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## AP **PENDIX A QUESTIONNA** **IRE**2 

## On **- line Survey** 

**of State Vocational Rehabilitation (VR) A**  **gencies on the Delivery** 

**of Services through the VR Grants Program** To enter the Survey of State VR Agencies on the Delivery of Services through the VR Grants Program, please type your Login and Password in the boxes below, then click **Login** . The next page will be the first page of the survey you are requested to complete. User Login: Password: 

## US Department of Education Rehabilitation Services Administration

**OMB # 1820 -** **xxxx Expiration Date: xx** **- xx** **- xxxx**  **This survey**

**is designed to be completed by the person(s) most knowledgeable about**  **the delivery**

**of state VR**  **services , including knowledge of your agency’s policies and**  **practices in providing VR services to individuals with disabilities.**

**Public Burden Statement:** According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collec tion of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 90 hours per response, including time for reviewing instructions, searching existing data so urces, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary ( Section 14(a) of the Rehabilitation Act (P.L. 93 - 112; P.L. 105 -220) . Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, W ashington, DC 20210 -4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820-XXXX. Note: Please do not return the completed Study of the Delivery of Services under the State Vocational Rehabilitation Grants Program to this address.3



## On - line Survey of State VR Agencies on the Delivery of Services through the VR Grants Program Contact Us **Instructions and Recommendations for Completing the Survey**  Werecommend that you use Internet Explorer or Firefox to complete this survey.  The survey pages are best viewed through a full -sized browser window  Please do NOT use your browser’s forward or back buttons to navigate through the survey. If you do, your answers may be lost. Instead, please use the “Previous Question” and “Next Question” buttons on the bottom of each page.  Please use the “Comments” box at the bottom of each question to provide additional information that may help clarify your response.  You may exit the survey at any time by selecting the “logout” button at the top of the screen. Your survey answers will automatically be saved. When you return, you will have the option of resuming the survey from your point of exit.  Once you complete the survey, you will be asked to submit it. Once you click the “Submit” button, you will not be able to re-enter your survey. Continue4 **Instructions** The frame of reference for the survey is October 2011 through September 2012, Federal Fiscal Year (FFY) 2012. W hen asked to provide numbers, amounts, or percentages, please provide values as of September 30 , 2012, unless otherwise specified. VR Agency:

________________________________ _______________ Date: _____ / _____ / _______ (DD/MM/YYYY) Completed by:

________________________________ __ Title:

__________________________ Completed by:

________________________________ __ Title:

__________________________ Completed by:

________________________________ __ Title:

__________________________ **I. A GENCY STRUCTURE A** **ND STA FF**  1. Please indicate the number of l ocal VR offices operated by the VR agency on September 30 , 2012 through which you delivered services:

_______ 2 . On September 30, 2012, how many of your agencies counselors had a general caseload, a specialized caseload, or a mixed caseload of g eneral and specialized cases? W hat was the average caseload size for each type of caseload? Please use the table below to provide your response.

**Type of caseload Number of**  **counselors Average** 

**caseload** General caseload Specialty caseload Mixed caseload of general and specialty 3 . How much money was available in FFY 2012 per counselor to serve any client and/or purchase any service?

$_______

_______ Ag ency does not designate amounts per counselor5

4 . Is the VR agency **currently facing**  any of the following limitations on its operations?  Yes [CHECK ALL THAT APPLY]  State- level hiring freeze  State unable to provide matching funding  Budget cuts to other agencies reduce ability to obtain match through agreements  Implementation of legislation to merge agency  Implementation of legislation to split combined agency  Designated state agency (DSA) making changes that weaken designated state unit (DSU)  Other (specify)  No 5 . Wh at, if

a ny, particular actions has the agency taken in the past year to address recruitment and retention of VR agency staff? (CHECK ALL THAT APPLY)

 Strengthened relationship with University programs  Increased amount of staff training  Revised CSPD standards and/or goals  Expanded authority and autonomy of field staff  Revised pay scales  Other (specify) **Comprehensive Residential Rehabilitation Center** 6 . Did the VR agency operate a comprehensive residential rehabilitation center (i.e., a residential facility that provides a wide array of rehabilitation services to individuals with all types of disabiliti es) in FFY 2012?

