indicates a significant improvement during this period in the numbers of plans being written. Acceptable career development plans were found to be in place for 94% or 77 of 89 individuals (See Table 2 below). A review of ISPs and CDPs for a sample of TTP and Birch Target Population members receiving adult services conducted by the Court Monitor and an independent



?

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 5 of 27 PageID #: 3199 
consultant on October 2nd and 3rd 2018 found that both documents had been completed and were in place for each of the individuals selected.

Plan Quality. DDD is revising its individual support planning (ISP) format to strengthen the use of person-centered planning guidelines in developing a whole life plan that includes the preparation of a comprehensive ISP/CDP/Plan of Care. The Division has shared a variety of plan templates with providers and plan writers that can be altered to encourage flexibility and greater person centeredness. During a review of provider agencies conducted by the Court Monitor in August 2018, providers gave positive feedback on the new person-centered planning process and the training being furnished by the Sherlock Center and DDD.

Although personcentered thinking training is expanding and improvements are being made, challenges continue to exist. While ISPs and CDPs were in the files, documentation that personcentered planning

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had taken place was less clear. The use of person-centered planning approaches was

able to be determined in less than half or 8 (47%) of the 17 plans reviewed. Evidence of

person-centered planning was not found in the remaining 9 plans (53%). By provider

agency, person centered approaches were apparent in 6 of 9 (67%) files reviewed at ESRI

and in two of three (67%) of files reviewed at Perspectives. Indications that person-

centered planning had taken place was not reflected in the plans of three individuals



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Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 6 of 27 PageID #: 3200 
served by Fogarty, nor in the plans of the single individuals reviewed at Work Opportunities Unlimited and Looking Upwards. It is important to note that our conclusions are based on reviews to determine the extent to which person-centered planning is described and referenced in individuals’ ISPs and CDPs.
ISPs and CDPs included personal goals and as well as goals for employment and integrated day services. And, in the majority of cases the services being received were in alignment with the goals identified in the person’s ISP and CDP (12 of 17 records, 71%). The CDPs and ISPs for many individuals referenced their service and support interests and preferences. Unfortunately, personal preferences and interests were not typically evident or reflected in the services and supports that are being received. Conversations held between the Monitor or independent consultant and individuals receiving support revealed variations between the plans reviewed and the services being provided.
In addition, the records typically did not include clear descriptions of the findings of assessments that had been performed, the services needed to address those findings, the services that were being provided, and the outcomes being achieved as a result of those services. The attached review summary, prepared by the independent consultant Dr. William Ashe, identifies findings and makes recommendations regarding strategies for advancing improvements noted in ISP and CDP person-centeredness and outcomes (see attached).
Assessment: Requirement Not Met, Progress Made. The need to improve the quality of person-centered career development planning for members of the ISA target populations receiving adult services was noted in the Monitor’s Second and Third reviews of State Activities in Response to the Order of Compliance with Outstanding Interim Settlement Agreement Requirements Filed on June 23, 2017 issued respectively on 11/29/2017 and 4/9/2018. Improvements have been noted but continued efforts need to be made by the State to ensure the quality of career development planning.
Actions to be Taken: DDD must address the recommendations included in the independent consultant’s report to:



A

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 7 of 27 PageID #: 3201 
a. Continue provider and stakeholder training utilizing the Rhode Island Personcentered Thinking Guide
b. Consider publishing several ISP/CDPs that meet the State’s standards for personcenteredness as examples for providers to review.
c. Establish person-centered planning standards against which to measure the quality of ISPs and CDPs. Consider and discuss with the Court Monitor requiring that the Person-Centered Process Structural Components from the Rhode Island Personcentered Thinking Guide (page 5-8) be used as the standard.
d. Require individual’s personal preferences to be clearly identified in the personcentered planning process and be reflected in the goals and objectives that are developed and the services provided.
e. Review training curricula to ensure training on integrated community day services addresses the need to avoid the overuse of community locations by groups of individuals from more than one agency at the same time.
f. Ensure through the ISP and CDP process that the communication needs of each individual are adequately addressed.
2. Transition Planning for Youth. Ref: ISA §VIII(4)(a)-(e); (5)&(6).
a. PPSD - Birch. PPSD has continued to make progress on assuring that all Birch enrollees begin a transition planning process at age 14 years and continues as until they exit secondary school as required by ISA §VIII(4)(a)-(e). Data reported by PPSD suggest that that PPSD is meeting the requirements of §VII(4), (5), (6), &(7): i. All Birch students (65 of 65) were assigned to an employment team by age 14 years. ii. All Birch students (65 of 65) received, no later than during the first year of entry to Birch, and with the assistance of the employment planning team, the formulation of employment-related recommendations of the IEP to discover and record students’ personal interests and goals for postsecondary employment and/or postsecondary education. iii. All Birch students received a comprehensive introduction to or enrollment in State services and the formulation of employment related recommendations in the IEP and ISP, where applicable, by age 16 years (44 of 65 individuals).



B

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 8 of 27 PageID #: 3202 
iv. All Birch students, (39 of 65) as appropriate, met with their employment planning team not later than the year in which a student turned 18 years of age to: facilitate possible post-secondary employment placements, be introduced to Supported Employment Services in an integrated community-based employment setting, and have the opportunity to be placed in such a setting prior to the end of his or her participation at Birch.
v. All Birch Youth in transition (21 of 65) are receiving benefits planning information, according to the standards set forth in Section IV(8). Benefits planning services have been requested from ORS for members of the 2018 and 2019 exit populations.
vi. A person-centered career development plan has been developed and is in place for each Birch Transition Target Population member.
vii. Trial Work Experiences. PPSD reports that 16 of 36 individuals (44%) have completed their first trial work experience, 7 of 36 individuals (19.4%) have completed their second trial work experience.
Assessment: Requirements Met.
3. Other compliance related issues – None at this time

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Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 9 of 27 PageID #: 3203 
B. Interim Settlement Agreement Provisions Applicable to Only the State of Rhode Island
4. Employment Placements: Ref: ISA §IV; Court Order §I(3). DDD and ORS continue to work with supported employment providers to place the 46 ISA target population members identified in the Court Order filed on June 23, 2017. The State’s original plan called for the placement of 15 individuals by April 30, 2018, another 16 persons by July 31, 2018, and the remaining 15 persons after August 1, 2018. Table 3 provides a description of the status of the 46 individuals. As of June 30, 2018, a total of 16 target population members are receiving supported employment placements, an increase of two individuals over the previous quarter ending March 31, 2018. Employment services are being provided to another 13 individuals who are additionally receiving integrated day, pre-employment and job development services bring the total to 29 persons who are employed or are receiving supported employment services. Nineteen (19) of these 29 individuals are participating in the Person-centered Supported Employment Program (PCSEP) 2.0 with the goal of expanding the hours worked or locating a new job. ORS has open cases for 14 ISA members interested in receiving employment services.
An analysis of the remaining ISA target population members performed by the State reveals that of the 17 individuals who are not employed or receiving employment services, three (3) are retired and are receiving integrated day services, three (3) are receiving integrated day services and are not seeking employment, 8 individuals have withdrawn from services and their cases are closed, and three (3) persons are not active or have not responded to efforts to contact them.
Assessment: Requirement Not Met, Progress is being Made. The State is requested to continue to prioritize efforts to place the remaining 13 ISA Target Population members receiving employment services and report on progress through the State’s Quarterly Report.
5. Day Services. Ref. ISA §VI.
Reviews of integrated day services conducted by the Monitor and the independent consultant revealed only modest improvements in the quality of integrated day services



D

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 10 of 27 PageID #: 3204 

over the findings reported in November 2017. While career development plans and the

alignment of plans and services have improved, non-work integrated day services at

ESRI/CWS and other providers serving this population consist of a relatively narrow range of options in which people participate on a daily basis. Target population members typically choose activities from lists or menus that have been developed by groups of participants or by staff. Activity options may vary by the day, week or month. Although some individuals select and participate in activities on their own with little assistance from staff, most access community-based events and resources in small groups of two to three or four individuals.

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Those who do receive one-on-one assistance typically do so within the context of the larger

group. As noted in the November 2017 report mentioned above, the activities that

individuals engage in are typically non-participatory in nature and involve attending a

community event, visiting a local library, going to a restaurant for coffee, or walking

through stores in the mall. This pattern was noted in our most recent review conducted on

October 2-3, 2018 where we found that the same locations are being used by several

individuals at the same time and, in some cases, by more than a single provider agency

simultaneously.

Assessment: Requirement Not Met. The State is requested to continue to provide technical assistance and direction to providers to improve the quality of day services being provided.



Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 11 of 27 PageID #: 3205 
Recommended Actions. DDD must develop a specific review tool or rubric, or include within an existing tool, the capacity to measure the quality of the integrated day services received by ISA (and Consent Decree) target population members. The tool should be designed to evaluate and document the extent to which the integrated day services being provided reflect the goals and preferences of the individual, and address the Integrated Day Services Characteristics outlined in Figure 1 and address the recommendations outlined in the attached independent’s report. The tool or description of expanded capacity is to be submitted to the Monitor for review along with the quarterly report on January 31, 2019.
6. Other compliance related issues – none at this time
C. Consent Decree Provisions Applicable to the State of Rhode Island
7. Employment Placements. Ref: Consent Decree §IV Youth Exit Target Population The State is required to have provided a support employment placement to all individuals in the Youth Exit Population by July 1, 2016 (Consent Decree §IV[8][d]). The Consent Decree Placement Data Report for the Quarter ending June 30, 2018 lists a total of 565 individuals in the Youth Exit Target Population Current Census.1 Adjusting this number to reflect individuals who are deceased, who have voluntarily left services, are not attending, haven’t applied or have been determined to be ineligible leaves 426 individuals as the “target population for employment.”
As shown in Report 2 of the aforementioned Consent Decree Placement Data Report,2 a total of 235 individuals received supported employment by June 30, 2018, approximately 55% of the placement benchmark. In response to the Court Monitor’s request,3 DDD and ORS collaborated on the creation of a plan to ensure the placement of the remaining Youth Exit Population members within a reasonable timeframe. DDD and ORS developed and implemented the DDD and ORS Plan for Supported Employment Placements of Youth Exit


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Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 12 of 27 PageID #: 3206 
Population Members Identified Under the Consent Decree on August 31, 2017. The Placement Plan set a benchmark of placing 50% of the target population by June 30, 2018. The State slightly exceeded the benchmark by placing 53% of the target population by this date. The State continues to work to place the remaining Youth Exit Target Population members. The Division has developed an internal process for reaching out to all members of the Youth Exit population who have not had an employment placement, directly engaging providers serving these individuals as well as reaching out to their families and to individuals in selfdirected services to ensure they have been offered options for employment services.

DDD provided updated information on the placement status of the Youth Exit Population on September 29, 2018 reporting an active census of 417 individuals and an employment census of 334 target population members

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(See Table 4). Of the 334 individuals, 257 (77%) have received a supported employment

placement. The remaining 77 individuals are receiving job development (23%). DDD is

keeping the Monitor informed of its progress on expanding the numbers of Youth Exit

Target Population members receiving supported employment placements and related

services through regular quarterly reports and ongoing meetings and discussions.

Assessment: Requirement Not Met. The State is requested to continue to report on the placement outcomes of the Youth Exit Target Population through regular quarterly reports on ongoing meetings and discussions.

8. Integrated Day Services. Ref: Consent Decree §VI.

The nature of the integrated day services being provided to Consent Decree target population members is consistent with the descriptions of the day services and supports



<=

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 13 of 27 PageID #: 3207 
being furnished to ISA target population members by the ten organizations identified in Table 1 above. On August 7-9, 2018 the Court Monitor and independent consultant met with state agency department heads and the directors and key staff of 16 provider agencies to discuss and learn about the organization and delivery of integrated day services and the steps that each organization is taking to transform its service delivery systems to meet the requirements outlined in the Consent Decree and the CD and ISA.
The majority of the agencies visited (69%) reported that they were implementing changes to meet State and/or Consent Decree requirements, but only 4 of the 16 organizations (25%) indicated that they had developed a plan with specific goals to guide their change process. The remaining 12 agencies did not have plans. One provider organization reported that it had a plan under development. Another agency reported that it had a plan but no steps were being taken toward implementation. A couple of agency directors said that they had not prepared a plan per se but had identified and were moving forward on making changes in key areas such as closing one or more day program facilities, improving staff training, decreasing group size, etc. About half of the agencies reported that they had closed their facility-based programs.
During this review, several provider agencies described steps they are taking to improve their ability to support integrated day services. More than half (56%) are supporting or setting up small community settings referred to as “hubs” that are designed to give individuals receiving community supports a place to go during the day between activities or events to rest, have lunch, attend to medical or health needs or take care of personal duties.
Regarding individual choice of day service activities, the majority of organizations (11 of 16 - 69%) reported that they offered both individually selected and menu-driven options for people receiving support. Three agencies (19%) reported that all services were individually selected and two agencies (13%) reported all services were chosen from pre-set menus. Agency directors and staff acknowledged the improvements that state has made in direct support staff wages but significant numbers indicated that they continue to run deficits in key areas and that funding allocations for individual services are insufficient to cover the



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Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 14 of 27 PageID #: 3208 
costs of the services that must be provided. Respondents also identified major barriers to service delivery related to transportation (94%), funding allocation amounts and billing procedures (88%) and staffing turnover and retention (69%). On the positive side, provider agency directors acknowledged the support and technical assistance that the State is providing regarding integrated day services through the Conversion Institute at the Sherlock Center and the training on person-centered thinking and practices.
Consistent with the descriptions of the status of integrated day services offered to ISA Target Population members, reviews conducted by the Monitor and the independent consultant revealed only modest improvements in the quality of integrated day supports being furnished to members of the Consent Decree target populations over the past year. Service providers are aware that changes in their organization and delivery of integrated day services need to be made. Some are moving quickly to design and experiment with new models to improve their ability to deliver and support integrated day services consistent with the integrated day service characteristics identified in §VI(B)(1)-(6) (see above).
Assessment: Requirements Not Met; Progress is being made. Progress is being made in the design, development and delivery of integrated day services furnished to Consent Decree target population members. The State has issued clear and appropriate Guidelines for Integrated Day Services and is building its capacity to review, evaluate and improve the quality of services and supports being offered by provider organizations. The expansion of high quality person-centered individual support plans and career development plans, consistent with the Rhode Island Person-centered Thinking Guide, will form the foundation for the development and implementation of individualized integrated day service alternatives consistent with the requirements of the Consent Decree. The Rhode Island Senate has established the Project Sustainability Commission to review and make recommendations regarding the system of funding for individuals with developmental disabilities in Rhode Island.
Recommended Actions: See recommended actions for improving the assessment of integrated day services for ISA target population members included in Section 5 above.



<?

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 15 of 27 PageID #: 3209 
9. Career Development Planning. Ref Consent Decree §VII.

The State continues to improve the number of career development plans across each target population as well as the alignment of ISP and CDPs with the services and supports provided through increased training and technical assistance. The Consent Decree Data Report for the quarter ending June 30, 2018 indicates that the State has essentially met the required benchmarks for each of the Consent Decree’s four target populations (Summarized Table 5 below).

DDD and ORS have made significant progress in their efforts to ensure that that every

Consent Decree target population member receives a career development plan. Now that

individuals have CDPs, continued and focused emphasis must be placed on improving the

quality and person-centeredness of those plans, and on ensuring that individuals’ goals and

preferences are clearly identified and reflected in the services and supports he or she

receives. As noted in Section II(A)(1)(b) above, reviews of ISPs and CDPs revealed little

evidence of person-centered planning and typically did not include individual profiles as

described in the RI Person-centered Thinking Guide. Also absent were clear descriptions of

the findings of assessments that had been performed, the services needed to address those

findings, the services actually being provided and the outcomes being achieved as a result

of those services.
The need for in-depth training and technical assistance has been noted by DDD and ORS. The State has expanded the training and technical assistance being offered and is working with provider

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organizations to improve the quality of person-centered individual support plans and career

development plans as well as related planning activities. The Rhode Island Person-Centered

Thinking Guide was developed and more than 250 copies were distributed to provider

agencies and families. A curriculum for Person-centered Thinking Facilitator Training was

developed. Five sections of facilitator training were completed with 110 participants across



<@

Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 16 of 27 PageID #: 3210 
34 provider organizations, advocacy groups, families and others. The Sherlock Center is initiating a pilot project to increase person-centered thinking understanding and capacity statewide. Approximately 25 agencies have committed to pilot the model outlined in the Person-Centered Thinking Guide and Facilitator Training with a small number of people. The Center anticipates that the pilot will be able to reach 150 to 200 individuals. A measurement rubric has been developed to assess progress and provide guidance for future development and implementation. In addition, customized technical assistance is being provided to provider agencies focusing on individual agency transformation, the development of strategic plans and supporting change system-wide. Finally, a “PersonCentered Thinking Leadership” community of practice was established in March and is meeting monthly, proving assistance to provider agency staff interested in making change. Innovation is encouraged. Participating providers: Avatar, Blackstone, ESRI/CWS, Fogarty, JRI, Living Innovation, Looking Upwards, Maher, Olean, Opportunities Unlimited, Perspectives, ReFocus, West Bay.
Assessment: DDD and ORS have met the requirement that each individual receive a career development plan (§IV[5]). The State is providing ongoing training and technical assistance to providers to increase the skills and expertise of staff in person-centered thinking, planning and service design. Continued attention needs to focus on improving the quality of person-centered career development planning.
Recommended Actions: Additional actions must be taken by the State to ensure, consistent with the requirements set forth in Consent Decree §VII(5) (a)-(c), that each plan: (a) sets forth the person’s skills, interests, strengths and abilities; (b) is integrated into the person’s IPE, ISP, IEP, and ILP and summary of performance where applicable; and (c) identifies the nature and scope of services needed to remove obstacles to participating in integrated employment and integrated day services meeting the definitions and standards set forth in Sections V – VI.
10. Other Compliance Related Issues – none at this time.



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Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 17 of 27 PageID #: 3211  Respectfully Submitted,
Charles Moseley Ed.D. Court Monitor October 29, 2018



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Case 1:14-cv-00175-JJM-PAS Document 85 Filed 10/30/18 Page 18 of 27 PageID #: 3212 
APPENDIX
William H. Ashe, Ed.D
Independent Consultant CB;$*)''$ ''0'"$#)0;@A?<  
Privileged and Confidential Report for Use and Distribution by the Recipient at his Exclusive Election

October 23, 2018
Dr. Charles Moseley Court Monitor U.S. District Court Rhode Island Consent Decree and Interim Settlement Agreement PO Box 544 Charlotte VT 05445
Dear Dr. Moseley;
On October 2nd and 3rd, 2018 a team of individuals that included you and me, along with representatives from the Department of Justice visited Rhode Island for the purpose of reviewing the status of a small sample of service recipients drawn from the Birch and TTP target populations. The focus of this review was to better understand the following:
 1. The quality of person-centered planning that has taken place in the ISP
(Individual Service Plan) and the CDP (Career Development Plan). This review was intended to be guided and informed by the Rhode Island Person-Centered Thinking Guide), specifically the sections describing the components of a complete person-centered plan (page 4) and the Quality Indicators (pp. 5-8).
2. The quality and comprehensiveness of the ISP and the CDP, as well as the alignment of the goals, objectives, preferences, and service needs outlined in the two documents.
3. The alignment of the services being provided and received with the goals, objectives and preferences that are indicated in the ISP and the CDP.



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In preparing this brief report I had access to information from this review on 17 people, 8 of whom are members of the Birch population, and 9 who are members of the TTP population. As a guide for these reviews we all used an Individual Review Form which you had prepared specifically for this visit. I am attaching a copy of this document to this report for easy reference. In developing this report I used the completed review forms, along with a review of selected ISPs and CDP’s. I also relied upon my personal visits with, and observations of, 8 individuals who I was able to spend time with during this visit.
Data Summary The data that were collected during this review were organized into a table that reflected the observations made about the quality and content of the ISP’s and CDP’s. The data are summarized across these17 categories and are summarized in Table 1.
Data Categories
• Initials of the Recipient • Initials of the Reviewer (CM- Charles Moseley; WA-William Ashe) • Provider Name • Employment Status • Current Weekly Hours Worked • Hours in Community Inclusive Day Supports per Week • Hours per Week in Segregated Settings • Status of How Integrated Activities are Organized • Career Development Plan Up to Date • Career Development Plan Include Employment Goals • Overall Plan Includes Both Employment and Community
Integration Goals • Do the Goals Appear Consistent with What is Actually Happening • Did the Participate Receive Benefits Plan Information • Is There a Written Benefits Plan on Record • Were the Plans Developed as Part of a Person-centered Process • Did the Participant Receive a Vocational Assessment • Did the Participant Receive a Trial Work Experience



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Table 1: October 2-3 Survey Results

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As can be seen in Table 1, not all of the information we were seeking was

contained in the documents we reviewed. However, the absence of information

does not necessarily mean that the Provider does not have this information. It

means that this particular information was not contained in the documents

that reviewers had available to them at the time of our review.