 Yes  No [SKIP TO ITEM 7] 6a. Please indicate the number of FTE staff positions at the center on September 30 , 2012:

_______ 6 b. Please indicate the total amount of funds used to support the center in FFY 2012: $_______6 6c . Please indicate the total number of i ndividuals who completed services at comprehensive residential rehabilitation center in FFY 2012:

_______ **Orientation and Training Centers** 7 . Did the VR agency operate any orientation and training centers (OTCs) for blind persons in FFY 2012?

 Yes  No [SKIP TO ITEM 8] 7a. Please indicate the number of OTCs the VR agency operated on September 30 , 2012:

_______ 7 b. Please indicate the number of FTE staff positions at the OTCs on September 30 , 2012:

_______ 7c. Please indicate the total amount of funds used to support the OTCs in FFY 2012: $_______ 7d . Please indicate the total number of individuals who completed services at OTCs for blind persons in FFY 2012?

_______ **Centers for Deaf or Hard of Hearing** 8 . Did the VR agency operate any specialized (or state run) centers for services for individuals who are deaf or hard of hearing in FFY 2012?

 Yes  No [SKIP TO ITEM 9]7 8a. Please indicate the number of centers fo r the deaf

o r hard of

h earing the VR agency operated on September 30 , 2012:

_______ 8 b. Please indicate the number of FTE staff positions at the center(s) for the deaf and hard of hearing on September 30 , 2012:

_______ 8c. Please indicate the total amount of funds used to support the center(s) for the deaf and hard of hearing in FFY 2012: $_______ 8d . Please indicate the total number of i ndividuals who completed services at centers fo r individuals who are deaf or hard of hearing in FFY 2012?

_______ **Other Centers** 9 . Did the VR agency operate any other centers through which it delivered centralized services (e.g., vocational evaluation, assistive technology) in FFY 2012?

 Yes  No [SKIP TO ITEM 10] 9a. Please indicate the number of other service centers the VR agency operated on September 30 , 2012 and the type(s) of centralized service(s) they delivered: # _______ Type(s) of service(s) 9 b. Please indicate the number of FTE staff positions at these other service centers on September 30 , 2012:

_______8 9c. Please indicate the total amount of funds used to support these other service centers in FFY 2012: $_______ 9d . Please indicate the total number of individuals wh o completed services at these other centers in FFY 2012?

_______ **Order of Selection** 10 . Is the VR agency currently operating under an order of selection (OOS) regardless of having wait list categories open or closed ?

 Not operating under OOS [SKIP TO ITEM 1 1 ]  Yes 10a . Wh at factors does the VR agency consider in opening a wait listed category? [CHECK ALL THAT APPLY]  Sufficient number of staff  Federal funding  State matching funds  Forecasts of the number of individuals to be served  Current caseload size  Other (specify) **Vendors in General**  **( Al**  **l Providers of Purchased Services)**  1 1 . Approximately how many vendors did business with the VR agency in FFY 2012?

_______ (number of vendors) 1 2 . How would you characterize the supply of VR vendors in the state in FFY 2012 with regard to types of services they provide?

 Adequate to meet the needs of individuals for all types of services  Adequate to meet the needs of individuals for most types of services  Adequate to meet the needs of individuals for only a few types of services  Inadequate to meet the needs of individuals for any types of services9

1 3 . How would you characterize the supply of vendors in the state in FFY 2012 geographically?