As can been seen in Table 1, of the 17 people that were reviewed 11 people (65%) were working at the time of the review while 6 (35%) were not working. Of the 11 people who were employed, it was possible to determine the number of



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weekly hours of employment for 9 of them. For these 9 individuals, the average weekly hours of employment was 7.8 with a range from 2 hours per week to 18 hours per week).
While we understood that everyone in the sample engaged in Community Integrated Day Services, we could only determine the number of weekly hours for 8 (47%) of these individuals. Again, this does not mean the provider did not have this information just that it was not included in the information we had during our review. For the 8 individuals we had information on, the average weekly hours was 13.5 with these hours ranging from a low of 4 hours per week to a high of 30 hours per week. Only one individual was found to be spending day services hours (12 per week) in a segregated setting (Person 5).
The majority of the individuals (N=10/59%) were participating in community integrated activities through a repeating weekly schedule. There was evidence that the selection of the particular activities in most instances resulted from a person-centered process that enabled individuals to choose what they wanted to from a menu of options. In 4 instances (24%) it was not possible to determine how the activities were chosen. In one (6%) instance (Person 8) there was information only available for the employment portion of his weekly schedule. In another instance all the information reviewed was from 2017 so it was not possible to determine the current status from these documents. In one additional instance the record indicated that the recipient (number 17) was receiving employment services while we found her attending an Adult Day Center. In this case what this person seemed to be doing did not correspond to what was being suggested in her record.
A Career Development Plan was found in all records except for participant SP. In 5 other instances (29%) Career Development Plans were present but they were out of date. In the other 11 records (65%) there were Career Development Plans that were complete and up to date. There were employment goals in the Career Development Plans for 15 (88%) of the 17 files reviewed. Overall when looking at the ISP’s and the CDP’s together employment goals were found for 16 (94%) with only one person (person 9) not having an employment goal. There were 2 instances (12%) where Community Integrated Day Service goals were lacking.
Regarding Benefits information and planning, 9 recipients (53%) had received benefits information while 8 (47%) had not. Written benefits plans were identified for 7 of the recipients (41%) with the remaining 10 recipients (59%) not having written benefits plans in their records.
There were fairly wide differences in the way individual plans were developed. The goal is for everyone to have plans that are clearly developed through a person-centered planning process. The guidelines for these plans are identified in the Rhode Island Person-centered Thinking Guide which was created by the



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Sherlock Center in February of 2018. As this guide is fairly new it is very reasonable to assume that plans being developed in the future will more clearly evidence a person-centered approach. This being said, during this present review we found no real evidence in 9 of the 17 plans (53%) that personcentered approaches were actually being used. Person-centered approaches were clearly evident in 8 (47%) of the plans reviewed overall. By provider agency, person centered approaches were evident in 6 of 9 (67%) files reviewed at ESRI and in 2 of 3 (67%) of files reviewed at Perspectives. Person-centered planning was not evident in the three files reviewed at Fogarty, or in the single files reviewed at Work Opportunities Unlimited and Looking Upwards. It is important to note that these conclusions are based on reviews to determine the extent to which person-centered planning is evident in individuals’ ISPs and CDPs.
With respect to vocational assessment and planning only a single individual (person 9) had not had a vocational assessment, however this individual did have a trial work experience identified in his record. Only one instance was noted of a recipient (person 8) not having a trial work experience. In one other instance (person 4) the presence or absence of a trial work experience could not be determined.
Overall Impressions
1. What is the quality of the person-centered planning that was taking place in the development of the Individual Service Plan and the Career Development Plans of the recipients reviewed during this visit?
As mentioned above, we were unable to find clear evidence of person-centered planning in 53% (N=9) of the plans we reviewed. For the remaining 47% (N=8) with person-centered plans there were wide variations in the details that these plans provided. This observation was true when looking at plans between agencies and within the same agency. Nevertheless, the movement in the direction of using person-centered planning is a significant step forward from what has been seen in previous visits. The newly created Rhode Island Personcentered Thinking Guide has identified the desired components (page 4) of a person-centered plan as follows: 
• Indicators that the person is prepared to actively participate in planning;
• Knowledge of community opportunities and experiences that would expand the person’s life experiences and match strengths, interests, preferences, and needs;
• A personal profile;



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• Plan details for each area included in the plan (current experiences, statement of goal or life domain expectations, action steps, and implementation details);
• Measurement strategies; • Description of strategies and supports to keep the person safe (if
needed); • Schedule for review.
None of the person-centered plans we reviewed contained all of these elements. For example, no plan included a personal profile so it was not really possible to understand who the participant really was. When our review of the record was paired with the opportunity to actually meet the participant, this overall understanding became a little easier. The written plans should be far more robust in terms the type and degree of detail provided in the plans. As an example, in several of the plans a PATH document was included in the record. Where this was the case, there was rich information about the person often displayed through the pictorial representation of these discussions. However, it was not possible to understand how the recipients’ programs were designed or modified to capture the essence of these discussions through any new program directions. It seemed as though the individual’s program after the MAPS planning process often remained unchanged as a result of this planning. Despite these observations, it is fair to say that the implementation of personcentered planning remains a work in progress where there has been significant but uneven advances in the development of person-centered planning practices. There remains a significant amount of work yet to be done.
2. What is the quality and comprehensiveness of the ISPs and the CDPs?
As mentioned in number 1 above, there is very inconsistent quality in these plan documents although overall, they seem to be moving in the right direction. The same can be said about the comprehensiveness of these plans. Often questions posed by the ISP process are being answered with one or two sentences. Such limited responses to important program areas provides little depth to develop an appropriately responsive plan. In some instances, the answers to questions did not appear to be coming from the perspective of the individual. For example, some actual responses to the ISP question of what I need to work on were:
• (name) needs to work on broadening his choices for activities within the community.
• (name) needs to work on money management skills. (name) also needs to work on communication skills by learning to express his wants and needs verbally as opposed to opening his wallet and showing community advocate that he has money as a means to communicate that he wants to go to the store.



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• (name) needs to continue to work on moving his body and strengthening his arms, hands and legs through controlled exercises.
• (name) would like to work on making medical and dental appointments. (name) also wants to work on training for a cook’s position at his current place of employment.
As can be seen these responses are quite variable in the degree to which they reflect the opinions of the service recipient. This question is one of the questions under the major ISP/CDP heading of “WHAT IS IMPORTANT TO ME”. This is a very person-centered question which is asking for an answer that reflects what the person views as important. In the first three bullets above, the responses to this question feel like they came from the perspective of staff and not the individual. The fourth bullet seems to show a response that clearly comes from the person and not the staff. It is brief but much more in line with a person-centered process. Even though the response in the fourth bullet is person-centered, there is no goal in this plan that directly addresses either of these stated desires making the overall plan less person-centered than it could be.
Another observation about comprehensiveness can be seen in the scope of these plans. As an example, there are a number of individuals in this sample who have significant communication issues. There does not appear to be any focused response on how such significant needs will be addressed. There are also a few individuals in the sample where it is unclear the extent to which English is the primary language. There are statements to this effect, however, nothing in the records reviewed explained how these judgements were made. Overall the identification of barriers seems to be a weakness across many of the plans that were reviewed.
3. Are the services actually aligned with the goals, objectives, and preferences identified in the ISP and CDP?
 As with one and two above, there is wide variation between the plans reviewed and what is actually occurring. There are certainly instances where plan goals are in alignment, at least partially. In referring back to Table 1 we saw four instances (24%) where we felt alignment was absent in the plans we reviewed (for Community Integrated Day Services). Frequently however, there were clear instances of personal preference identified in the planning process that did not appear to be reflected in the services that were actually happening. Just one example of this is a gentleman who clearly indicated he wanted to learn how to read and how to use a computer. There are five goals identified in his plan with none of these responding to this individual’s stated desires.



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It is very important for provider agencies to improve their ability to adjust the way programs and services are designed and delivered to respond to the stated preferences of participants. Without this follow through the person-centered planning process will fall short of its goals. It is very easy for someone other than the individual to inject his or her own priorities in instances where personal preferences are really being called for. Good strategies need to be in place to minimize the extent to which the priorities of someone other than the individual are substituted for personal preferences. Personal preferences need to be validated through the person-centered planning process and incorporated into the implementation of the individual’s overall plan.
Recommendations
Provider agencies should be reinforced for the degree of change that they have made towards moving the system closer to an individualized and personcentered model. Certainly, the changes that are evident at Easter Seals of Rhode Island (ESRI) are very substantial. There is little resemblance of this organization today then was the case just a year ago. However, there are still very substantial steps that need to be taken in order to get this organization to an acceptable level of “person-centeredness”. Based on the review we have just completed this need goes beyond ESRI and extends in some respect to all of the plans we reviewed. With this in mind the following recommendations are made:
a. Continue training efforts that follow the Rhode Island Person-centered Thinking Guide as developed by the Sherlock Center. The list of contributors to this document encompass many stakeholders in the Rhode Island system. For this reason, stakeholder buy in to develop plans that meet the requirements articulated in this guide should be very attainable.
b. Consider publishing for training purposes several ISPs that meet the person-centeredness standard suggested in this guideline. Service Coordinators/Case Managers should be expected to demonstrate their understanding of person-centeredness by having their ISP’s reviewed against these standards.
c. Require that personal preferences identified in the person-centered planning process are reflected in the goals and objectives that are developed, and that these goals are addressed and integrated into the services and supports that an individual is receiving.
d. Agencies should diversify the way that community integrated day services are being provided. Based on observations, the same locations are being used for several individuals at the same time. From our observations it did not seem like groupings were being organized based on existing friendship connections. Beyond this,



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some of these locations are being used by more than a single agency simultaneously. Examples of this are the Bowlarama where several staff from other agencies were sitting together with their clipboards watching the people they brought to bowl at the same time that the person being visited was bowling. The YMCA was another example. There is nothing wrong with friends going places together. However, it felt a little like these community resources were themselves becoming a little bit like a day program.
e. Among the people visited were some individuals who had complicated issues who would benefit considerably from more aggressive planning and intervention. Communication was perhaps the largest issue among this group. This included people where English may or may not be their primary language, as well as individual’s whose speech was very limited. Additionally, there are people who may benefit from alternative communication methods. Current staff are very familiar with these individuals and develop communication strategies that are not easily transferred to the community at large. Having the input of specialists (communication, behavioral, etc.) in these types of circumstances would likely enhance service delivery.
Summary
This visit to Rhode Island was for the purpose of reviewing the extent to which ISPs and CDPs were being developed in a person-centered fashion. To do this a small sample of records were chosen from individuals who are members of the Birch or TPP target populations. Visits with these individuals were scheduled to coincide with times when they were participating in community integrated day services. The goals and objectives identified in the plan documents were assessed to the extent possible with what the reviewer was able to glean from the observation and conversation with the individual during these site visits. The results of these reviews are displayed in Table 1 above, and are discussed in the body of this report.
In general we saw a person-centered planning system that was in the process of being implemented. There was clear evidence that significant progress has already been made to move the services to a more individualized and integrated service model. While the foundations for person-centered planning have been laid, there remains a lot of work ahead to move this process to meet the standards that are identified in the Rhode Island Person-centered Thinking Guide. Some recommendations to move this process forward have also been included in this report.
Based on the documents reviewed during this visit, coupled with direct observations that were made, there is a significant ongoing need for continued training on person-centered planning with an emphasis on how to take a plan



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and put it into action. A good person-centered plan by itself does not produce good person-centered outcomes. How to individualize and implement these plans needs to be a focus for training.
I very much appreciate the opportunity to be part of this review process in Rhode Island. The ability to meet and spend a little time with some of the individuals who were selected for this review was particularly rewarding. I also want to state that all of the staff I met with were very helpful. I was also very impressed with their level of commitment to the people that they are working with. If I can provide you with any additional information I would be happy to do so.
Sincerely,
William Ashe, Ed.D. Consultant 870 South Barre Road Barre, Vermont 05641



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 Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 1 of 11
U.S. District Court District of Rhode Island (Providence) CIVIL DOCKET FOR CASE #: 1:14−cv−00175−JJM−PAS

CLOSED

United States of America v. State of Rhode Island Assigned to: Judge John J. McConnell, Jr. Referred to: Magistrate Judge Patricia A. Sullivan Related cases: (View Related Cases) Cause: 42:12101 Americans With Disabilities Act
Plaintiff

Date Filed: 04/08/2014 Date Terminated: 09/17/2015 Jury Demand: None Nature of Suit: 446 Civil Rights: Americans with Disabilities − Other Jurisdiction: U.S. Government Plaintiff

United States of America

represented by Amy Retsinas Romero United States Attorney's Office District of Rhode Island 50 Kennedy Plaza Providence, RI 02903 401−709−5010 Email: amy.romero@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Regina Kline United States Department of Justice Civil Rights Division 950 Pennsylvania Avenue, NW (NYA) Washington, DC 20530 202−305−0047 Email: regina.kline@usdoj.gov TERMINATED: 01/19/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Richard Myrus United States Attorney's Office 50 Kennedy Plaza Providence, RI 02903 401−709−5029 Email: Richard.Myrus@USDOJ.gov TERMINATED: 12/18/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Victoria L. Thomas U.S. Department of Justice Disability Rights Section Civil Rights Division 1425 New York Ave., NW Room 6019 Washington, DC 20005 202−616−2925 Email: victoria.thomas2@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Lindsey M. Weinstock United States Department of Justice 950 Pennsylvania Avenue NW (NYA) Washington, DC 20004 202−616−2221 Email: lindsey.weinstock@usdoj.gov ATTORNEY TO BE NOTICED

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 2 of 11

Nicole K. Zeitler U.S. Department of Justice Civil Rights Division− Disability Rights Section 1425 New York Ave., NW 6027 Washington, DC 20005 202−616−4783 Email: nicole.zeitler@usdoj.gov ATTORNEY TO BE NOTICED

V. Defendant State of Rhode Island
Intervenor Community Living of Rhode Island, Inc.

represented by Marc DeSisto DeSisto Law LLC 60 Ship street Providence, RI 02903 272−4442 Fax: 272−9937 Email: marc@desistolaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Jeffrey W. Kasle Olenn & Penza LLP 530 Greenwich Avenue Warwick, RI 02886 401−737−3700 Fax: 401−737−5466 Email: jwk@olenn−penza.com ATTORNEY TO BE NOTICED

V. Interested Party Dr. Charles Moseley

represented by Charles Moseley P.O. Box 544 Charlotte, VT 05445 703−850−1635 Email: crmos9@gmail.com PRO SE

Date Filed 04/08/2014 04/08/2014 04/08/2014
04/09/2014

# Docket Text
1 COMPLAINT filed by United States of America. (Attachments: # 1 Civil Cover Sheet)(Farrell Pletcher, Paula) (Entered: 04/08/2014)
2 NOTICE of Appearance by Marc DeSisto on behalf of State of Rhode Island. (Farrell Pletcher, Paula) (Entered: 04/08/2014)
3 Joint MOTION for Entry of Consent Decree with Supporting Memo filed by United States of America. Responses due by 4/25/2014 (Attachments: # 1 Text of Proposed Order, # 2 Proposed Consent Decree, # 3 Supporting Memorandum)(Kline, Regina) (Entered: 04/08/2014)
4 ORDER granting 3 Joint Motion for entry of consent decree; Consent Decree shall be entered as a final order and judgment in this case; the Court shall retain jurisdiction over the case to enforce the Consent Decree until this case is dismissed; the Court shall have the power to enforce the Consent Decree. So Ordered by Senior Judge Ronald R. Lagueux on 4/9/14. (Cavaco, Janice) (Entered: 04/09/2014)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 3 of 11

04/09/2014 09/16/2015 09/17/2015 10/23/2015 11/05/2015 11/05/2015 12/04/2015
12/07/2015 12/09/2015 01/20/2016 01/29/2016 02/23/2016 02/24/2016 02/24/2016 02/24/2016 03/01/2016 03/03/2016 03/03/2016 03/03/2016

5 CONSENT DECREE entered. So Ordered by Senior Judge Ronald R. Lagueux on 4/9/14. (Cavaco, Janice) (Entered: 04/09/2014)
6 ORDER OF RECUSAL. Senior Judge Ronald R. Lagueux recused. Case reassigned to Judge John J. McConnell, Jr. for all further proceedings. So Ordered by Senior Judge Ronald R. Lagueux on 9/16/2015. (Cavaco, Janice) (Entered: 09/16/2015)
7 STATUS REPORT on Consent Decree submitted by Charles Moseley EdD, U.S. District Court Monitor. (Farrell Pletcher, Paula) (Entered: 09/17/2015)
NOTICE of Hearing: Status Conference set for Tuesday, 12/8/2015 at 02:00 PM in Judge McConnell Chambers − Room 211 (Barletta, Barbara) (Entered: 10/23/2015)
8 NOTICE of Appearance by Lindsey M. Weinstock on behalf of United States of America (Weinstock, Lindsey) (Entered: 11/05/2015)
9 NOTICE of Appearance by Victoria Thomas on behalf of United States of America (Weinstock, Lindsey) Modified on 11/5/2015 to correct name (Barletta, Barbara). (Entered: 11/05/2015)
REVISED NOTICE of Hearing: Status Conference set for Tuesday, 12/8/2015 at 02:00 PM in Courtroom 3 before Judge John J. McConnell, Jr.; PLEASE NOTE THAT THIS CONFERENCE WILL NOW BE HELD IN COURTROOM 3(Barletta, Barbara) (Entered: 12/04/2015)
HEARING CANCELLED: The Status Conference scheduled for Tuesday, 12/8/15 at 2:00 p.m. before Judge John J. McConnell, Jr. is cancelled and will be rescheduled (Barletta, Barbara) (Entered: 12/07/2015)
REVISED NOTICE of Hearing: Status Hearing is RESET to Tuesday, 1/26/2016 at 11:00 AM in Courtroom 3 before Judge John J. McConnell, Jr.(Barletta, Barbara) (Entered: 12/09/2015)
10 Report of Court Monitor for 1/1/15 through 9/30/15 (Attachments: # 1 Consultant Report) (Barletta, Barbara) (Entered: 01/20/2016)
NOTICE of Hearing: Status Conference set for Monday, 5/2/2016 at 01:30 PM in Courtroom 3 before Judge John J. McConnell, Jr.(Barletta, Barbara) (Entered: 01/29/2016)
NOTICE of Hearing: Telephone Conference set for Wednesday, 2/24/2016 at 02:30 PM before Judge John J. McConnell, Jr.; Court to initiate call(Barletta, Barbara) (Entered: 02/23/2016)
REVISED NOTICE of Hearing: Telephone Conference is RESET to Wednesday, 2/24/2016 at 01:30 PM before Judge John J. McConnell, Jr.; PLEASE NOTE TIME CHANGE(Barletta, Barbara) (Entered: 02/24/2016)
Minute Entry for proceedings held before Judge John J. McConnell, Jr.: Telephone Conference held on 2/24/2016; Victoria Thomas, Marc DeSisto and Charles Moseley participated (Barletta, Barbara) (Entered: 02/24/2016)
NOTICE of Hearing: Status Conference set for Monday, 3/14/2016 at 10:00 AM in Courtroom 3 before Judge John J. McConnell, Jr.; Counsel for the United States is granted leave to appear by telephone(Barletta, Barbara) (Entered: 02/24/2016)
11 Joint MOTION for Hearing filed by United States of America. Responses due by 3/18/2016 (Attachments: # 1 Text of Proposed Order, # 2 Certificate of service)(Thomas, Victoria) (Entered: 03/01/2016)
12 NOTICE of Appearance by Nicole K. Zeitler on behalf of United States of America (Zeitler, Nicole) (Entered: 03/03/2016)
13 ORDER granting 11 Motion for Hearing and outlining remedial action plan− So Ordered by Judge John J. McConnell, Jr. on 3/3/2016. (Barletta, Barbara) (Entered: 03/03/2016)
NOTICE of Hearing: Evidentiary Hearing set for Friday, 4/8/2016 at 10:00 AM in Courtroom 3 before Judge John J. McConnell, Jr.(Barletta, Barbara) (Entered: 03/03/2016)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 4 of 11

03/14/2016
03/18/2016 03/18/2016 03/30/2016 04/01/2016 04/01/2016 04/04/2016
04/05/2016 04/05/2016 04/05/2016 04/06/2016 04/06/2016 04/06/2016 04/08/2016
04/11/2016 04/19/2016

Minute Entry for proceedings held before Judge John J. McConnell, Jr.: Status Conference held on 3/14/2016. Nicole Zeitler for Plaintiff. Marc DeSisto for Defendant. Dr. Charles Mosley (Court Monitor by Telephone). Evidentiary Hearing to proceed on 4/8/2016. Court adjourned. (Court Reporter Kare Wischnoswky in Courtroom 3 at 10:08 am.) (McGuire, Vickie) (Entered: 03/14/2016)
14 Court Monitor's Progress Status update dated 3/9/16 (Barletta, Barbara) (Entered: 03/18/2016)
15 TRANSCRIPT ORDER for proceedings held on 3/14/2016 before Judge McConnell.. (Weinstock, Lindsey) (Entered: 03/18/2016)
NOTICE of Hearing: Telephone Conference set for Friday, 4/1/2016 at 02:00 PM before Judge John J. McConnell, Jr.; Call in instructions to be provided to counsel(Barletta, Barbara) (Entered: 03/30/2016)
16 STATUS REPORT by State of Rhode Island. (Attachments: # 1 Exhibit 1, # 2 Exhibit 1.1, # 3 Exhibit 1.2, # 4 Exhibit 2, # 5 Exhibit 3, # 6 Exhibit 4−summary, # 7 Exhibit 6, # 8 Exhibit 6.1, # 9 Exhibit 6.2, # 10 Exhibit 7, # 11 Exhibit 8, # 12 Exhibit 8.1, # 13 Exhibit 9)(DeSisto, Marc) (Entered: 04/01/2016)
Minute Entry for proceedings held before Judge John J. McConnell, Jr.: Telephone/Status Conference held on 4/1/2016. Counsel of record present. (McGuire, Vickie) (Entered: 04/01/2016)
17 TRANSCRIPT of Status Conference held on March 14, 2016, before Judge John J. McConnell, Jr. Court Reporter Karen Wischnowsky, Telephone number (401) 529−7406. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter or PACER. NOTICE TO COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 4/25/2016. Redacted Transcript Deadline set for 5/5/2016. Release of Transcript Restriction set for 7/5/2016. (Wischnowsky, Karen) (Entered: 04/04/2016)
18 DECLARATION of Anne Mulready_RIDLC by United States of America. (Zeitler, Nicole) (Entered: 04/05/2016)
19 DECLARATION of Tammy Russo by United States of America. (Zeitler, Nicole) (Entered: 04/05/2016)
20 REDACTION BHDDH Feb. 11 2016 Letter by United States of America. (Zeitler, Nicole) (Entered: 04/05/2016)
21 EXHIBIT IN SUPPORT by State of Rhode Island in support of 16 Status Report, . (Attachments: # 1 Supplement Ex. 4, # 2 Supplement Ex. 4)(DeSisto, Marc) (Entered: 04/06/2016)
22 DECLARATION of Claire Rosenbaum by United States of America. (Zeitler, Nicole) (Entered: 04/06/2016)
23 REDACTION BHDDH Quarterly Service Package Letters by United States of America. (Zeitler, Nicole) (Main Document 23 replaced on 4/6/2016) (Barletta, Barbara). (Entered: 04/06/2016)
Minute Entry for proceedings held before Judge John J. McConnell, Jr.: Status Conference held on 4/8/2016. Nicole Zeitler for Plaintiff. Marc DeSisto for Defendants. Dr. Charles Mosley Court Monitor. Defendants report progress of compliance to the Consent Decree. Parties to contact court for the next status conference. Court adjourned. (Court Reporter Karen Wischnowsky in Courtroom 3 at 10:00 am.) (McGuire, Vickie) (Entered: 04/08/2016)
24 TRANSCRIPT ORDER for proceedings held on 4/8/2016 before Judge McConnell.. (Weinstock, Lindsey) (Entered: 04/11/2016)
25 TRANSCRIPT of Evidentiary Hearing held on April 8, 2016, before Judge John J. McConnell, Jr. Court Reporter Karen Wischnowsky, Telephone number (401)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 5 of 11

04/29/2016 04/29/2016 05/02/2016
05/05/2016 05/06/2016 05/06/2016 05/10/2016
05/10/2016 05/12/2016 05/16/2016 05/18/2016 06/15/2016 07/01/2016 07/22/2016

529−7406. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter or PACER. NOTICE TO COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 5/10/2016. Redacted Transcript Deadline set for 5/20/2016. Release of Transcript Restriction set for 7/18/2016. (Wischnowsky, Karen) (Entered: 04/19/2016)
26 STATUS REPORT by State of Rhode Island. (DeSisto, Marc) (Entered: 04/29/2016)
27 Report of the Court Monitor (Barletta, Barbara) (Entered: 04/29/2016)
Minute Entry for proceedings held before Judge John J. McConnell, Jr.: Status Conference held on 5/2/2016. Nicole Zeitler for Plaintiff. Marc DeSisto for Defendants. Dr. Charles Mosley Court Monitor. Defendants report progress of compliance to the Consent Decree. Parties to contact court for the next status conference. Court adjourned. (Court Reporter Karen Wischnowsky in Courtroom 3 at 1:57 pm.) (McGuire, Vickie) (Entered: 05/02/2016)
28 Letter to Judge McConnell received on May 4, 2016 (Barletta, Barbara) (Entered: 05/05/2016)
29 TRANSCRIPT ORDER for proceedings held on 5/2/2016 before Judge McConnell.. (Weinstock, Lindsey) (Entered: 05/06/2016)
30 MOTION to enter proposed order filed by United States of America in support of 13 Order on Motion for Hearing Motion to Enter Proposed Order. (Attachments: # 1 Text of Proposed Order Proposed Order)(Zeitler, Nicole) Modified on 5/6/2016 to correct (Barletta, Barbara). (Entered: 05/06/2016)
31 TRANSCRIPT of Status Conference held on May 2, 2016, before Judge John J. McConnell, Jr. Court Reporter Karen Wischnowsky, Telephone number 401−529−7406. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter or PACER. NOTICE TO COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 5/31/2016. Redacted Transcript Deadline set for 6/10/2016. Release of Transcript Restriction set for 8/8/2016. (Wischnowsky, Karen) (Entered: 05/10/2016)
32 TRANSCRIPT ORDER for proceedings held on May 2, 2016 before Judge McConnell.. (DeSisto, Marc) (Entered: 05/10/2016)
33 RESPONSE in Opposition re 30 MOTION filed by State of Rhode Island. Replies due by 5/23/2016. (Attachments: # 1 Exhibit A, # 2 Exhibit B)(DeSisto, Marc) (Entered: 05/12/2016)
34 REPLY to Response to Motion re 33 Response in Opposition to Motion to Enter Proposed Order filed by United States of America. (Zeitler, Nicole) (Entered: 05/16/2016)
35 ORDER granting 30 Motion to Enter a Proposed Order re: Compliance with 5 Consent Decree. So Ordered by Judge John J. McConnell, Jr. on 5/18/2016. (Jackson, Ryan) (Entered: 05/18/2016)
36 Follow up letter to Judge McConnell re 28 Letter (Barletta, Barbara) (Entered: 06/21/2016)
37 STATUS REPORT in compliance with Court's Order of May 18, 2016 by State of Rhode Island. (Attachments: # 1 Exhibit 1, # 2 Exhibit 2, # 3 Exhibit 3, # 4 Exhibit 4, # 5 Exhibit 5, # 6 Exhibit 6)(DeSisto, Marc) (Entered: 07/01/2016)
38 Report of the Court Monitor (Barletta, Barbara) (Entered: 07/22/2016)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 6 of 11

07/27/2016 07/28/2016 07/29/2016 08/05/2016 08/18/2016 09/09/2016 09/15/2016 09/15/2016 09/15/2016 09/16/2016 09/16/2016
09/20/2016 10/14/2016
11/01/2016 11/01/2016 11/01/2016 01/19/2017 01/19/2017

39 SUPPLEMENTAL EXHIBIT 3 AND EXHIBIT 5 by State of Rhode Island in support of 37 Status Report (Attachments: # 1 Exhibit 5)(Barletta, Barbara) (Entered: 07/27/2016)
40 Compliance Report dated 7/27/16 filed by the Court Monitor (Barletta, Barbara) (Entered: 07/28/2016)
41 STATUS REPORT Fourth Edition by State of Rhode Island. (Attachments: # 1 Exhibit 1−5, # 2 Exhibit 6−9)(DeSisto, Marc) (Entered: 07/29/2016)
42 EXHIBIT IN SUPPORT by State of Rhode Island in support of 41 Status Report . (Attachments: # 1 Exhibit, # 2 Exhibit)(DeSisto, Marc) (Entered: 08/05/2016)
NOTICE of Hearing: Status Conference set for Friday, 9/16/2016 at 02:00 PM in Courtroom 3 before Judge John J. McConnell, Jr.(Barletta, Barbara) (Entered: 08/18/2016)
43 Report of the Court Monitor (Barletta, Barbara) (Entered: 09/09/2016)
44 Addendum to 43 Report of the Court Monitor (Barletta, Barbara) (Entered: 09/15/2016)
45 EXHIBIT IN SUPPORT by State of Rhode Island in support of 41 Status Report . (Attachments: # 1 Exhibit 1(a), # 2 Exhibit 1(b), # 3 Exhibit 1(c))(DeSisto, Marc) (Entered: 09/15/2016)
46 STATUS REPORT Outlining a Summary of Topics for Discussion at the September 16, 2016 Status Conference by United States of America. (Zeitler, Nicole) (Entered: 09/15/2016)
47 Revised Addendum to 44 Addendum to Court Monitor's report dated 9/9/16 by Charles Moseley. (Barletta, Barbara) (Barletta, Barbara). (Entered: 09/16/2016)
Minute Entry for proceedings held before Judge John J. McConnell, Jr.: Status Conference held on 9/16/2016. Counsel of record present. Defendants report progress regarding consent decree. Government requests a show cause hearing. Court defers. Court adjourned. vm (Court Reporter Denise Veitch in Courtroom 3 at 2:00 pm.) (McGuire, Vickie) (Entered: 09/16/2016)
48 TRANSCRIPT ORDER for proceedings held on 9/16/16 before Judge McConnell.. (Zeitler, Nicole) (Entered: 09/20/2016)
49 TRANSCRIPT of Status Conference, held on September 16, 2016, before Judge John J. McConnell, Jr. Court Reporter Denise P. Veitch, Telephone number 401−323−9337. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. NOTICE TO COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 11/4/2016. Redacted Transcript Deadline set for 11/14/2016. Release of Transcript Restriction set for 1/12/2017. (Veitch, Denise) (Entered: 10/14/2016)
50 Report of the Court Monitor dated 10/31/16 (Barletta, Barbara) (Entered: 11/01/2016)
NOTICE of Hearing: Status Conference set for Friday, 1/17/2017 at 10:00 AM in Courtroom 3 before Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 11/01/2016)
CORRECTED Notice of Hearing: Status Conference set for Friday, 1/27/2017 at 10:00 AM in Courtroom 3 before Judge John J. McConnell, Jr.; (Barletta, Barbara) (Entered: 11/01/2016)
51 NOTICE by United States of America of Withdrawal of Regina Kline (Zeitler, Nicole) (Entered: 01/19/2017)
52 STATUS REPORT 5th Status Report by State of Rhode Island. (DeSisto, Marc) (Entered: 01/19/2017)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 7 of 11

01/20/2017 01/20/2017 01/25/2017 02/06/2017 02/06/2017 02/10/2017 03/03/2017 03/06/2017 03/06/2017 03/10/2017
03/13/2017 03/30/2017 04/19/2017 04/19/2017 04/19/2017
04/24/2017

HEARING CANCELLED: The Status Conference scheduled for Friday, 1/27/17 at 10:00 a.m. in Courtroom 3 before Judge John J. McConnell, Jr. is cancelled and will be rescheduled (Barletta, Barbara) (Entered: 01/20/2017)
REVISED NOTICE of Hearing: Status Conference is RESET to Tuesday, 2/14/2017 at 10:00 AM in Courtroom 3 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 01/20/2017)
53 Report of the Court Monitor (Barletta, Barbara) (Entered: 01/25/2017)
HEARING CANCELLED: The Status Conference scheduled for Tuesday, 2/14/17 at 10:00 a.m. in Courtroom 3 before Judge John J. McConnell, Jr. is cancelled and will be rescheduled (Barletta, Barbara) (Entered: 02/06/2017)
REVISED NOTICE of Hearing: Status Conference is RESET to Friday, 3/10/2017 at 11:00 AM in Courtroom 3 before District Judge John J. McConnell, Jr.(Barletta, Barbara) (Entered: 02/06/2017)
54 Addendum to 53 Court Monitor report by Charles Moseley. (Barletta, Barbara) (Entered: 02/13/2017)
55 Court Monitor Report for period ending 9/30/16 (Attachments: # 1 Consent Decree Data Report)(Barletta, Barbara) (Entered: 03/03/2017)
56 STATUS REPORT in compliance with Court Order of May 18, 2015 − State's Sixth Status Report by State of Rhode Island. (Attachments: # 1 Exhibit)(DeSisto, Marc) (Entered: 03/06/2017)
57 STATUS REPORT Outlining a Summary of Topics for Discussion at the March 10, 2017 Status Conference by United States of America. (Zeitler, Nicole) (Entered: 03/06/2017)
Minute Entry for proceedings held before District Judge John J. McConnell, Jr.: Status Conference held on 3/10/2017. Counsel of record present. Defendants report progress regarding consent decree. Government report areas of continued concern. Court adjourned. (Court Reporter karen Wischnowsky in Courtroom 3 at 11:05 am.) (McGuire, Vickie) (Entered: 03/10/2017)
NOTICE of Hearing: Status Hearing set for Friday, 7/28/2017 at 10:00 AM in Courtroom 3 before District Judge John J. McConnell, Jr.(Barletta, Barbara) (Entered: 03/13/2017)
58 TRANSCRIPT ORDER for proceedings held on March 10, 2017 before Judge John J. McConnell, Jr... (Zeitler, Nicole) (Entered: 03/30/2017)
59 COURT MONITOR'S REPORT (Barletta, Barbara) (Entered: 04/19/2017)
CORRECTIVE DOCKET ENTRY Regarding: 59 Court Monitor's Report ; this document does not contain the report and all attachments and will be refiled (Barletta, Barbara) (Entered: 04/19/2017)
60 Review of State's response to the Court Monitor's 1/25/17 report on Consent Decree Compliance (Attachments: # 1 Plan for increasing hours worked by consent decree target population members, # 2 CDP Outcomes and Practices Benchmark # 4, # 3 CDP Plan Outcomes − SWS and Day, # 4 PCP Guidance, # 5 Benefits Planning Benchmark #6, # 6 Redacted List of Employed with no benefits plan, # 7 Transition Planning for Youth Trial Work, # 8 Redacted ORS Youth Exit Trial Work, # 9 Redacted Trial Work Experience, # 10 RIDE CDP Rubric−9−9−16, # 11 ORS Policy Directive, # 12 DDD Consent Decree Transitional Activities, # 13 Memo−SPED Dir Consent Decree Requirements 2−28−17, # 14 RI Transition Timeline Feb. 20, # 15 RIDE Emp. First Policy Final, # 16 Training and Certification of State 2c Benchmark #2, # 17 Response to Review of EFTF Comments, # 18 Provider Capacity Plan 2−28−17 updated 4−15−17)(Barletta, Barbara) (Entered: 04/19/2017)
61 TRANSCRIPT of Status Conference held on March 10, 2017, before Judge John J. McConnell, Jr. Court Reporter Karen Wischnowsky, Telephone number (401) 529−7406. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter or PACER. NOTICE TO

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 8 of 11

06/14/2017 06/26/2017 07/17/2017 07/17/2017 07/17/2017 07/19/2017 07/26/2017 07/27/2017 07/28/2017
08/02/2017 08/02/2017 08/08/2017
10/10/2017

COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 5/15/2017. Redacted Transcript Deadline set for 5/25/2017. Release of Transcript Restriction set for 7/24/2017. (Wischnowsky, Karen) (Entered: 04/24/2017)
62 COURT MONITOR'S REPORT issued 6/13/17 (Barletta, Barbara) (Entered: 06/14/2017)
NOTICE of Hearing: Telephone Conference set for Monday, 7/17/2017 at 08:30 AM in before District Judge John J. McConnell, Jr.; Court to initiate call. Kindly provide clerk at 401−752−7202 with contact information if it differs from the docket sheet(Barletta, Barbara) (Entered: 06/26/2017)
Minute Entry for proceedings held before District Judge John J. McConnell, Jr.: Telephone Conference held on 7/17/2017; Nicole K. Zeitler, Marc DeSisto and Charles Mosley participated (Barletta, Barbara) (Entered: 07/17/2017)
REVISED NOTICE of Hearing: Status Conference set for Friday, 7/28/2017 at 10:00 AM will be held in the historic Library − Room 310 before District Judge John J. McConnell, Jr. ; PLEASE NOTE LOCATION CHANGE(Barletta, Barbara) (Entered: 07/17/2017)
REVISED NOTICE of Hearing: Status Conference set for Friday, 7/28/2017 at 11:00 AM in the Historic Library − Room 310 before District Judge John J. McConnell, Jr.; Please note time change (Barletta, Barbara) (Entered: 07/17/2017)
63 COURT MONITOR'S REPORT dated 7/19/17 (Barletta, Barbara) (Entered: 07/19/2017)
64 STATUS REPORT Outlining a Summary of Topics for Discussion at the July 28, 2017 Status Conference by United States of America. (Zeitler, Nicole) (Entered: 07/26/2017)
65 COURT MONITOR'S STATUS REPORT 1/25/17 through 1/20/17 (Barletta, Barbara) (Entered: 07/27/2017)
Minute Entry for proceedings held before District Judge John J. McConnell, Jr.: Status Conference held on 7/28/2017.Counsel of record present. Defendants report progress regarding consent decree. Government report areas of continued concern. Court adjourned. (Court Reporter Karen Wischnowsky in Historic Library at 11:00 am.) (McGuire, Vickie) (Entered: 07/28/2017)
66 TRANSCRIPT ORDER for proceedings held on 7/28/2017 before Judge John J. McConnell, Jr.. Ordinary Transcript delivery selected. Transcript to be delivered in 30 days.. (Zeitler, Nicole) (Entered: 08/02/2017)
67 TRANSCRIPT ORDER ACKNOWLEDGMENT Entered re: 66 Transcript Order. Court Reporter/Transcriber: Karen Wischnowsky. Transcript due by 9/1/2017. (Dias, Jennifer) (Entered: 08/02/2017)
68 TRANSCRIPT of Status Conference held on July 28, 2017, before Judge John J. McConnell, Jr. Court Reporter Karen Wischnowsky, Telephone number (401) 529−7406. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter or PACER. NOTICE TO COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 8/29/2017. Redacted Transcript Deadline set for 9/8/2017. Release of Transcript Restriction set for 11/6/2017. (Wischnowsky, Karen) (Entered: 08/08/2017)
NOTICE of Hearing: Status Hearing set for Thursday, 11/30/2017 at 11:00 AM in Courtroom 1 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 10/10/2017)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 9 of 11

12/05/2017 01/02/2018 01/19/2018 04/05/2018 04/06/2018 04/06/2018 04/06/2018 04/09/2018 04/09/2018 04/10/2018
04/23/2018 04/23/2018 05/09/2018 05/09/2018
05/16/2018 05/17/2018