 Adequate to meet the needs of individuals in all areas of the state  Adequate to meet the needs of individuals in only high population density areas of the state  Inadequate to meet the needs of individuals in any areas of the state 1 4 . How did the VR agency ensure reasonable costs for purchased services in FFY 2012? [CHECK ALL THAT APPLY]

 Agency did not purchase services [SKIP TO ITEM 20]  Use competitive bid process  Use performance- based contracting  Monitor service providers  Require certification (e.g., CARF)  Estab lish service cost list  Other (specify) 1 5 . To what extent did the VR agency use performance- based contracts for client services in FFY 2012 in which vendors are paid only after individuals achieve certain milestones?

 VR agency did not use performance- based contracts at all  VR agency used performance- based contracts only with vendors of specific services (specify services)  VR agency used performance- based contracts with all vendors 1 6 . Wh at were the VR agency’s sources of information in FFY 2012 on the costs and performance of specific vendors? [CHECK ALL THAT APPLY]

 Formal on-site monitoring on an annual or more frequent basis  Formal on-site monitoring less often than annually  Written reports from agency vendors  Vendor invoices  Counselor assessment  Purchasing technician assessment  Client assessment/satisfaction  Other (specify) 1 7 . Did the VR agency’s data system provide counselors with access to information on the quality and performance of specific vendors in FFY 2012?

 Yes  No10

1 8 . Did the VR agency’s data system provide counselors with access to information on the costs of specific services of vendors in FFY 2012?

 Yes  No 1 9 . Wh at is the greatest challenge to improving the quality and availability of vendors? **II. SERVICE DELIVERY A** **PPROA CHES**  20 . Wh ich of

the following best characterizes the VR agency’s overall approach to delivering services in FFY 2012?

 VR agency delivered a greater number of services directly through agency-employed staff  VR agency purchased most services  An equal amount of services were delivered directly through VR agencyemployed staff and purchased 2 1 . In the last five years, has the VR agency changed (i.e., increased or decreased) the number of services delivered directly through agency-e mployed staff?

 Yes, VR agency has increased the number of services provided directly through agency-employed staff  Yes, VR agency has decreased the number of services provided directly through agency employed staff  No, VR agency has not changed the number of services provided directly through agency-employed staff [SKIP TO ITEM 24] 22 . Why did the VR agency implement this change in the way it delivers services? [SELECT THE MOST IMPORTANT REASON]

 To improve consumer outcomes  To obtain more control over cost of services  To reduce costs  To mitigate agency staffing issues (i.e., recruitment and retention of qualified staff)  To improve availability of vendors  To ensure quality of service delivery  To improve access to services in rural areas  Other (specif

y)11

2 3 . To what extent has this change(s) in the way the VR agency delivers services met the intended purpose of the VR agency?

 Great extent  Some extent  Not at all  Too early to know 24 . Among the factors listed below, and recognizing that they include consumer, funding, or organizational challenges, please rank the three greatest challenges to improving the delivery of VR services, with 1 being the greatest challenge. Rank a. Inadequate funding generally b. Inability to secure full state matching funds c. I mpact of Maintenance of Effort (MOE) on the willingness of the state to match reallotment dollars d . Lack of transportation e . Insufficient number of vendors f. Staff vacancies and/or turnover g . Order of selection status h . Lack of extended services funding for individuals in supported employment (SE) i . State procurement regulations j . Insufficient interagency coordination at state level k . Insufficient interagency coordination at local level l . Limited control over key administrative decisions m . Other (specify) 2 5 . Please describe what steps, if any, the agency is taking to address these challenges. **VR Counseling Services** 26 . Did the VR agency operate with specifically assigned “VR Service Delivery Teams” (teams of inte rnal, or internal and external, members for delivery of specific services ) in FFY 2012?

 Yes (please describe the composition of those teams and the populations they serve)  No12

2 7 . Did the VR agency contract with any private entities for counseling services (i.e., persons who perform delegable VR functions) in FFY 2012?

 Yes (specify number of private counselors under contract during FFY 2012): _____  No 2 8 . Has the VR agency changed its approach to delivering counseling services in the last five years (e.g., focusing previously generalized counselors, switching to a team approach, or making policy changes, including regarding an order of selection)?