NOTICE of Hearing: Status Conference set for Monday, 4/9/2018 at 02:00 PM in Courtroom 1 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 12/05/2017)
Reset Hearings: Status Conference os RESET to Tuesday, 4/10/2017 at 02:00 PM in Courtroom 1 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 01/02/2018)
69 COURT MONITOR'S STATUS REPORT from 4/1/17 through 9/30/17 (Barletta, Barbara) (Entered: 01/19/2018)
70 NOTICE by United States of America Outlining a Summary of Topics for Discussion at the April 10, 2018 Case Nos. CA 14−175 and 13−442 Status Conference (Thomas, Victoria) (Entered: 04/05/2018)
71 MOTION to Intervene filed by Community Living of Rhode Island, Inc.. Responses due by 4/20/2018. (Kasle, Jeffrey) (Entered: 04/06/2018)
NOTICE of Hearing on Motion 71 MOTION to Intervene : Motion Hearing set for Tuesday, 4/10/2018 at 02:00 PM in Courtroom 1 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 04/06/2018)
72 COURT MONITOR'S REPORT 8/1/17 through 12/31/17 (Barletta, Barbara) (Entered: 04/06/2018)
73 MOTION to Withdraw 71 MOTION to Intervene filed by Community Living of Rhode Island, Inc.. Responses due by 4/23/2018. (Kasle, Jeffrey) (Entered: 04/09/2018)
TEXT ORDER granting 73 Motion to Withdraw and withdrawing 71 Motion to Intervene− So Ordered by District Judge John J. McConnell, Jr. on 4/9/2018. (Barletta, Barbara) (Entered: 04/09/2018)
Minute Entry for proceedings held before District Judge John J. McConnell, Jr.: Status Conference held on 4/10/2018. Counsel of record present. All parties present status reports of progress & concerns regarding consent decree. Court adjourned. (Court Reporter Karen Wischnowsky in Courtroom 1 at 2:00 pm.) (McGuire, Vickie) (Entered: 04/10/2018)
74 TRANSCRIPT ORDER for proceedings held on 4/10/18−4/10/18 before Judge John J. McConnell, Jr.. Ordinary Transcript delivery selected. Transcript to be delivered in 30 days.. (Zeitler, Nicole) (Entered: 04/23/2018)
75 TRANSCRIPT ORDER ACKNOWLEDGMENT Entered re: 74 Transcript Order. Court Reporter/Transcriber: Karen Wischnowsky. Transcript due by 5/23/2018. (Dias, Jennifer) (Entered: 04/23/2018)
76 Letter to Judge McConnell requesting stop in budget cuts (Barletta, Barbara) (Entered: 05/09/2018)
77 TRANSCRIPT of Status Conference held on April 10, 2018, before Judge John J. McConnell, Jr. Court Reporter Karen Wischnowsky, Telephone number (401) 529−7406. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter or PACER. NOTICE TO COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 5/30/2018. Redacted Transcript Deadline set for 6/11/2018. Release of Transcript Restriction set for 8/7/2018. (Wischnowsky, Karen) (Entered: 05/09/2018)
78 Letter from Governor Raimondo to Court Monitor (Barletta, Barbara) (Entered: 05/16/2018)
79 Letter from Court Monitor to Secretary of Health and Human Services (Barletta, Barbara) (Entered: 05/17/2018)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 10 of 11

06/01/2018 07/13/2018 08/27/2018 08/27/2018 09/04/2018 09/06/2018 09/12/2018 09/13/2018 10/23/2018 10/30/2018 10/30/2018
12/06/2018 12/06/2018 12/12/2018 12/12/2018 01/03/2019
02/27/2019

80 COURT MONITOR'S UPDATE dated 6/1/18 (Barletta, Barbara) (Entered: 06/04/2018)
81 Court Monitor's Report for the period 1/1/18 through 3/31/18 (Barletta, Barbara) (Main Document 81 replaced on 7/16/2018) (Barletta, Barbara). (Entered: 07/13/2018)
NOTICE of Hearing: Status Conference set for Tuesday, 10/23/2018 at 02:00 PM in Courtroom 1 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 08/27/2018)
HEARING CANCELLED: The Status Conference scheduled for Tuesday, 10/23/18 at 2:00 p.m. in Courtroom 1 before Judge John J. McConnell, Jr. is cancelled and will be rescheduled (Barletta, Barbara) (Entered: 08/27/2018)
82 Court Monitor's Report for the period 4/1/2018 through 6/30/2018 (Urizandi, Nisshy) (Entered: 09/04/2018)
83 REVISED Court Monitor's Report from 4/1/18 through 6/30/18 (Barletta, Barbara) (Entered: 09/06/2018)
NOTICE of Hearing: Status Conference set for Friday, 11/2/2018 at 02:00 PM in Courtroom 1 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 09/12/2018)
REVISED NOTICE of Hearing: Status Conference is RESCHEDULED to Tuesday, 10/30/2018 at 03:00 PM in Courtroom 1 before District Judge John J. McConnell, Jr. (Barletta, Barbara) (Entered: 09/13/2018)
84 NOTICE by United States of America Joint Filing Summary of Topics for October 30, 2018 Status Conference for Case Nos. CA 14−175 and 13−442 (Thomas, Victoria) (Entered: 10/23/2018)
85 COURT MONITOR'S FOURTH REPORT dated October 29, 2018 (Barletta, Barbara) (Entered: 10/30/2018)
Minute Entry for proceedings held before District Judge John J. McConnell, Jr.: Status Conference held on 10/30/2018. Counsel of record present. All parties present status reports of progress & concerns regarding consent decree. Court adjourned. (Court Reporter Karen Wischnowsky in Courtroom 1 at 3:00 pm.) (McGuire, Vickie) (Entered: 10/30/2018)
86 TRANSCRIPT ORDER for proceedings held on 10/30/18 before Judge McConnell. Ordinary Transcript delivery selected. Transcript to be delivered in 30 days.. (Zeitler, Nicole) (Entered: 12/06/2018)
87 TRANSCRIPT ORDER ACKNOWLEDGMENT Entered re: 86 Transcript Order. Court Reporter/Transcriber: Karen Wischnowsky. (Dias, Jennifer) (Entered: 12/06/2018)
88 NOTICE of Appearance by Amy Retsinas Romero on behalf of All Plaintiffs (Romero, Amy) (Entered: 12/12/2018)
89 NOTICE by United States of America of Withdrawal of Richard Myrus (Romero, Amy) (Entered: 12/12/2018)
90 TRANSCRIPT of Status Conference held on October 30, 2018, before Judge John J. McConnell, Jr. Court Reporter Karen Wischnowsky, Telephone number (401) 752−7045. Transcript may be viewed at the court public terminal or purchased through the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through the Court Reporter or PACER. NOTICE TO COUNSEL: Redaction Requests must be filed for personal identifiers only. All other redactions must be requested by motion. For local policy and sample redaction request visit our website at www.rid.uscourts.gov and select Transcripts under the Case Information menu option. Redaction Request due 1/24/2019. Redacted Transcript Deadline set for 2/4/2019. Release of Transcript Restriction set for 4/3/2019. (Wischnowsky, Karen) (Entered: 01/03/2019)
91 Court Monitor's letter to Judge McConnell regarding budget summary (Attachments: # 1 2020 budget summary) (Barletta, Barbara) (Entered: 02/27/2019)

Case: 1:14-cv-00175-JJM-PAS As of: 04/03/2019 11:00 AM EDT 11 of 11
03/20/2019 92 COURT MONITOR'S REPORT for the period ending 9/30/18 (Barletta, Barbara) (Entered: 03/20/2019)

 
 FACT SHEET
Rhode Island Supported Employment and Integrated Day Services Consent Decree
Background
The consent decree resolves the Civil Rights Division’s Jan. 6, 2014, findings that the State of Rhode Island violated the Americans with Disabilities Act (ADA) and the Supreme Court’s decision in Olmstead v. L.C. by failing to serve individuals with intellectual and developmental disabilities (I/DD) in the most integrated day activity service setting appropriate for their needs, and by placing transition-age youth at serious risk of segregation. The consent decree focuses on three target populations: (1) individuals in sheltered workshops; (2) individuals in facility-based day programs; and (3) youth in transition from secondary school.
Frequently Used Terms
 A sheltered workshop is a segregated facility that exclusively or primarily employs persons with I/DD. Sheltered workshops are usually large institutional facilities in which persons with I/DD have little or no contact with non-disabled persons besides paid staff. People with I/DD in sheltered workshops typically earn wages that are well below minimum wage.
 Facility-based day programs are programs in which people with disabilities participate in segregated non-work activities during the day. These services are often provided by the same service providers and in the same buildings as sheltered workshops.
 Supported employment services allow persons with disabilities to work in typical jobs in the community at competitive wages. Such services include job discovery, vocational assessment, job coaching, and job training. These services enable individuals with I/DD to access jobs in typical work settings where they can interact with non-disabled coworkers, customers, and peers, and enjoy the same benefits of employment that their non-disabled peers enjoy.
 Integrated day services allow persons with I/DD to engage in self-directed activities in the community at times and frequencies and with persons of their choosing, and to interact to the fullest extent possible with non-disabled peers. For instance, integrated day services allow persons with I/DD to participate in and gain membership in mainstream community-based recreational, social, educational, cultural, and athletic activities, including community volunteer activities and training activities.
Employment and Day Services in Rhode Island
In Rhode Island, day activity services for individuals with I/DD include sheltered workshops, facility-based day programs, integrated supported employment, and integrated day services. The state plans, funds, and administers these services through provider agencies licensed by the state.
The Finding: In Rhode Island, approximately 80 percent of the people with I/DD receiving state services, about 2,700 individuals, are placed in segregated sheltered workshops or facility-based

day programs. By contrast, only about 12 percent, or approximately 385 individuals, participate in individualized, integrated employment. The investigation found that the state has over-relied on segregated service settings to the exclusion of integrated alternatives.
Placement in segregated settings is frequently permanent: nearly half (46.2 percent) of the individuals in sheltered workshops have been in that setting for ten years or more, and over onethird (34.2 percent) have been there for fifteen years or more. Individuals with I/DD in sheltered workshops in Rhode Island reportedly earn an average of only about $2.21 per hour.
The Remedy: Under the consent decree, the state has pledged a sustained commitment to transform its service system over the next 10 years, providing relief to approximately 3,250 people. Rhode Island will provide supported employment placements to approximately 2,000 individuals, including at least 700 people currently in sheltered workshops, at least 950 people currently in facility-based non-work programs, and approximately 300-350 students leaving high school.
Supported employment placements must provide persons with I/DD with supported employment services in integrated employment settings where they (1) are paid at least minimum wage, (2) work the maximum number of hours consistent with their abilities and preferences, and (3) interact with peers without disabilities to the fullest extent possible. As a group (not individually), persons receiving supported employment placements under the consent decree will average 20 hours of work per week in integrated employment settings. All persons receiving supported employment placements will also be provided with integrated non-work services, ensuring that individuals have access to integrated work and non-work hours for a total 40 hours per week.
To ensure informed choice, individuals with I/DD may remain in segregated programs if they request a variance after they have received a vocational assessment, a trial work experience, outreach information and benefits counseling.
Transition-Age Youth
The Finding: The ADA and Olmstead prohibit public entities from placing individuals, including young people with I/DD, at serious risk of unnecessary segregation. According to state data, among youth with I/DD who transitioned out of Rhode Island secondary schools between 2010 and 2012, only about five percent transitioned into jobs in integrated settings, even though many more of these youth are able to work in integrated employment and are not opposed to doing so.
The Remedy: Under the consent decree, the state will provide transition services to approximately 1,250 youth between the ages of 14 and 21. Also under the proposed consent decree, the Rhode Island Department of Education (RIDE) will adopt an employment first policy, making work in integrated employment settings a priority service option for youth. State agencies will promote the implementation of a school-to-work transition planning process that will include specific timelines and benchmarks for all youth between the ages of 14 and 21. Youth in transition will receive integrated vocational and situational assessments, trial work experiences, and an array of other services to ensure that they have meaningful opportunities to work in the community after they exit school.
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Other Provisions
Outreach, Education and Support:  The state will develop an outreach, in-reach and education program that explains the benefits of supported employment and addresses families’ concerns about participating in supported employment.  The state will create an employment first task force of local stakeholders, advocacy organizations, parent and business leadership networks, individuals with I/DD and family representatives.
Provider Capacity:  The state will establish a sheltered workshop conversion institute to assist qualified providers of sheltered workshop services to convert their employment programs to supported employment services.  The state will establish a sheltered workshop conversion trust fund of $800,000 to assist with upfront start-up costs to providers that have agreed to convert their services from primarily sheltered employment to primarily supported employment services.  The state will pursue a contract with technical assistance providers to provide leadership, training and technical assistance to employment and day services providers and to state staff.
Interagency Collaboration:  The state will implement interagency agreements among the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH), the Office of Rehabilitation Services (ORS) and RIDE.
Funding:  The state will reallocate resources currently expended on sheltered workshop and segregated day programs to instead fund supported employment and/or integrated day services as an individual transitions from segregated to integrated service settings, allowing funding to follow the person without an increase in cost.  The state will ensure that its reimbursement model for day activity services is sufficiently flexible to allow reimbursement for costs such as transportation, employer negotiation and counseling clients by phone. This will enable providers to support and provide services to individuals in supported employment placements even when the provider staff is not face-to-face with a client.
Quality Assurance:  The state will implement a statewide quality improvement initiative and will regularly conduct on-site reviews of its day activity service programs and publish reports describing its findings and recommendations, identifying any program deficiencies and requiring a plan of correction, where appropriate.
Data Collection and Monitoring:  The state will collect data and report on a variety of data points and report to the United States periodically.  Compliance with the consent decree will be overseen by a monitor jointly selected by the parties.
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 U.S. Department of Justice Civil Rights Division

DJ 204-66-55

Assistant Attorney General 950 Pennsylvania Ave, NW - RFK Washington, DC 20530

January 6, 2014

VIA U.S. MAIL AND E-MAIL

Mr. Marc DeSisto, Esq. DeSisto Law Offices 211 Angell Street Providence, RI 02906

On behalf of the Honorable Peter F. Kilmartin Attorney General for the State of Rhode Island Office of the Attorney General 150 South Main Street Providence, RI 02903

Re: United States' Title II ADA Investigation of Employment, Vocational, and Day Services for Persons with Intellectual and Developmental Disabilities in Rhode Island

Dear Mr. DeSisto:

We write to report the findings of the Civil Rights Division's investigation of the State of Rhode Island's ("the State" or "Rhode Island") system of providing employment, vocational, and day services to persons with intellectual and developmental disabilities ("I1DD") and, in particular, the State's provision of such services in segregated day activity service programs, including sheltered workshops and facility-based day programs. We have assessed the State's compliance with Title II of the Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12132 et.
seq., as interpreted by Olmstead v. L.c., 527 U.S. 581 (1999), which requires that services,
programs, and activities provided by public entities, including States, be delivered in the most integrated setting appropriate to the needs of persons with disabilities. The Department of Justice (the "Department") is authorized to seek a remedy for violations of Title II of the ADA. 42 U.S.C. § 12133.

We further write to provide you with notice of the State's failure to comply with the ADA and of the minimum steps that Rhode Island must take to meet its civil rights obligations under the law.

Before proceeding with our findings, we would like to thank the State for the assistance and cooperation extended to us during this investigation. We would also like to acknowledge the courtesy, professionalism, and commitment of the State officials and counsel involved in this matter to date. Further, we would like to thank providers, stakeholders, families, and service recipients for their candor and cooperation in assisting our investigation. Since the initiation of

our investigation, Rhode Island has demonstrated significant leadership in taking critical steps to implement the Interim Settlement Agreement between the United States, the State, and the City of Providence ("the City") in United States v. State of Rhode Island and City of Providence, No. 1:13-cv-00442 (D.R.I. July 11,2013), a matter pertaining to the adult service provider Training Thru Placement, Inc. ("TTP") and the Harold A. Birch Vocational Program at Mount Pleasant High School ("Birch"). We look forward to continuing to work amicably with the State to resolve the violations described below.
I. INTRODUCTION
Title II of the ADA prohibits discrimination in all "services, programs, or activities of a public entity." 42 U.S.C. § 12132. Title II's integration mandate requires that the "services, programs, or activities of a public entity" be provided "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." 28 C.F.R. § 35.130(d). Such a setting is one that "enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible[.]" 28 C.F.R. pt. 35, app. B at 673. Based on Title II and its integration mandate, the United States Supreme Court held that the "unjustified isolation" of persons with disabilities by State and local governments constitutes discrimination under Title II. Olmstead v. L.C., 527 U.S. 581, 597 (1999). Accordingly, the civil rights of persons with disabilities are violated by unnecessary segregation in a wide variety of non-residential settings, including in segregated employment, vocational, and day programs.
Over twenty years ago, Rhode Island was a national leader in shifiing its state service system away from segregated residential care. The State closed its state institution for . individuals with developmental disabilities, the Ladd School, "through strong collaboration with multiple stakeholders, including self-advocates, family members ... providers, and community leaders."! Rhode Island is one of a minority of states that no longer has any state-operated institutions for people with I1DD, and is one of an even smaller number with no state-funded, privately-operated institutions for this population.2 In this regard, Rhode Island has demonstrated strong commitment to the benefits oftransitioning individuals with I1DD into integrated residential settings. However, Title II of the ADA and Olmstead mandate that individuals be given the opportunity for meaningful community integration in all areas of life, not just where they live.
The ADA establishes a broad mandate, including that citizens with disabilities have the right to live integrated lives. See, e.g., 42 U.S.C. §§ 12101(a)(2), (b)(1)-(2). Title II is part of the ADA's "clear and comprehensive national mandate" to end the segregation of persons with disabilities in virtually all aspects of American life, including employment, public accommodations, and transportation. See id. § 12101. "Quite simply, the ADA's broad language
I Dep't of Behavioral Health, Developmental Disabilities & Hosps. ("BHDDH"), "Employment First Rhode Island State Policy and Five Year Implementation Plan" (Feb. 2013) (on file with BHDDH) [hereinafter "Employment First Five Year Implementation Plan"].
2 lih; see also United Cerebral Palsy, "The Case for Inclusion," at 3 (2013), available at http://www.ucp.org/the-
case-for-inclusion/201 3/images/Case_For_lnclusion_Report_2013.pdf("As of2011, 13 states have no state institutions to seclude those with !DIDO, including Alabama (new this year), Alaska, Hawaii, Maine, Michigan, Minnesota (which closed its last remaining institution in June 2011), New Hampshire, New Mexico, Oregon, Rhode Island, Vermont, West Virginia and DC."); K. Charlie Lakin et aI., "Residential Services for Persons with Disabilities: Status and Trends Through 2009," at iii, available at http://rtc.umn.edu/risp/docs/risp2009.pdf.
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brings within its scope anything a public entity does." Lee v. City of Los Angeles, 250 F.3d 668, 691 (9th Cir. 2001) (internal quotations omitted); see also Iverson v. City of Boston, 452 F.3d 94,99 (1st Cir. 2006). It is the State's obligation to fulfill this mandate on behalf of its citizens, whether they receive services during the day or in residential settings at night, and regardless of the severity of their disabilities. The Supreme Court recognized in Olmstead that "social contacts, work options, economic independellce, ... and cultural enrichment" are among the "everyday life activities" severely diminished by unnecessary segregation. Olmstead, 527 U.S. at 600-01. For many people with disabilities, including individuals with I1DD, these are the very everyday life activities made possible by the availability of integrated employment and day serVIces.
In Rhode Island, in spite of the State's significant commitment to ensuring that people can live in integrated settings, thousands of individtlals still spend the majority of their daytime hours receiving employment and day services in segregated sheltered workshops and facilitybased day programs, even though they are capable of and want to receive employment and day services in the community. Many such individuals have been relegated to these segregated programs for decades. For example, nearly half (46.2%) of individuals in facility-based employment in Rhode Island have been there for a decade or longer, and just over one third (34.2%) of individuals have been there for fifteen or more years.3 As they are confined to these settings indefinitely, individuals are prevented from advancing towards independence and economic self-sufficiency. Individuals in Rhode Island segregated sheltered workshop settings earn an average of $2.21 per hour; by contrast, persons who receive individualized supported employment services in integrated settings earn an average of $8.92 per hour. 4 Individuals in segregated non-work day programs are cut off from earnings or interacting with nondisabled peers altogether, even though many of these individuals can and want to work and receive integrated day services in the community. Such unjustified daily segregation firmly places many of the benefits of community life beyond the reach of people with disabilities, even though they are residing in the community. This segregation also deprives the greater community of the benefit of such persons' participation in the everyday life of the community.
Likewise, many youth with I/DD throughout Rhode Island can and want to work and experience full and meaningful participation in their communities after exiting school. More than any generation before them, these young persons have benefitted from civil rights protections that were designed to contribute to their preparedness for integrated post-secondary lives. Accordingly, they desire the employment and day services necessary to allow them the opportunity to work in integrated settings and to participate in activities of their choosing when they are not working. In fact, many such youth have long expected to receive such services following their exit from secondary school. Yet, the State service system has failed to offer them the critical transition, vocational, and employment services necessary to make work and participation in post-secondary integrated employment and day settings a reality. Consequently, many young people with I1DD have been placed at risk of unnecessary segregation in facilitybased sheltered workshops and day programs where they will experience a serious and permanent restriction on the quality and trajectory of their adult lives.
3 Paul V. Sherlock Ctr., 2012 RI DD Employment and Day Activity Data Summary (on file with the Paul V. Sherlock Center) [hereinafter "20 12 Sherlock Survey"]'
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People with disabilities in Rhode Island are talented and able people. If given access to the appropriate community-based services and supports, they will bring diversity and value to the community workplace, contribute to the "bottom line" of businesses, and strengthen and enrich communities throughout the Ocean State as citizens, co-workers, customers, and peers. By receiving services that will allow them to access competitive wage jobs and, when they are not receiving employment or residential services, to participate in meaningful activities in the community, these individuals also will gain economic independence and freedom.
While sheltered workshops and facility-based day programs may be permissible placements for some individuals with I/DD who make an informed choice to rely on them, the State of Rhode Island has unnecessarily and unjustifiably over-relied on such programs to the exclusion of integrated alternatives like supported employment and integrated day services. Many adults and youth with I1DD across Rhode Island can and want to receive employment and day services in integrated settings. As the Department of Justice has previously advised the State of Rhode Island, the civil rights of people who can and want to receive employment services in the community are violated when they are unnecessarily segregated in facility-based sheltered workshops. Likewise, the civil rights of people who can and want to receive day services in the community are violated when they are unnecessarily segregated in facility-based day programs. Moreover, as in the context of residential service settings, administering and funding day activity services, including employment services, in integrated settings is not only practicable but has been shown to lower costs over the longer term, and does not fundamentally alter state service systems.
When publicly funded State service systems impose a false and unnecessary choice upon individuals with disabilities-between accessing valuable employment and day services or accessing integrated settings-it violates both individuals' civil rights and the public's trust. In doing so, the State deprives the greater community and marketplace of the potential economic and social contributions of such individuals, and the individuals themselves are denied the opportunity to "move proudly into the economic mainstream of American life"-one of the primary purposes of the ADA. 5
The below findings summarizing our statewide investigation of Rhode Island's employment and day services system follow the Department's related findings in June 2013 regarding TTP and Birch-two of the largest I1DD programs in the State. On June 7, 2013, the Department issued a Letter of Findings to the State of Rhode Island, and a separate Letter of Findings to the City of Providence. The Department found that the State violated Title II of the ADA by unnecessarily segregating approximately 90 individuals with I/DD at TTP, and found that the State and City placed approximately 85 Birch students at serious risk of unnecessary segregation at TTP because of the lack of integrated transition services, integrated employment opportunities, and appropriate referrals to prepare students with I1DD for transition into work in integrated settings.
Following issuance of the June 7, 2013 Letters of Findings, the United States engaged in rapid but sustained efforts to resolve the violations identified with respect to the approximately 200 people at TTP and Birch. The United States focused on TTP and Birch more immediately-
5 Se" Remarks of President George H.W. Bush at the Signing of the Americans with Disabilities Act (July 26, 1990), available at hup://www.eeoc.gov/eeoc/history/3Sth/videos/ada_signing_text.htm!.
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while continuing its statewide investigation-because of issues that directly impacted the ability of those programs to continue to operate. On June 13,2013, the State and City entered into a court enforceable Interim Settlement Agreement with the United States to resolve the identified violations, providing relief to the approximately 200 Rhode Islanders with I/DD who received services from TTP and Birch, and requiring the State and City to provide adults and youth in transition with robust and person-centered career development planning, transition services, supportcd employment placements, and integrated day services. Under the Interim Settlement Agreement, "[t]he parties expressly acknowledge[d] and agree[d] that the United States w[ould] continue its investigation of the remainder of the State's day activity service system and w[ould] seek to remedy any and all violations of Title II of the ADA and Olmstead identified at the conclusion of the United States' continuing investigation.,,6 We make the following findings pursuant to our statewide investigation of the remainder of Rhode Island's day activity service system.
II. SUMMARY OF FINDINGS
We have concluded that the State has failed to provide employment, vocational, and day services to persons with I1DD in the most integrated setting appropriate to their needs, in violation of the ADA. The State plans, structures, and administers its system of providing employment, vocational, and day services in a maImer that delivers such services primarily in segregated sheltered workshops and facility-based day programs, rather than in integrated employment and day settings. Sheltered workshops and facility-based day programs segregate individuals from the community and provide little or no opportunity to interact with persons without disabilities, other than paid staff. Many persons with I/DD in, or at risk of entering, sheltered workshops and facility-based day programs in Rhode Island are capable of, and not opposed to, receiving such services in the community, where they would have the opportunity to access individual jobs, that pay minimum wage 01' higher, and integrated community activities, including self-directed activities in the community at times, frequencies, and with persons of their choosing when they are not receiving employment 01' residential services.
Our investigation found that Rhode Island provides some integrated services to some persons with I/DD, including persons with significant support needs. These services have succeeded in allowing such persons to work in jobs in the community alongside non-disabled workers and to participate in meaningful day activities in the community at times when they are not working or receiving residential services. Nevertheless, most persons with I/DD receiving employment, vocational, and day services from the state remain unnecessarily-and often indefinitely-confined to facility-based settings. In addition, people with I1DD newly entering, or about to enter, the adult service system from schools are at risk of unnecessarily entering segregated sheltered workshops and facility-based day programs.
Individuals are in, 01' at risk of entering, segregated sheltered workshops and facilitybased day programs due to systemic State actions and policies, which include:
• The State's failure to develop a sufficient quantity of integrated transition, employment, vocational, and day services and supports for individuals with I/DD;
G Interim Settlement Agreement, United States v. State of Rhode Island and City of Providence, No.1: 13-cv-00442 (D.R.I. July II, 2013), § I(D).
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• The State's direction of available employment resources to segregated sheltered workshops rather than to integrated employment services;
• The State's direction of available day program resources to segregated facility-based day programs rather than to integrated day services;
• The State's use of systemic criteria and methods of administration that unnecessarily require persons with I1DD to attend sheltered workshops and facility-based day programs in order to access and receive employment, vocational, and day services.
These findings are consistent with a survey report commissioned by the State, which demonstrates that in20l2, of3,235 respondents in the employment and day activity service system for persons with I1DD, just 383 individuals (approximately 12%) reported that they participated in individualized, integrated paid employment; by contrast, 2,572 individuals (approximately 80%) reported participating in facility-based day programs, and 839 individuals (approximately 26%) reported participating in sheltered workshops.? This reliance on segregated employment and day programs appears contrary to the preferences and interests of participants, and, for many, it is contrary to their experiences prior to entry into these programs. For instance, after interviewing individuals with I/DD at seven different Rhode Island sheltered workshop providers, one survey found that approximately 43 % of individuals reported that they had experienced integrated employment in the past, and in many cases just prior to their current placement in the workshop. 8 Regardless of an individual's previous work experiences, however, entryinto a segregated sheltered workshop or facility-based day program is often determinative of one's continued segregation there. As previously indicated, individuals tend to remain in facility-based day activity service programs for decades at a time, and Rhode Island offers very few services and supports to assist individuals to transition back to integrated employment and day settings from segregated employment and day settings.
Rhode Island has recently recognized that "employment opportunities in fully integrated work settings shall be the first and priority option explored in the service planning for working age adults with developmental disabilities in Rhode Island.,,9 The Rhode Island Employment First Policy recognizes that, "While all options are important and valued, integrated employment is more valued than non-employment, segregated employment, facility-based employment, or day habilitation ....,,10
Despite these policy statements, thousands of individuals with I/DD are unnecessarily segregated in sheltered workshops and facility-based day programs throughout Rhode Island. While many in sheltered workshops and day programs can and want to work and engage in meaningful activities in the community, the State has denied or failed to provide such persons
72012 Sherlock Survey, supra note 3. This data includes duplicate counts for individuals who participate in more than one service setting.
8 Information on file with R.l. Disability Law Ctr. (2013).
9 BHDDl-I, "Rhode Island Employment First Policy: A Time for Action," available at www.riddc.org/downloads/BHDDHEmploymentFirstPolicy21213.doc [hereinafter "Employment First Policy"].
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with services and supports that would enable them to do so. Instead, the State has dedicated significantly more resources to sheltered workshops and facility-based day programs than it has to supported employment and integrated day services.
The experiences of individuals in Rhode Island, including those already receiving relief under the Interim Settlement Agreement, have demonstrated that persons with I/DD can be reasonably accommodated in integrated employment and day settings. As a result of thc Intcrim Settlement Agreement, some individuals have already begun to transition from sheltered workshops to competitive wage jobs in the community. For instance, individuals from TTP and Birch have received services and supports to allow them to find, obtain, and maintain competitive wage jobs in clerical/office positions, food service and customer service positions. Individuals have obtained jobs working for the State; local governments; small businesses; and some individuals are preparing to work for large corporations. Also as a result of the Interim Settlement Agreement, some former sheltered workshop participants work full-time in competitive wage jobs in their supported employment placements and will be eligible to receive employer-based health care and other benefits, while others work part-time in competitive wage jobs and participate in integrated day activities during the hours that they are not working. Furthermore, some individuals have acclimated to their new positions and to the integrated work setting to such an extent that their job coaches have started to fade their on-site services and coworkers have begun to provide them with natural supports while on the job. Other individuals have requested specific training in particular tasks to allow them to qualify for advancement and promotion opportunities in the workplace. Accordingly, the individuals from TTP and Birch that have already begun to receive relief under the Interim Settlement Agreement have demonstrated effectively that reasonably accommodating individuals with I1DD in integrated employment and day settings is achievable within Rhode Island's day activity service system.
III. INVESTIGATION
On January 14,2013, the U.S. Department of Justice notified the State that we were opening an investigation into whether the State's reliance on day activity services provided in facility-based settings, including sheltered workshops and day programs, violated Title II of the ADA. In that letter, we specifically stated that our investigation "will examine whether Rhode Island unjustifiably and unnecessarily segregates persons with I/DD in sheltered workshops [and facility-based day programs] ... as part of its Day Activity Services, 46-1-14 R.I. Code R. § 43.0, instead of providing such persons the opportunity to receive integrated, supported employment and day services that would enable them to interact with non-disabled individuals to the fullest extent possible." Accordingly, we requested documents and data from the State pertaining to its day activity service system.
In January and February 2013, our staff, along with a consulting expert, conducted onsite visits to day activity service providers in Rhode Island for individuals with I/DD, including sheltered workshops and facility-based day programs, as well as supported employment and integrated day programs. The programs that we toured were geographically and demographically diverse. During these visits we interviewed administrators, executives, board members, and direct support staff; we toured facilities and programs; and we observed and spoke with participants engaged in activities typical to their normal schedules and routines. As part of the investigation, we also interviewed numerous other providers, stakeholders, individuals with I/DD, transition experts, academics, state officials, and parents and family members of service recipients knowledgeable about Rhode Island's day activity service system and transition
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services for persons with I1DD. Throughout the remainder of2013, our staff continued to visit providers and interview additional direct support staff and individuals with I/DD, as well as numerous parents and family members.
IV. BACKGROUND
A sheltered workshop is a segregated facility that exclusively or primarily employs persons with disabilities. Sheltered workshops are usually located in large institutional facilities in which persons with disabilities have little to no contact with non-disabled persons besides paid staff. In sheltered workshops, persons with disabilities typically earn wages that are well below minimum wage. I I Similarly, in facility-based day programs, where individuals participate in non-work daytime activities, individuals with disabilities have little or no contact with nondisabled persons besides paid staff. In Rhode Island, sheltered workshops and facility-based day programs are typically co-located. 12
By contrast, supported employment services typically include the services necessary to place, maintain, and provide ongoing support to individuals with I1DD in integrated employment settings in the community. Rhode Island defines supported employment services as:
activities needed to help the Participant(s) develop the specific job skills necessary to sustain paid employment, earning at least 50% of the state minimum wage and working in an integrated environment. This includes regular contacts at a Participant job site that is outside of a center based day service site. Supported employment can also be provided to support Participants who create their own business or micro-enterprise. Supported employment may be delivered one-onone to a Partl.c.lpant or s1lared W.it11 two or more Partl.c.lpants. 13
II Under the Fair Labor Standards Act, workers are paid based on their measured productivity when compared to non-disabled workers performing similar work. See 29 U.S.C. §§ 214(c)(1)-(2). Thus, for ajob that is compensated at Rhode Island's minimum wage of $8.00 per hour, a disabled worker in a sheltered workshop who is determined to be half as productive as a non-disabled worker would earn $4.00 pel' hour. The employer must measure the productivity of disabled workers every six months. Id. § 214(c)(2)(A).
12 Rhode Island defines a "Center-Based Day Program Service" as a "facility-based day program where services are delivered by a licensed [Developmental Disability Organization] on behalf of Participants." 46-1-14 R.I. Code R. § 1.14. Although this definition omits reference to "sheltered workshop programs," in practice, center-based day programs in Rhode Island are structured, licensed, and funded to include both facility-based sheltered workshop and day program services.
13 The State has also submitted to the federal Centers for Medicare and Medicaid Services ("CMS") the following description of supported employment services:
Supported Employment: Includes activities needed to sustain paid work by individuals receiving waiver services, including supervision, transportation and training. When supported employment services are provided at a work site in which persons without disabilities are employed, payment will be made only for the adaptations, supervision and training required by individuals receiving waiver services as a result of their disabilities, and will not include payment for the supervisory activities rendered as a normal part of the business setting.
Rhode Island Global Consumer Choice Compact Section IllS Demonstration Approval Documents, Attachment B (Jan. 16,2009), at 51, available at http://www.eohhs.rLgov/documents/documents 10/Rl_1115_Demo_GW_12_09.pdf.
8

46-1-14 R.I. Code R. § 1.95 ; see also id. §§ 45.05-.06. In addition to supported employment services, Rhode Island also provides integrated day services, or "Community-Based Day Program Services." Integrated day services are services that allow persons with I/DD to engage in self-directed activities in the community at times, frequencies, and with persons of their choosing, and to interact to the fullest extent possible with non-disabled peers. 14
The State manages its vocational, Medicaid, employment, and day services for persons with I/DD through its Executive Office of Health & I-Iuman Services ("EOHHS"). EOHHS coordinates several State agencies in their delivery of services to adults with I/DD, including: (1) the Department of Human Services, in which the Office of Rehabilitation Services ("ORS") is a sub-agency; and (2) the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals ("BHDDH"), including its Division of Developmental Disabilities ("DDD"). These agencies determine the amount and allocation of funding for the above-mentioned services, including the range of employment and day services, the licensing of employment and day service providers, and the level of funding for sheltered workshops and facility-based day programs versus integrated supported employment and integrated day programs.
ORS provides services to individuals with disabilities, including individuals with I/DD, through its Vocational Rehabilitation Program. The services provided through this program focus on initial job readiness and placement. See 39-1-112 R.I. Code R. § 101.2(II)(B). The vocational rehabilitation services provided by ORS pursuant to an Individual Plan for Employment ("IPE") are time-limited to a maximum of eighteen months. See id. § 115.14(III)(B)(1); see also 34 C.F.R. §§ 363.6(c)(2)(iii)-(iv).
DI-IDDI-I is the state agency responsible for providing day activity services and supports to approximately 3,600 adults with I/DD who, under the Medicaid Waiver, may direct their own services through one of approximately 40 BHDDI-I-licensed agencies. IS The types of services that the BHDDH-licensed service providers may provide to individuals with I/DD who are their customers include (1) residential support services, 46-1-14 R.I. Code R. §§ 39.0-42.0; and (2) non-residential supports, which are called "day activity services," id. §§ 43.0-45.0.
In Rhode Island, individuals with I/DD seeking day activity services can theoretically choose among a variety of day activities, including facility-based sheltered workshop services, facility-based day program services, integrated supported employment, or integrated day services within the State's system. In practice, however, this theoretical choice has been largely undermined by the State's significant over-reliance on sheltered workshops and facility-based day programs, leaving individuals who want to avail themselves of employment and day services with virtually no choice other than segregated programs.
14 Rhode Island defines Community-Based Day Program Services as, "day program services provided in the community, delivered by a licensed developmental disability organization on behalf of a Participant." 46-1-14 R.1. Code R. § 1. 17.
15 See Rhode Island's Response to the United States' Jan. 14,2013 Doc. Req. p.3 question 2 (on file with BHDDl-I); BHDDH, DOD, "Agencies Licensed to Provide Support and Services to People with Developmental Disabilities" (Mar. 28,20(2). The current list, dated Jan. 6,2014, is available at: http://www.bhddh.ri.gov/apps/DDDAgencyList.php.
9

In addition to the State's delivery of services to adults with I/DD, the State-through the Rhode Island Department of Education ("RIDE"), BHDDH, and ORS-administers, oversees, and provides transition services for students with I1DD in secondary schools to prepare students to leave school and enter post-secondary employment or education. Transition services are "a coordinated set of activities for a young person with a disability, designed within an outcome oriented process, that promotes movement from school to post-school activities including postsecondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation." R.I. Gen. Laws § 16-24-18(e)(1).
Rhode Island law requires local school districts to conduct individualized plmming for children with I/DD regarding their post-secondary employment and education goals. This process of transition plmming must begin by the time a child with I/DD is fourteen years of age. Id. § 16-24-18(d). Also, pursuant to Rhode Island law, ORS vocational rehabilitation counselors and BHDDH representatives must be included in the individualized transition planning process when they are "party to the delivery and implementation of the individual plan." Id.
As discussed above, in March 2013, after the initiation of this investigation, BHDDH adopted an Employment First policy, which prioritizes integrated work above all other service options and which includes a priority for integrated activities during non-working hours:
It is expected that through implementation of this policy, individuals will be engaged primarily in paid employment. However, it is recognized that for individuals who are working on a part time basis, employment may not fully occupy their weekday hours. For these individuals, it is expected that the priority for activities during non-working daytime hours should be on supporting individuals in other typical adult activities in the community, including volunteer work, recreation, and daily living activities. 16
Accordingly, the BHDDH Employment First Policy recognizes the importance of and prioritizes integrated employment and integrated day services.
V. FINDINGS
We conclude that the State fails to provide employment, vocational, and day services to persons with I1DD in the most integrated setting appropriate to their needs. Under Title II of the ADA, 42 U.S.C. § 12131 et seq., a public entity must "administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities." 28 C.F.R. § 35.130(d). 17 The "most integrated setting" is one that "enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible[.]" 28 C.F.R. pt. 35, app. B at 673. As explained below, sheltered workshops and facility-based day programs fail to provide this required level of integration and interaction between persons with and without disabilities.
Title II of the ADA states as follows: "no qualified individual with a disability shall, by
16 Employment First Five Year Implementation Plan, supra note 1.
17 The implementing regulations of Section 504 of the Rehabilitation Act, 29 U.S.C. § 794(a), contain a similar requirement. See 28 C.F.R. § 41.51 (d).
10

reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity." Id. § 12132. As Congress found, "[i]ntegration is fundamental to the purposes of the ADA. Provision of segregated accommodations and services relegate persons with disabilities to second-class citizen status." See H.R. Rep. No. 101-485(III), at 56 (1990), reprinted in 1990 u.S.C.C.A.N. 445, 479; see also 28 C.F.R. pt. 35, app. B at 673 (same); Helen L. v. DiDario, 46 F.3d 325,335 (3d Cir. 1995) ("The ADA is intended to insure that qualified individuals receive services in a manner consistent with basic human dignity rather than a manner which shunts them aside, hides, and ignores them.").
In Olmstead, the Supreme Court held that public entities are required to provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community-based treatment; and (3) community services can be reasonably accommodated, taking into account the resources available to the entity and the needs of other persons with disabilities. Olmstead v. L.C., 527 U.S. 581, 587 (1999). In so holding, the Court explained that "institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life." Id. at 600. The Court also recognized the harm caused by unnecessary segregation: "confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment." Id. at 601.
The Olmstead principles apply to day activity programs, such as segregated sheltered worksliops and day programs. In Lane v. Kitzhaber, 841 F. Supp. 2d 1199 (D. Or. 2012), persons with I1DD who are in, or who have been referred to, Oregon sheltered workshops sued under Title II of the ADA and Olmstead. The Lane plaintiffs alleged that the State had failcd to provide them with employment and vocational services in the most integrated setting appropriate to their needs-namely, supported employment. Id. at 1206. The Court found that the "broad language and remedial purposes of the ADA" support the conclusion that the integration mandate applies to employment services. Id. at 1205. The court declined to find that the application of the Supreme Court's holding in Olmstead was limited to residential settings, and instead concluded "that the risk of institutionalization addressed in [Olmstead] includes segregation in the employment setting." Id. In holding that Olmstead applies to employment settings, the court in Lane specifically stated that, "[a]lthough the means and settings differ [from the residential context], the end goal is the same, namely to prevent the unjustified institutional isolation of persons with disabilities." Id. (internal quotation omitted).
The Department of Justice has made clear that Olmstead principles apply to all the services, programs, and activities of state and local governments, including employment and day services. The Department has provided guidance stating: "Integrated settings are those that provide individuals with disabilities opportunities to live, work, and receive services in the greater community, like individuals without disabilities.... Segregated settings include, but are not limited to ... settings that provide for daytime activities primarily with other individuals with disabilities.,,18
18 "Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.," Question I (June 22,2011), available at http;llwww.ada.gov/olmstead/q&a_olmstead.htm.
11

Other federal agencies have also applied Olmstead principles to employment services. The Centers for Medicare and Medicaid Services (CMS), which oversees Medicaid, has recognized Olmstead's application to non-residential employment and vocational services provided under Medicaid. CMS has announced that States "have obligations pursuant to ... the Supreme Court's Olmstead decision" requiring that "an individual's plan of care regarding employment services should be constructed in a manner that ... ensures provision of services in the most integrated setting appropriate.,,19 CMS has specifically addressed the applicability of Olmstead to integrated employment and day services provided through the 1115 Waiver Demonstration Program, stating in recent guidance:
All [Managed Long Term Services and Supports ("MLTSS")] programs must be implemented consistent with the Americans with Disabilities Act (ADA) and the Supreme Court's Olmstead v. L.C. decision. Under the law, MLTSS must be delivered in the most integrated fashion, in the most integrated setting, and in a way that offers the greatest opportunities for active community and workforce parti.C.IpatI.On.20
In addition, since January 22,2001, the Rehabilitation Services Administration has prohibited federal vocational rehabilitation funds from being used for long-term placement of persons with disabilities in "extended employment," meaning sheltered workshops and other segregated settm• gs. 21
Likewise, the Olmstead analysis applies to segregated day programs. In holding that Olmstead applies to employment settings, the court in Lane noted that there exists "no statutory or regulatory basis for concluding that the integration mandate to provide services in the most integrated setting appropriate applies only where the plaintiff faces a risk of institutionalization in a residential setting." Lane, 841 F. Supp. 2d at 1206. Indeed, the plain language of Title II and Olmstead ensure individuals the right to live integrated lives-where they reside, where they work, and where they spend the remainder of their daytime hours.22
19 U.S. Dep't of Health & Human Servs. ("HHS"), CMS Info. Bulletin, "Updates to the § 1915 (c) Waiver Instructions and Technical Guide regarding employment and employment related services," at 5 (Sept. 16,2011), available at http://downloads.cms.gov/cmsgov/archived-downloads/CMCSBulletins/downloads/ClB-9-16-11.pdf.
20 HHS, CMS Info. Bulletin, "Guidance to States Using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs," at 3 (May 20, 2013), available at http://www.medicaid.gov/MedicaidCHlP-Program-lnformation/By-Topics/Delivery-Systems/Downloads/1115-and-1915b-MLTSS-guidance.pdf.
21 See 66 Fed. Reg. 7250; see also 29 U.S.C. § 720(a)(I), (3)(B) (Title I of the Rehabilitation Act) ("Individuals with disabilities must be provided the opportunities to obtain gainful employment in integrated settings."); U.S. Dep't of Educ., Office of Special Educ. & Rehabilitative Servs., Rehab. Servs. Admin., Technical Assistance Circular, 06-01 (Nov. 21, 2005), available at http://www2.ed.gov/policy/speced/guid/rsa/tac-06-0 l.doc.
22 See "Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.," supra note 18 ("Integrated settings are those that provide individuals with disabilities opportunities to live, work, and receive services in the greater community, like individuals without disabilities. Integrated settings are located in mainstream society; offer access to community activities and opportunities at times, frequencies and with persons of an individual's choosing; afford individuals choice in their daily life activities; and provide individuals with disabilities the opportunity to interact with nondisabled persons to the fullest extent possible.... Segregated settings include, but are not limited to ... settings that provide for daytime activities primarily with other individuals with disabilities."). The United States has entered into
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As earlier stated, in June 2013, the Department of Justice entered into a court enforceable Interim Settlement Agreement with Rhode Island and the City of Providence after finding the State and City in violation of Title II of the ADA and Olmstead for unnecessarily segregating individuals in two particular facility-based employment and day settings and placing those individuals at risk of such segregation.23 The Interim Settlement Agreement, entered by Order of the United States District Court for the District of Rhode Island on July 11,2013, will provide relief to approximately 200 Rhode Islanders with I/DD who received services from (1) a segregated sheltered workshop and day program provider, and (2) a special education program which ran a segregated sheltered workshop inside a Providence public high school. Pursuant to the Interim Settlement Agreement, the State and City will provide adults and youth in transition with robust and person-centered career development planning, transitional services, supported employment placements, and integrated day services.
A. Day Activity Service Programs, Including Sheltered Workshops and FacilityBased Day Programs, are Segregated Settings
For the following reasons we find Rhode Island's facility-based day activity service programs, including sheltered workshops and facility-based day programs, to be segregated settings that are designed and function like most institutional settings.
1. Isolation from Non-disabled Peers
Facility-l:Jased day activity programs, including sheltered workshops and facility-based day programs, do not provide persons with disabilities the opportunity to interact with nondisabled persons to "the fullest extent possible." See 28 C.F.R. pt. 35 app. B, at 673; see also Lane v. Kitzhaber, 283 F.R.D. 587, 599 (D. 01'.2012) ("With respect to the [defendants' contention that there is weirle in a sheltered workshop that can be truly integrated,] plaintiffs' evidence supports their allegation that no sheltered workshop is truly integrated."). Observations made at numerous facilities during the course of our investigation support this conclusion. For instance, of the hundreds of individuals observed by our staff and consulting expert in sheltered workshop and facility-based day program settings, nearly all of the individuals observed were persons with I/DD, with the exception of a handful of paid staff in each facility. Service recipients in fayility-based day activity programs are isolated from interactions with non-disabled peers, often by the very location and placement of the sheltered workshop and day program facilities, many of which are located in self-contained industrial parks or isolated residential neighborhoods, apart from other businesses, restaurants, or public spaces. Cf. Benjamin v. Dep't of Pub. Welfare, 768 F. Supp. 2d 747, 750 (M.D. Pa. 2011) (adopting plaintiffs' finding of fact that plaintiffs are segregated because, inter alia, they "do not have as much opportunity to
several court-enforceable agreements with public entities that include the provision of integrated employment and day activity services. See, e.g., Consent Decree, United States v. Virginia, 3:12CV059 (E.D. Va. 2012), p.ll ("Within 180 days of this Agreement, the Commonwealth shall develop, as part of its Employment First policy, an implcmcntation plan to increase integrated day opportunities for individuals in thc target population, including supported employment, community volunteer activities, community recreational opportunities, and other integrated day activities.") (emphasis added).
23 Interim Settlement Agreement, United States v. State of Rhode Island and City of Providence, I: 13-cv-00442 (D.R.I. July 11,2013).
13

interact with a wide range of people."). Individuals typically spend most of their daytime hours at the facilities.
2. Institutional Nature of the Settings
Day activity service programs are structured and function like other institutions in that the service recipients' days are inflexible and highly regimented. In Rhode Island's sheltered workshop settings, individuals routinely engage in rote manual tasks, including assembling, sorting, packaging, and labeling, while typically sitting at cafeteria-style tables. For instance, we observed service recipients engaged in such repetitive and mundane tasks as assembling cardboard jewelry boxes, putting tops on lotion bottles, placing stickers on boxes of dog biscuits, placing stoppers onto medical syringes, and taking wrappers off bars of soap. The tasks are frequently not matched by the provider to individuals' abilities and strengths. Service recipients typically work in crowded, shared spaces, occupied only by other individuals with disabilities, except for paid staff. Most staff members serve as supervisors, monitoring production and supervising the behavior of adult service recipients. Individuals usually perform tasks on a fixed schedule, wherein all service recipients work the same shifts, take designated breaks on the premises, arrive and depart from the facility mostly in provider-owned vehicles, and eat lunch all at approximately the same times. In totality, these factors reveal the institutional nature of Rhode Island's sheltered workshop settings?4 See Disability Advocates, Inc. v. Paterson, 653 F. Supp. 2d 184, at 199-201 (E.D.N.Y. 2009) vacated on other grounds sub nom. DAI v. N.Y. Coal. for Quality Assisted Living, 675 F. 3d 149 (2d Cir. 2012) (describing institutional characteristics which include, inter alia, inflexible routines and regimented daily activities with little autonomy, or being subject to an "extensive and significant set of rules" limiting individuals' freedom to make choices about how they spend their time).
The facility-based day program settings that we observed throughout Rhode Island had many of the same institutional features as the sheltered workshops. All of the sheltered workshops that we visited were co-located with facility-based day programs, and a significant portion of service recipients split their daytime hours between both settings. Instead of piecework or assembly work, individuals with I1DD in Rhode Island day program settings engage in non-work activities like coloring, playing children's games, and watching television. Like sheltered workshops, the facility-based day programs are crowded, shared spaces occupied exclusively by other individuals with disabilities, except for paid staff. Most individuals receive transportation to and from the day program through provider-owned vehicles, and once at the facility individuals' schedules are fixed. They typically engage in organized, structured activities, eat lunch, and arrive and depart from the facility nearly at the same times. Staff members in the day program serve as room monitors, organizing games or activities and seeking to resolve any behavioral or health issues that may arise throughout the day.
We observed that the lines between sheltered workshop and day program activities were often blurred throughout the State system. Like the sheltered workshops, the facility-based day programs that we visited maintained strong institutional characteristics. In some day program
24 Importantly, unlike most factory workers, service recipients in sheltered workshops do not have access to competitive wages, health insurance, employee benefits, vacation days, unionization or collective bargaining, and they experience virtually no opportunities for advancement within the work setting. These aspects of working in a sheltered workshop also reveal the institutional nature of the setting.
14

rooms, individuals performed tasks identical to tasks in the sheltered workshop across the hallway. In multiple other locations, we observed individuals working in provider-owned greenhouses with only individuals with I1DD, other than paid staff, on a regular, fixed schedule. These individuals typically paint the bases of pots, make potpourri, and pick dead leaves off of plants, in support of goods which are eventually sold to the public in attached retail stores. We were told that these individuals are not paid, however, as the greenhouse work is considered a therapeutic day program activity. These individuals-like those people that we observed in more traditional sheltered workshops and day programs-could not easily leave the facility to take a break, eat lunch, or socialize with non-disabled peers in public spaces when they were not working. See id. at 200-07 (describing characteristics of institutions to include, inter alia, large numbers of individuals with disabilities congregated together with few opportunities to interact with individuals outside of the institution).
Individuals in sheltered workshops have limited freedom to choose the tasks that they perform or the activities that they engage in. Service recipients at each of a sheltered workshop's various work stations are typically made to perform nearly identical tasks at the same time as the other individuals at their station. The only flexibility afforded individuals in sheltered workshops in terms of the tasks that they perform is the choice in materials they may sort or package, depending on the availability of contracts. Nevertheless, for most service recipients, the manual movements required in the sheltered workshop, whether placing objects in boxys, placing labels on bags or boxes, or sealing bags or boxes, remain nearly the same, regardless of the station where individuals are working.
In the facility-based day programs, individuals have limited freedom to participate in activities of their choosing, as most activities, like coloring or participating in games, are fixed activities which are scheduled and arranged by staff for the larger group of day program service recipients. In several instances, we observed individuals who were not engaged in the activities that were planned and arranged for the group. Consequently, these individuals sat idly off to the side of the day program floor, in relative isolation from all other service recipients and staff.
The physical layout of sheltered workshops and facility-based day programs are institutional in nature. Both sheltered workshop and day program facilities frequently contain separate office spaces, conference rooms, and separate restrooms for management and staff, apart from the workshop and day program floor. Also, in the sheltered workshop, service recipients' workspace bears little resemblance to most work settings in the community, as there are no private areas or private places for individuals to store personal items. Instead, people with disabilities sit, communally, at cafeteria-style tables in large, and typically noisy, rooms. Also, unlike most jobs in the community, service recipients are made to work within the constant, unobstructed view of paid staff monitoring their activities. Id. at 199-201 (describing institutional characteristics that evidence segregation, which include, inter alia, the physical layout of a facility, furnishings, and general lack of privacy, including private spaces).
While some competitive wage jobs in industrial plants or factories similarly provide for limited personal space, and perhaps even include constant monitoring, for most Rhode Island service recipients, this environment is the only work setting made available to them, as integrated alternatives do not exist in sufficient supply. This leaves service recipients with little choice but to work in a facility-based setting. Altogether, these factors make the sheltered workshop setting tantamount to an institution and not a typical work setting.
15

Similarly, the design of most facility-based day programs lacks the privacy, autonomy, and control that are afforded to individuals who participate in socially and culturally normative daytime activities in the community. Like sheltered workshops, most day program facilities do not provide service recipients with the opportunity to engage in meaningful activities outside of a group setting. Individuals in facility-based day progl~ams typically spend the majority of their day in large indoor spaces with only other people with I1DD, other than paid staff, where they engage in planned activities, oftentimes in classroom settings or at large communal tables. In one day program, we observed rows of individuals with I1DD in oversized recliners in a large open area as they watched a children's video while under the supervision of paid staff. There appeared to be very few spaces in that facility where individuals could retreat should they desire not to participate in the planned activity or to engage in an activity of their choosing apart from a group.
3. Lengthy and Protracted Placements
Individuals are often relegated to facility-based day activity service programs for decades, representing a permanent placement. As stated earlier, nearly half (46.2%) of individuals in Rhode Island facility-based employment have received services in that setting for ten or more years, and just over one-third (34.2%) of individuals in facility-based employment have been there for fifteen or more years?5 Individuals in facility-based day programs face a similar reality. We met with, and were told about, scores of individuals who have received services from facility-based day programs for one or more decades. One provider characterized her facility-based program as providing services from "birth to death" for individuals with I1DD. Indeed, we observed a group of young adults at this day program who had received services from the provider together in a group since they were children.
4. Negative Consequences of Segregation
In addition to their isolation from non-disabled peers and protracted placements, service recipients also have been subjected to other significantly negative consequences as a result of obtaining services in a segregated, sheltered workshop and/or day program. Rhode Island service recipients in sheltered workshops earn exceedingly low wages when compared to persons with I1DD in integrated employment throughout the State. According to data obtained as part of our investigation, the average hourly wage of sheltered workshop participants in Rhode Island is approximately $2.21 per hour.26 By contrast, persons with disabilities who receive individualized supported employment services in integrated settings earn approximately $8.92 per hour,27 which is more than Rhode Island's minimum wage of $8.00?8 Further, individuals with disabilities in Rhode Island facility-based day programs earn no wages at all, even though many can and want to work. Accordingly, the significantly low wages of sheltered workshop
25 2012 Sherlock Survey, supra note 3.
26 lQ.,
28 Rhode Island's minimum wage was increased from $7.40 per hour in 2012, to $7.75 per hour in 2013, to $8.00 per hour as of January 1,2014. See R.I. Oep't of Labor & Training, Workforce Regulation & Safety, Labor Standards, Minimum Wage, http://www.dlt.ri.gov/ls/minwage.htm (last visited Jan. 5,2014).
16

participants and the complete lack of earnings of day program participants are negative consequences of such individuals' unnecessary and unjustifiable segregation.
Individuals with disabilities are able to achieve economic independence by accessing minimum or competitive wages, and such compensation can allow them greater participation in the community. As Rhode Island's own policies have recognized, "All people, including those with disabilities, gain many benefits from having ajob.... Many people with disabilities live at or below the poverty level, and earning income from paying jobs helps supplement their resources and improves the quality of their lives.,,29 For example, we met with one individual with I/DD at a diner as he was participating in a breakfast club program, where he meets up with other individuals with I/DD and direct support staff once per week to socialize and start his day in the community. This service recipient is one of the small number of individuals who have been able to access supported employment services and integrated day services through the State service system. According to his employment specialist, this individual is well-matched to his retail job because of his outgoing and sociable personality, and enjoys speaking and interacting with customers. As he calculated the gratuity on his bill-a skill that he had learned in the breakfast club-he informed us that he worked at a large clothing retailer earning $10 per hour. He has been awarded several pay raises since he began working in this job, and he receives paid sick and vacation days-the kind of advancements and benefits that are extended neither to individuals in Rhode Island sheltered workshops nor to any individuals in day programs. He said. that he routinely used the money he earned from his job to pay for breakfast and to engage in other recreational activities like going to the local bowling alley, taking sailing lessons, and engaging in impromptu activities with his friends. The money earned from his job appears to help him extend his opportunities to socialize beyond the limits of his working hours. In a facility-based day activity program, however, this same individual would be unlikely to earn the disposable income to afford such recreational activities, and even with adequate financial support, he would not possess the freedom to leave the facility to engage in such activities.
We met with another individual who formerly lived as a dependent of her adult son and participated in a day program, having never worked before reaching her fifties. She previously did not believe that she could attain ajob at all, let alone one that paid competitive wages, and was fearful of working; however, with the encouragement of her peers, she sought the services of an employment specialist. She obtained ajob at a fast food restaurant four days per week for 15 to 20 hours per week. With bi-weekly visits from her employment specialist to provide support, including job coaching, she has retained this job for eight years, and received holiday bonuses and recognition as "Employee of the Month." She explained how her life has improved since she began receiving supported employment services. She can now afford to live independently in an apartment with "big windows" and in close proximity to her job, allowing her to walk to and from work; she also engages in numerous recreational and other opportunities that she previously could not access, having never previously earned an income. For instance, she now goes to the theater, on boating trips, and to outdoor concerts. Accordingly, competitive wages have enabled her to participate to a greater extent in the community.
29 Employment First Policy, supra note 9.
17

B. The Majority of Rhode Island's Employment and Vocational Services Are Delivered in Sheltered Workshop and Facility-Based Day Program Settings
Considerable evidence indicates that only a small portion of persons with I1DD in Rhode Island can access integrated supported employment services and integrated day services that would allow them to work or engage in daytime activities in the community. This is in spite of Rhode Island's recently adopted Employment First Policy, which emphasizes that: (1) work in integrated settings should be the first and priority service option explored in service plaruling for individuals with I/DD; (2) "the optimal employment status" for individuals with disabilities is working "the maximum number of hours [that] they are capable of working, and earning the prevailing wage with any associated benefits;" and (3) individuals should be supported in "other typical adult activities in the community, including volunteer, recreation, and daily living activities" during non-work hours.3o According to data provided directly by the State in response to this investigation, in July 2011,83% of the individuals with I/DD in the day activity service system accessed "non-integrated day activities. ,,31
As earlier stated, Rhode Island's over-reliance on segregated settings is confirmed by a 2012 State-commissioned survey which demonstrates that of 3,23 5 respondents in the employment and day service system, just 383 individuals (or ap~roximately 12%) reported that they participated in individualized integrated paid employment. 2 By comparison, 2,572 individuals (or approximately 80%) reported participating in facility-based day programs, and 839 individuals (or approximately 26%) reported participating in sheltered workshops.33
The State's over-reliance on segregated settings is even more pronounced in the number of hours that participants reportedly spend in each service setting. According to State documents, "[o]nly a small portion of all hours billed for day activities (less than 10%) are for supported employment or prevocational training. ,,34 The State-commissioned survey of program participants reveals that in one month, the respondents who reported participating in facilitybased day programs averaged approximately 80 hours in facility-based and/or home-based nonwork activities and 38 hours engaged in facility-based jobs. The respondents who reported participating in individualized integrated employment averaged only approximately 42 hours in
30 Employment First Five Year Implementation Plan, supra note 1.
31 BI-IDDH, Project Sustainability: Funding Initiatives Supporting Inclusion, Community Integration and Supported Employment, Feb. 14, 2013, at 7 Con file with the BHDDH) [hereinafter "Project Sustainability Funding Initiatives"].
32 2012 Sherlock Survey, supra note 3.
33 lQ., The study includes duplicate counting for individuals accessing one or more service settings.
34 Project Sustainability Funding Initiatives at 7, supra note 31. Because this figure includes prevocational training C1&,., sheltered workshop activities), the number of hours billed for individual supported employment is actually far smaller. Due to the lack of qualitative standards attached to the meaning of Community-Based Day Program Services, it is difficult to measure the number of individuals receiving meaningful community-based day services. However, one State document claims that "[c]lose to 20% of all units ... are billed for community-based day programs." lQ., We have questions about the quantity and quality of the services being measured as CommunityBased Day Program Services; nonetheless, that the data reflects that only 20% of all units billed are CommunityBased Day Program Services indicates that the vast majority of all day services are provided in segregated facilitybased settings. Accordingly, despite the lack of clarity in the data, we maintain that the State has over-relied on facility-based programs to the exclusion of integrated day service options.
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community-based work activities.35 Accordingly, day activity service program participants spend the vast majority oftheir daytime hours in segregated settings.
C. Many Persons in Sheltered Workshops and Facility-Based Day Programs Could Be Served in Integrated Work and Day Settings
It has been nationally recognized that most, if not all, persons with I/DD are capable of working in integrated settings and engaging in integrated day activities in the community. In promulgating Title I of the Rehabilitation Act, the federal statute governing the administration of vocational rehabilitation services for people with disabilities, Congress advanced the principle that even "individuals with the most significant disabilities[] are generally presumed to be capable of engaging in gainful employment and the provision of individualized vocational rehabilitation services can improve their ability to become gainfully employed." 29 U.S.C. § nO(a)(3)(A). Federal courts have also recognized that facility-based programs, including sheltered workshops, are no longer considered the first or priority service option for individuals with disabilities. See Homeward Bound, Inc. v. Hissom Mem. Ctr., No. 85-C-437-E, 1987 WL 27104, at *38 (N.D. Okla. JuI. 24, 1987) ("Whereas sheltered workshops and work activity centers were previously considered the only possible place in which to employ people with disabling conditions, now many professionals consider these places the last resort when every other employment option has failed."). Employment First Policies, stating that employment in integrated settings is the first and prjority service option for individuals with disabilities, have been officially adopted in 26 states, and Employment First efforts have been identified in 42 states.36 Rhode Island's Employment First Policy states, "It is recognized that full implementation of this policy will be a long-term process, requiring a fundamental shift in thinking from a mind-set of integrated employment as an option for some individuals, to employment as a goal for all.,,37
Our investigation revealed that Rhode Island service providers are capable of providing services in integrated settings, and that service recipients are capable of receiving services in integrated settings. Both have done it before. Several large Rhode Island day activity service providers told us that they historically served a much larger percentage of persons with I/DD in their programs in integrated employment settings. 38 And, as mentioned earlier, close to half of individuals recently interviewed at sheltered workshop providers reported working in integrated employment before.39 This reality fm'ther confirms that many persons in sheltered workshops and day programs do not need to be served in segregated settings. Further, we observed few, if any, providers opposed to offering more integrated services. For the most part, providers expressed a willingness to convert their service models if given the appropriate technical assistance, incentives, and support from the State. With the elimination of critical systemic
35 2012 Sherlock Survey, supra note 3.
36 State Employment Leadership Network (SELN), Employment First Resource List (Sept. 2013), available at http://www.selnmembers.org/components/com_wordpress/wp-content/uploads/20 1311 0/seln-ef-20 13 -09. pdf.
37 Employment First Five Year implementation Plan, supra note 1 (emphasis in original).
38 See, e.g., BHDDH, "Real Jobs for Real Pay: Success Stories," http://www.bhddh.rLgov/ddd/pdf/Trudeau_ReaIJobs%20Real%20Pay1.pdf (last visited Jan. 5,2014).
39 Information on file with R.l. Disability Law etr. (2013).
19

barriers, Rhode Island can expand the presence and availability of integrated service options, including supported employment and integrated day services, enabling those who can and want to work and participate in the community to do so.
Through our investigation, we confirmed that Rhode Island provides integrated employment and day services to a small portion of individuals, including individuals with significant support needs who both work in the community and participate in day activities in integrated settings when they are not working. For these few individuals, such services have allowed them to work in competitive employment in typical work settings alongside nondisabled peers and to participate in self-directed activities in the community at times, frequencies, and with persons of their choosing when they are not working or receiving residential services. For instance, we met with individuals with I/DD who earned competitive wages working in retail stores, restaurants, movie theaters, bowling alleys, supermarkets, and offices. Other services enable these individuals to participate in meaningful social and recreational activities of their choosing when they are not working, like internships, community volunteer experiences, cooking classes, athletic events, and job clubs. Some Rhode Islanders also receive services and supports to participate in self-directed daytime activities, apart from a group, at times and frequencies of their choosing. For instance, we met a man with I/DD who planned to celebrate his wife's birthday and their anniversary and arranged for support staff to assist him in his celebratory outing with his wife. Our investigation revealed that other individuals have access to support staff when participating in activities with friends, going to church, or running errands. Nevertheless, most persons with I/DD in segregated sheltered workshops and day programs remain unnecessarily, and often indefinitely, confined to those settings without such services and supports.
Our consulting expert obscrved and/or spoke with hundreds of sheltered workshop and facility-based day program participants and noted that they have disabilities similar to persons being served successfully in integrated employment and day settings in Rhode Island. She found that the overall level of need of persons in sheltered workshops and their abilities rendered them capable of working in the community. Additionally, she found that the overall level of need of persons in facility-based day programs and their abilities rendered them capable of working in the community. In fact, she found that the support needs and capabilities of individuals in sheltered workshops and individuals in day programs were largely indistinguishable, and it was her professional opinion that very few, if any, of the individuals that she observed in sheltered workshops and day programs could not work in competitive employment. Many providers of both sheltered workshops and facility based day program services told us that they, too, believed that most persons with I1DD in their programs could, with appropriate supports and services, be served successfully in the community.4o
40 20 12 Sherlock Survey, supra note 3. Data indicates that individuals who already work in individualized integrated employment are largely indistinguishable from those in sheltered workshops and facility-based day programs. According to a 2012 State commissioned survey, approximately 53% of consumers in individualized integrated employment spend one or more hours in facility-based or home-based non-work activity per week. rd. Likewise, there is significant overlap in the populations served in Rhode Island's sheltered workshops and facility-based day programs. According to the same survey, approximately 86% of individuals in sheltered work also spend one or
more hours in facility-based and/or home-based non-work activities per week. & Finally, the survey shows that,
like individuals in integrated employment, at the end of the day many of the individuals in sheltered employment and facility-based day programs return to their own homes or apartments, where they live and care for themselves
independently. &
20

In addition, we uncovered no evidence that persons with I/DD in sheltered workshops and day programs would oppose supported employment and integrated day services that would allow them to work in an individual job and participate in integrated activities during times when they were not working, if given the choice and opportunity to do so. See Olmstead v. L.C., 527 U.S. 581,607 (1999). Rhode Island's Employment First Five Year Implementation Plan states, "It is not sufficient to say 'Fred doesn't want to work' if Fred has never experienced work that matches his interests outside of a sheltered setting, or if Fred's only understanding of the word 'work' is attending a [day program] or sheltered workshop.,,41 We agree. However, a Statecommissioned survey revealed that, in 2012, fewer than 4% of individuals in facility-based Developmental Disability Organization ("DDO") programs spent any time looking for ajob,42 meaning they were not actively engaged by provider staff in the process of identifying and locating employment.
Our investigation further revealed, and our expert concluded, that few persons in the employment and day service system are provided a meaningful and informed choice of supported employment and integrated day services. For example, we observed one day program participant engaged in completing a crossword puzzle while others around her colored and played games. She said, "crossword puzzles keep my mind sharp." When asked about her tenure in the day program, the individual revealed that she formerly worked in the sheltered workshop but she did not like the experience of doing piecework. Despite her apparent capabilities, there was no evidence that she had ever been introduced to or engaged in a plan to secure supported employment or integrated day services in the community, where she could engage in a job and/or day activities aligned with her preferences and skills.
We met another person who has been in a sheltered workshop and day program for 38 years and observed him operating a heat sealing machine. He told us that he has been performing the same tasks in the workshop for many of his 38 years there, but that his preference is, and has always been, to work with bicycles. According to program staff, this service recipient possesses great skill with the complex tasks involved in fixing and repairing bicycles. We were told that the agency's job developer tried to assist him securing ajob in a local bike shop, but the job developer could never access the appropriate services and supports for the individual, including behavioral supports, to allow him to work at the bike shop. Further, due to severe budget cuts, the agency was unable to keep several of its job developers on staff, including the job developer who tried to facilitate this service recipient's transition into competitive employment.43 Consequently, the service recipient, an outgoing and friendly man, continues as he has for years to operate the heat sealing machine on the program's workshop floor, and there are no lmownplans to secure him the services and supports he needs to obtain and maintain competitive employment.
41 Employment First Five Year Implementation Plan, supra note 1.
42 2012 Sherlock Survey, supra note 3.
43 See Paul V. Sherlock Ctr., "A Profile of the RI Developmental Disabilities Service System, at 4 (Nov. 5,2013) (on file with the Paul V. Sherlock Center) [hereinafter "Profile of the RI 00 System"] ("Rhode Island has experienced a greater decrease in [DO] funding than neighboring states. The change in total inflation-adjusted DO spending from 2006-2011 has been a decrease of 20% for Rl. Massachusetts experienced an increase of 2% and Connecticut had an increase of 1% over the same time period.") (internal citation omitted).
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D. Rhode Island Administers Its Employment, Vocational, and Day Services in a Manner that Segregates Persons with I1DD in Sheltered Workshops and Day Programs
Under the ADA, states may not "utilize criteria or methods of administration" that subject individuals to "discrimination on the basis of disability." 28 C.F.R. § 35.l30(b)(3)(i). Such illegal discrimination includes, inter alia, unnecessary segregation in sheltered workshops or day programs. See Pashby v. Delia, 709 F.3d 307,322 (4th Cir. 2013); see also M.R. v. Dreyfus, 697 F.3d 706, 734 (9th Cir. 2012) (recognizing claim under Olmstead for persons at risk of segregation); Lane v. Kitzhaber, 841 F. Supp. 2d 1199, 1205-06 (D. Or. 2012) (recognizing that ADA's integration mandate regulation extends beyond residential settings to the employment service system). Based on our investigation, we have concluded that the State is responsible, through its methods of administering its employment and day services system, for violating this provision with regard to the placement of persons with I/DD in segregated sheltered workshops and facility-based day programs.
While Rhode Island provides supported employment and integrated day services to some persons with disabilities, it has not developed adequate capacity to provide these services to all persons in sheltered workshops and day programs, or to all persons at risk of entering sheltered workshops and day programs, who could benefit from these settings and would not oppose being served in the community. See Olmstead, 527 U.S. at 587. Many day activity service providers that we interviewed identified as a barrier to serving sheltered workshop and day program participants in the community a lack of resources to provide job coaches, job developers, behavioral supports, transportation, and other necessary services and supports. Moreover, we wcre told of service recipients' lack of access to information about or opportunities to enroll in the Medicaid Buy-in program or to receive benefits planning services to allow them to maintain access to imEortant public benefits, including health care, while earning income from work in the community. 4 We were also told by numerous providers, staff, and stakeholders that, under the current rate structure, providers face difficulty retaining qualified or trained staff who can serve as community-based employment specialists, including job coaches and job developers, because oflow reimbursement rates. 45 Due to the significantly reduced rates, employment specialists have been forced to seek employment in other states, take second jobs, or leave the profession altogether. Also, providers and stakeholders consistently identified BHHDH's overall lack of consistent communication with, and the absence of concrete efforts to collaborate with, the provider and stakeholder community as a significant barrier to systems change.
44 Currently, the Rhode Island Medicaid Buy-in Program, also known as the "Sherlock Plan," has a significantly low enrollment rate. Numerous stakeholders stated that the program's under-utilization is the result of two primary factors: (1) the need for Rhode Island's regulations to be updated to clarify the purpose of and to incentivize the use of the Sherlock Plan; and (2) the need for computer software programs, used by state front-line staff, to include the Sherlock Plan as an option in its drop-down menus.
45 We heard from a range of providers, stakeholders, and families that, under the current service system's rate structure and following precipitous state budget cuts in 2011, the problem of retaining qualified and trained staff has been exacerbated by the comparatively generous compensation afforded day and residential provider staff at the State-funded Rhode Island Community Living and Supports (RICLAS). Several providers that we met with noted that they have lost qualified staff to RICLAS, and fear that they will not be able to attract new staff in the future because they cannot compete with the State-funded provider's compensation package.
22

Our investigation also revealed that, for most staff, the current service system does not support adequate opportunities for training, professional development, or introduction to best practices in supported employment or integrated day services. Currently, there appear to be no state certification requirements for job coaches, job developers and other employment specialists who work with individuals with I1DD. 46 This has resulted in the lack of a professionalized workforce that is trained to respond to the specific needs of individuals with I1DD who seek employment and integrated day services. Also, during our investigation, we were unable to identify any meaningful or effective financial incentive by the State that would encourage sheltered workshop and facility-based day programs to move consumers into integrated services in the community. In addition to the overall lack of service capacity and integrated supported employment and day services, our investigation revealed a number of policies, practices, or omissions by the State that further the unnecessary segregation of persons with I/DD in segregated sheltered workshops and day programs.
1. Failure ofBHDDH Social Workers and Case Managers to Interact with Supported Employment and Integrated Day Providers to Identify and Locate Opportunities for Individuals with I/DD
Throughout our investigation, we were consistently informed that BHDDH social workers typically do not provide information to service recipients and their families about integrated employment and integrated day service options. Moreover, we were informed that BHDDH staff rarely link individuals directly by referral with supported employment or integrated day providers. Instead, individuals are usually handed the BHDDH provider agency flyer that includes a list of approximately 40 Developmental Disability Organizations, the majority of which are facility-based providers, and are instructed to select a provider in their area from the list without much more consultation.
One supported employment provider stated that individuals usually have to learn of supported employment services on their own-through informed family members, advocates, or teachers-and then directly contact supported employment providers. According to the provider, this often means that the supported employment provider must contact BHDDH to obtain the necessary referral paperwork, long after the client has made his or her way to the program without BHDDH's assistance.
At most, our investigation revealed that BHDDH social workers take new or prospective entrants to the system on tours of facility-based programs in their geographic area, without ever introducing such persons to integrated alternatives. Even once linked, it is not uncommon for
46 While there are no specific certification requirements for employment professionals in the field of I/OO direct services, the State already maintains detailed training qualifications for employment professionals in the field of mental health and substance abuse services. Compare 46-1-14 R.I. Code R. § 45 .08 (enumerating the following qualifications for supported employment professionals who work with persons with 1/00: "a) Be certified by the state, which includes the completion of a criminal, abuse/neglect registry and professional background check; b) Be at least eighteen (18) years of age; c) Have a high school diploma or QED certification; d) Have education or experience to illustrate the skills required to pcrform the job; e) Receive specialized training from the licensed developmental disability organization."), with 46-1-13 R.T. Code R. § 9.14 (requiring that no less than 50% of employment staff at a behavioral health organization "[h]ave a relevant Master's Degree, or a certificate as a career development facilitator" or "have Rhode Island certification as a Supported Employment Professional .... The remaining fifty percent (50%) shall be actively engaged or enrolled, within eighteen (18) months of hire, in training leading to a relevant degree or certification.").
23

BHDDH's delays in processing the paperwork to force individuals to wait additional weeks and even months before they are approved to begin receiving services.
We found that the lack of statewide infrastructure for staff, tools, and resources specifically tailored to individuals with I/DD, has prevented some service recipients from being placed in integrated employment and day settings. The small number ofBHDDH social workers, their lack of training and specialization in working with individuals with I/DD, and the absence of a uniform, professionally appropriate vocational assessment, discovery, and career development plmming process are critically significant barriers to the referral and placement of individuals with I/DD in integrated settings. As a consequence of historically having no such systems firmly in place, individuals have been routinely evaluated in segregated settings, have received too few opportunities to discover their career interests and goals in integrated settings, and have been referred to segregated facilities as a matter of course.
Further, BHDDH has critically failed to link individuals who have been in facility-based programs, some for many years, with supported employment and integrated day services in the community. As mentioned earlier, a state-commissioned survey shows that very few individuals in facility-based programs are actively engaged with their caseworkers injob searches, revealing that the State relies on such programs for long-term, and not temporary, placements. Finally, the State has critically failed to invest resources in providing integrated vocational assessment, discovery, and career planning services to individuals in facility-based programs who cml and want to leave such programs to work and participate in the community.
2. Failure of ORS to Assist Individuals with I1DD to Enroll in Supported Employment Services in Order to Exit Segregated Sheltered Workshops and Facility-Based Day Programs
ORS is a valuable resource available to persons with I1DD in Rhode Island, as it can supply eligible individuals up to 18 months of initial funding for supported employment services, including initial vocational assessment and placement, as well as job coaching and job training in integrated work settings. However, ORS has failed to assist service recipients currently in segregated sheltered workshops and day program settings with the services and supports necessary to leave such settings. Consequently, most service recipients have been unable to leverage available vocational and employment resources for which they are eligible because ORS has not extended its services to individuals who have been unnecessarily segregated in employment and day programs, and who can and want to leave. Further, service recipients have been deprived of the opportunity to benefit from ORS' established vocational assessment process, which has functioned in the past as the only organized system of vocational and situational assessment and career planning for individuals with disabilities in the State. Likewise, many service recipients have been unable to access the assistance of ORS' available supply of vocational rehabilitation counselors-as well as ORS-funded job developers, job coaches, and other employment professionals-to assist individuals in transitioning from segregated to integrated employment and day settings. This is amply supported by evidence that in 2012, when surveyed, approximately 94% of respondents of the day activity service system had not been ORS clients within the past year, while just 2.8% had been ORS clients during the same period.47 As such, the State, including ORS, has failed to ensure that service recipients can meaningfully access the resources that they need to transition to more integrated settings.
47 2012 Sherlock Survey, supra note 3.
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3. Failure of the State Employment and Day Service System to Meet the Needs of People with Severe Disabilities
Our investigation revealed that the few individuals with I/DD who were referred by the State service system to individual supported employment typically had mild to moderate I/DD, and in large part, these referrals were made to the exclusion of referrals for individuals with more severe disabilities. Information provided by the State to the United States on February 14,2013, confirms this bias. A BHDDH report states that the new Supports Intensity Scale ("SIS") service packages-the lodestar of one's resource and personal budget allocation within the systemwere based on recommendations from a clinical validation study advising that the State should incentivize supported employment for "participants at the lower SIS levels, while communitybased day programs pertained to participants at all SIS levels.,,48 Given the limitations of the individual budgets allocated to them by the State, it appears that many individuals with the most severe disabilities have been "screened out" of receiving supported employment services in integrated work settings, and will be forced to receive primarily day services, even if they can and want to work. It is clear that many individuals with even the most severe disabilities can successfully work in integrated employment settings; as evidence, we look no further than the numerous Rhode Islanders with severe disabilities we met who successfully work in competitive wage jobs with the appropriate services and supports. By systemically designing its system of supported employment services without individuals with the most severe disabilities in mind, the State has unjustifiably excluded such individuals from work without individual consideration. This constitutes discrimination against individuals with severe disabilities, including individuals with I1DD.49

Our investigation also revealed many examples of individuals with I/DD who are deaf or

.

I

have hearing impairments and who face considerable barriers to accessing the interpretation

services necessary to allow them to work in integrated settings. While the State will often

provide interpretation services in segregated settings, it typically will not provide them in

integrated settings. 50 It appears that many individuals with co-occurring I/DD and deafness in

Rhode Island are capable of work, and may desire to be placed in community jobs, but they have

not been allowed access to the interpretation and other services that they need to do so,

contributing to their mmecessary placement in facility-based settings.

4. Failure of the State's Current Rate Setting Methodology and Reimbursement Model to Promote Integrated Supported Employment and Day Services

48 Project Sustainability Funding Initiatives at 4, supra note 3 I.
49 [n fact, federal vocational rehabilitation funding requires individuals with the most significant disabilities to be given priority in state vocational rehabilitation systems.
50 One provider told us of a client with I/DD and deafness who had gone to college and worked for a time in a retail job stocking shelves. Due to the lack of available interpretation services and extended supports, she could not understand her boss' instructions, leading her to lose the job. She was forced to return to a facility-based day program, where she could access appropriate interpretation services.
25

The process by which the State's new rate system is administered under "Project Sustainability" has the effect of discouraging individuals with I1DD from accessing integrated employment and day services. 51 Our investigation revealed that BHDDI-I staff maintains primary responsibility for administering the Supports Intensity Scale, and they are also part of the agency that administers the statewide budget for developmental disability services. This is a seeming conflict of interest because the need to keep consumers' resource allocations within budget may influence staff to administer the SIS in a way that reaches the pre-determined budgetary result. 52 Numerous persons stated that this lack of neutrality, and apparent tension between the need to assess the full spectrum of an individual's support needs and state efforts to cut costs, has negatively impacted the resources individually allocated to people with I/DD. 53
Further, we received considerable feedback from parents, family members, advocates, direct support staff, and providers that the individuals administering the SIS lack the training, qualification, or experience working with individuals with I1DD necessary to make resource allocation decisions on behalf of individuals with I/DD. Moreover, our investigation revealed that the SIS has in many cases been administered without access to translation or interpretation services. We also heard widespread complaints about the frequent failure ofBHDDI-I staff to include essential participants in the SIS administration, including family members, guardians, and individuals knowledgeable about the service recipient's preferences, skills, and abilities. We were informed of one instance where an individual with I/DD eloped during the early portion of the SIS administration, but nevertheless, a budget allocation decision was made by BHDDH staff based on the assessment's results. Many families also said that the State's requirement that the SIS assessment take place during restrictive business hours posed a logistical challenge to their patiicipation. Accordingly, we find that several formative practical and procedural barriers currently exist under Project Sustainability that contribute to individuals' inability to access the resources, including funding allocations, that they need to purchase services like supported employment and integrated day programming.
We also find the inflexibility of the State's reimbursement model to be a significant barrier to integrated employment and day opportunities for individuals with I/DD. For instance, under the current system, job developers and job coaches cannot be reimbursed for services that they provide at times when they are not "face-to-face" with their client at the job site. This practice discourages employment specialists from engaging in negotiation or dialogue with the
51 Rate setting and reimbmsement methodologies are critical components of any state's employment and day service systems, and they are essential to ensuring access to integrated settings. Rates determine the level of resources that individuals with disabilities may access, including the services and supports that will allow them to work or fully participate in their communities.
52 The SIS assessment is fundamentally a resource allocation tool in Rhode Island. The American Association on Intellectual and Developmental Disabilities ("AAIDD"), the originator of the SIS assessment, encourages states to, "[d]etermine strategies for managing potential real or perceived conflict of interest. In situations where states ... will use state staff to conduct interviews, an inherent conflict of interest may exist. This is especially true when the SIS is being used for resource allocation purposes." AALDD, "Safeguarding your investment: Guidelines for selecting trainers for the Supports Intensity Scale," available at http://aaidd.org/sis/training/articles/safeguardingyour-investmentH.Uo1 gMVOkajR.
53 See, e.g., Profile of the RI DD System at 5, supra note 43 ("37.5% of respondents to a survey of self-directed support users indicate that the level of community participation has changed since the implementation of regulatory changes in 2011. 62.5% indicate that the dollar value of their service package has changed and that they could not as a result maintain the same level of community activity.") (internal citation omitted).
26

employer; it does not promote cultivation of natural supports through co-workers; and it does not incentivize counseling the client remotely (~, by phone). The absence of these important services runs contrary to best practices in the provision of supported employment services. At the same time, nearly all of the employment specialists that we met with in the State, including job coaches and job developers, said that under the current rate structure they struggle to avoid operating at a loss when it comes to the transportation costs incurred while visiting their clients at various job and day activity sites. Finally, the inflexibility of the State's reimbursement model has made it exceedingly difficult for providers to expand and convert their service structure from primarily facility-based services to include integrated employment and integrated day services.
E. Youth with I1DD Exiting the School System Are at Risk of Placement in Sheltered Workshops and Facility-Based Day Programs
Due to the State's failure to promote the availability of sufficient integrated transition services, or to link students in school districts across Rhode Island with appropriate postsecondary services and supports like supported employment or integrated day services, youth with I1DD are at serious risk of entering segregated sheltered workshops and facility-based day programs in violation of Title II ofthe ADA. See Pashby v. Delia, 709 F.3d 307,322 (4th Cir. 2013) ("In sum, individuals who must enter institutions to obtain Medicaid services for which they qualify may be able to raise successful Title II ... claims because they face a risk of institutionalization.") (emphasis added); M.R. v. Dreyfus, 697 F.3d 706, 734 (9th Cir. 2012) ("An ADA plaintiff need not show that institutionalization is 'inevitable' or that she has 'no choice' but to submit to institutional care in order to state a violation of the integration mandate[;] [r]ather, a plaintiff need only show that the challenged state action creates a serious risk of institutionalization."); Fisher v. Okla. Health Care Auth., 335 F.3d 1175, 1181 (10th Cir. 2003) ("[P]rotections [of the ADA's integration mandate] would be meaningless if plaintiffs were required to segregate themselves by entering an institution before they could challenge an allegedly discriminatory law or policy that threatens to force them into segregated isolation.... [N]othing in the Olmstead decision supports a conclusion that institutionalization is a prerequisite to enforcement of the ADA's integration requirements."); Lane v. Kitzhaber, 841 F. Supp. 2d 1199, 1205 (D. Or. 2012) ("the risk of institutionalization addressed in both Olmstead and Dreyfus includes segregation in the employment setting.").
According to records produced by RIDE in response to this investigation, hundreds of youth with I1DD transition from secondary school to Rhode Island adult day and employment service providers each year. However, based on data produced by the State, only approximately 5% of the youth with I1DD who transitioned from Rhode Island secondary schools between 2010 and 2012 transitioned into jobs in integrated settings.54 Under the current system, the majority of transition-age youth with I/DD transition to facility-based providers, including sheltered workshops and facility-based day programs, to receive adult services. Other data offer proof of ' this well-worn path from school to facility-based adult programs: in 2012, almost 8% of individuals with I/DD in the day activity service system were reported to be youth age 24 or under. 55
54 State's document production in response to Letter from Regina Kline to William 1. Conley, Jr. (Mar. 4,2013), Request "0" (on file with RID E).
552012 Sherlock Survey, supra note 3.
27

Many parents and families that we interviewed informed us that the State-via its vocational rehabilitation counselors and BHDDH social'workers-frequently fails to present transition-age students with I1DD with v-iable alternatives to segregated sheltered workshops. Moreover, the State often fails to provide the appropriate transition services56 necessary to inform the employment-related recommendations contained in students' post-secondary planning documents. 57 These practices curtail students' access to post-secondary employment. Families also told us of a general lack of ORS and BHDDH presence in schools across Rhode Island to assist with the Individualized Education Program ("IEP") pIaiming process and with students' enrollment in the adult system. When such staff is present, we learned that they often encourage segregated post-secondary placements for students. For instance, we were told that BHDDH social workers often take youth to visit facility-based programs, including sheltered workshops and day programs, as part of the referral process directly from high school. Other students are assessed by vocational rehabilitation counselors in segregated settings to determine their eligibility for ORS services, frequently leading to permanent placement in segregated rather than integrated employment settings.
Our investigation revealed another significant factor placing students at risk: despite Rhode Island's express requirement that transition planning begin at age 14,58 the State has often failed to ensure that students are given meaningful information about, and opportunities to experience, integrated employment aI1d day services early enough to make an informed choice to transition to an integrated setting-instead of to a sheltered workshop or facility-based day program-following their exit from school. Individuals become eligible for ORS services at age 16,59 and for services through BHDDH at age 18.60 However, we were told that many students throughout Rhode Island only receive employment-related transition planning or are enrolled in
56 According to Rhode Island statute, "[t]ransition services ... means a coordinated set of activities ... that promotes movement from school to post-school activities including ... vocational training ... [and] adult services ...." R.I. Gen. Laws § 16-24-18(e)(1) (emphasis added). As mentioned, pursuant to Rhode Island law, ORS vocational rehabilitation counselors and BHDDH representatives must be included in the individualized transition planning process if they provide, or will provide, services to the young person with a disability under the individual's plan.lQ., § 16-24-18(d). ORS provides "Transition Services from School to Career" and "ORS Counselors provide technical assistance, consultation, information and referral services to school systems and work in close partnership with the 5 Regional Educational Collaboratives, netWORKri and other agencies to improve transition planning." See ORS, Vocational Rehabilitation Program, http://www.ors.ri.govIVR.html(last visited Jan. 5,2014); ORS, Transition, http://www.ors.state.ri.us/Transition.html (last visited Jan. 5, 2014). BHDDH administers services for individuals age 18 and older to assist in career planning and the formulation of vocational goals as part of the development of the Individual Support Plan ("ISP").
57 Post-secondary planning docume;lts can include an ISP or IPE. Individualized Education Programs ("IEPs") are also a potential vehicle for post-secondary planning.
58 R.I. Gen. Laws § 16-24-18(d).
59 46-1-5:4 R.I. Code R. § 4.1; 46-1-5:2 R.l. Code R. § 2.8.
60 See generally, U.S. Dep't of Educ., Office of Special Educ. & Rehabilitative Servs., Rehab. Servs. Admin., "Fiscal Year 2012 Monitoring Report on the Rhode Island Department of Human Services, Office of Rehabilitation Services Program" (July 16, 2012), available at http://www.ors.ri.gov/PDFfiles/2012%20ri%20monitoring%20visit.pdf; R.I. Disability Law Ctr., "A Consumer's Guide to Rhode Island State Vocational Rehabilitation Services," available at http://www.ridlc.org/publications/Consumers_Guide_to_RI_Voc_Rehab.pdf.
28

ORS or BHDDH services one year or less before their exit from school, if at all. Even students who receive some transition plmming services generally do not participate in integrated transition work placements and work-based lem11ing experiences such as site visits, job shadowing, soft skill and job skill development, internships, part-time employment, summer employment, youth development and leadership, peer and adult mentoring, and benefits plmming.
We acknowledge that, although few in number, there are pockets of excellence in Rhode Island where transition planning adheres to best practices by including the introduction of integrated work placements and work-based learning experiences. Many of the individuals with I/DD that we met with at their individual supported employment placements transitioned into those settings directly from a few high-performing schools that offered integrated work-related transition programs. However, our investigation revealed that in most Rhode Island schools, the State did not present students with a meaningful choice to participate in integrated alternatives, and the State, including RIDE, has not embedded into State policy that integrated work placements and work-based learning experiences are critical to mitigating the risk of unnecessary post-secondary placement in sheltered workshops and facility-based day programs. Some students still perform in-school jobs designated for students with disabilities (instead of performing those same jobs in the community); others acquire work-related skills in a special education classroom without ever being presented with the choice to exercise those skills in a community job; while still others receive work-related transition services from facility-based adult service providers, including sheltered workshops and segregated day programs.
The State, including BHDDH, has also failed to provide integrated and transition-related adult services to many students with I/DD who are eligible for them, further advancing the risk that such students will transition to segregated settings following their exit from school. Specifically, even though individuals become eligible for Medicaid services at age 18, BHDDH does not administer services to eligible youth with I1DD until they are 21 years old. Numerous parents, families, and service recipients informed us that this service gap has caused many students who exit high school prior to 21 years old to either sit at home without services, or to later enroll in sheltered workshop and day programs in order to receive employment services at all. The service gap has caused considerable entropy in the transition process for many youth who can and want to work. They are incentivized either to stay in the education system Ulmecessarily until they are 21 years old or exit school between the ages of 18 and 21 and experience the loss of educational benefits and the concomitant and unnecessary lack of access to the adult system. The failure to serve youth with I/DD who are eligible for adult services places them at serious risk of unnecessary segregation.
F. Serving Persons with I1DD in Integrated Employment Settings Can Be Reasonably Accommodated
Providing integrated services to adults in sheltered workshops and day programs and to students at risk of placement in such settings can be reasonably accommodated without a fundamental alteration to the state service system. The types of services needed to support adults and students with I1DD in integrated employment and day settings-including individualized transition services, supported employment, and community-based day services-already exist in Rhode Island's employment and day service system. The State could redirect the funds that it already expends supporting the State's current facility-based employment and day programs, to provide trmlsition, employment, and day services in integrated settings.
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The State already provides some integrated employment-related transition, supported employment, and integrated day services and supports to persons with I/DD. Expanding those
services to serve adults currently in sheltered workshops and facility-based day programs, and
youth who will transition from schools into the adult system, and who are at risk of unnecessary segregation in segregated sheltered workshops and facility-based day programs, is a reasonable modification of the State's day activity service system. See DAI v. Paterson, 598 F. Supp. 2d 289,335 (E.D.N.Y. 2009), vacated on other grounds sub nom. DAI v. N.Y. Coal. for Quality Assisted Living, 675 F.3d 149 (2d Cir. 2012) ("Where individuals with disabilities seek to receive services in a more integrated setting-and the state already provides services to others with disabilities in that setting-assessing and moving the particular plaintiffs to that setting, in and of itself is not a 'fundamental alteration. "') (emphasis in original); see also Messier v. Southbury Training School, 562 F. Supp. 2d 294,344-45 (D. Conn. 2008) (noting that the defendant state agency's "fundamental alteration claim [was] entirely inconsistent with its public commitment to further enhancing a system of community placement programming.").
Accordingly, redirecting and expanding resources currently expended upon segregated sheltered workshops and facility-based day programs to integrated transition, supported employment, and community-based day services for those individuals who are in or at risk of unnecessary segregation, will not be a fundamental alteration of the State's day activity service system. 61
VI. RECOMMENDED REMEDIAL MEASURES
To remedy the deficiencies discussed above and to protect the civil rights of individuals with I/DD who receive services in segregated sheltered workshops and day programs, the State should immediately implement the minimum remedial measures set forth below.
The State must identify, locate, and develop sufficient integrated supported employment services to enable those individuals who are unnecessarily segregated in sheltered workshops and facility-based day programs, and who can and want to work, to receive services in the most integrated setting appropriate to their needs. Supported employment services are services provided in the amount, duration, and intensity to allow persons with I/DD to work the maximum number of hours consistent with their abilities in integrated employment settings. Supported employment services include services necessary to place, maintain, and provide ongoing support to an individual with I/DD in an integrated employment setting. The unmistakable core of these services is support in an integrated employment setting; and absent on-the-job support that is uniquely tailored to the individual in integrated employment settings, the employment services do not and cannot be recognized as supported employment services.
61 One study found that in Rhode Island, persons with I/DD in supported employment returned $ 1.43 for every dollar spent on them. Robert E. Cimera, "National Cost Efficiency of Supported Employees with Intellectual Disabilities: 2002 to 2007," Am. 1. ofIntellectual and Developmental Disabilities, vol. 115, no. 1, at 26 (Jan. 2010), available at www.mig-rats.org/uploads/TheNationaICost-EfficiencyofSupportedEmployeeswithMR.pdf. Additionally, because supported employment helps persons with I1DD to secure competitive employment with higher wages and benefits, such services may assist some persons to become less dependent on public benefits, including state-funded health insurance and transportation subsidies. ld. at 23. Also, for many individuals, the amount of required support is likely to decrease over time, thus lowering costs over the longer term. rd. at 27. Conversely, the per-person cost of sheltered workshops tends either to stay the same or increase over time. Id.
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The State must also identify, locate, and develop sufficient integrated day services to enable those who are unnecessarily segregated in facility-based sheltered workshops and day programs to access integrated activities when they are not working or receiving residential services. Such services must be provided in the amount, duration, and intensity to allow persons with I/DD to engage in activities in the community at times, frequencies, and with persons of their choosing during hours when they are not receiving employment or residential services. The unmistakable core of these services is support in an integrated day setting; and absent support provided in integrated settings in the community where individuals may access activities that are uniquely tailored to their interests and preferences, the day services caml0t be recognized as integrated day services.
The State must also identify, locate, and develop sufficient transition services to enable those students who are at risk of unnecessary segregation in sheltered workshops and facilitybased day programs to access the appropriate transition services and supports necessary to allow them to participate in employment and day services in the most integrated setting appropriate to their needs upon exiting school. The unmistakable core of these services is support provided to a student early enough to make the informed choice to work or participate in an integrated postsecondary setting; the opportunity to work in an integrated setting prior to exit from school; and sufficient linkages to integrated employment and day settings through effective transition assessment and planning processes, including discovery, vocational and situational assessment, and person-centered planning in integrated settings.
Furthermore, the State must develop an effective plan to serve the thousands of individuals in segregated sheltered workshops and facility-based day programs, or at risk of placement in such programs, in appropriate integrated employment and day settings when they so choose. Such a plan should include directives sufficient to: (1) ensure that all individuals in sheltered workshops and facility-based day programs are offered a meaningful opportunity to access integrated supported employment and day services and that no individuals remain unnecessarily in segregated programs; and (2) ensure that no youth are unnecessarily placed in sheltered workshops and segregated day programs after transitioning from Rhode Island secondary schools, now or in the future.
The State should also develop policies and procedures to implement these statewide directives, including technical assistance to employment and day services providers, conditioning funding on the achievement of numerical targets, well-defined and measurable outcomes, education about and support of individuals' informed choice of service options, and implementation timelines.
Additionally, the State should incrementally shift its current funding of segregated sheltered workshops and facility-based day programs to integrated supported employment and community-based day services, allowing the money to follow the many individuals who can and want to participate in integrated employment and community-based day activities.
Finally, the State must implement an effective plan to transition individuals unnecessarily segregated in sheltered workshops and facility-based day programs to integrated employment and day settings in the community. The plan should include requirements for effective outreach and in-reach, transition, discovery, and vocational and situational assessment for service recipients and their families. All vocational assessments and evaluations should be conducted in
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integrated settings, where appropriate, and be based on the principle that, with sufficient services and supports, individuals with I/DD can work and spend their days in integrated settings.
No one who is qualified for integrated supported employment and/or day services should remain in segregated sheltered workshops and facility-based day programs, unless, after being fully informed, he or she declines the opportunity to receive services in an integrated work or day setting with access to appropriate services and supports, including supported employment and integrated day services.
VII. CONCLUSION Please note that this findings letter is a public document. It will be posted on the Civil Rights Division's website. We hope to continue working with Rhode Island in an amicable and cooperative fashion to resolve our outstanding concerns with respect to the services the State provides to persons with intellectual and developmental disabilities. We hope that you will give this information careful consideration and that it will assist in furthering the dialogue already begun by counsel to swiftly and resolutely address the areas that require immediate attention. We are obligated to advise you that, in the event that we are unable to reach a resolution regarding our concerns, the Attorney General may initiate a lawsuit pursuant to the ADA once we have determined that we cannot secure compliance voluntarily, 42 U.S.C. § 2000d-l, to correct deficiencies of the kind identified in this letter. We would prefer, however, to resolve this matter by working cooperatively with the State and are hopeful that we will be able to do so. If you have any questions regarding this letter, please call Rebecca Bond, Chief of the Civil Rights Division's Disability Rights Section, at (202) 307-0663.
Sincerely,
Jocelyn Samuels Acting Assistant Attorney General
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