 Yes (please describe):  No [SKIP TO ITEM 3 1 ] 2 9 . Why did the VR agency implement this change in its approach to delivering counseling services? [SELECT THE MOST IMPORTANT REASON]

 To improve consumer outcomes  To obtain more control over costs  To reduce costs  To ensure quality of service delivery  To mitigate agency staffing issues (i.e., recruitment and retention of qualified staff)  To improve information support system for counselors  To improve access to services in rural areas  Other (specify) 30 . To what extent has this change in the VR agency’s approach to delivering counseling services met the intended purpose?

 Great extent  Some extent  Not at all  Too early to know 3 1 . Wh at is the greatest challenge to improving counseling services?13

**Other Services** Job Placement 32 . How did the VR agency deliver job placement services in FFY 2012? [CHECK ALL THAT APPLY]

 VR agency purchased job placement services  VR agency provided job placement services directly through specialists  VR agency provided job placement services directly through VR counselors  Other (specify) 33 . How did the VR agency deliver the majority of job placement services in FFY 2012? [CHECK ONLY ONE]

 VR agency purchased job placement services  VR agency provided job placement services directly through specialists  VR agency provided job placement services directly through VR counselors  Other (specify) 34 . Wh at is the greatest challenge to improving job placement services?

Vocational Evaluation 35 . How did the VR agency deliver vocational evaluation services in FFY 2012? [CHECK ALL THAT APPLY]

 VR agency purchased vocational evaluation services  Another state agency provided vocational evaluation services  VR agency provided vocational evaluation services directly through vocational evaluators  VR agency provided vocational evaluation services directly through counselor(s) with vocational evaluation skills  VR agency both purchased vocational evaluation services and directly provided the services  Other (specify) 36 . Wh at is the greatest challenge to improving vocational evaluation services?14

Assistive Technology 3 7 . How did the VR agency deliver assistive technology services in FFY 2012? [CHECK ALL THAT APPLY]

 VR agency purchased assistive technology services  VR agency provided assistive technology services directly through specialists  VR agency provided assistive technology services as a comparable benefit from another state or local agency/entity  Other (specify) 38 . Wh at is the greatest challenge to improving assistive technology services?

**III. TA RGET POPUL** **ATI ONS A** **ND PA RTNERSHIPS**  **Coordination With Education A gencies**  **– Transitional Youth**  39 . Did any of the VR counselors with general caseloads serve transitional youth in FFY 2012?  Yes

 No [SKIP TO ITEM 40] 39a. Approximately what percentage of transitional youth served by the VR agency was served by VR counselors with general caseloads on September 30 , 2012? _______ %15

40 . Did the VR agency co- locate any VR counselors at secondary or postsecondary schools in FFY 2012?

 Yes ____ Number of counselors co- located at schools in FFY 2012  No 4 1 . Did the VR agency employ any individuals at the state level with responsibility for coor dinating or managing services to transitional youth in FFY 2012?  Yes _____ Number of FTEs  No [SKIP TO ITEM 43] 42 . Please indicate the responsibilities of state- level staff dedicated to coordinating or managing services to transitional youth. [CHECK ALL THAT APPLY]

 Training and technical assistance  Consultation with VR counselors  Participation in interagency committees focused on transition  Development of curricula  Outreach to school and other community organizations  In itiating VR IPE services to students while in high school  Other (specify) 43 . Is the VR agency considering implementing any changes in the delivery of VR services to transitional youth?

 Yes (briefly describe changes the agency is considering):  No 44 . Wh at is the greatest challenge to improving services and outcomes for transitional youth?16

**Coordination With Intellectual and Developmental Disabilities A gencies**  45 . Did the VR agency have a cooperative agreement or memorandum of understanding (MOU) with the state intellectual or developmental disabilities (IDD) agency in FFY 2012?  Yes

 No [SKIP TO ITEM 4 7] 46 . Wh at was the focus of the agreement and/or MOU? [CHECK ALL THAT APPLY]

 Cooperation and coordination in referral for VR services  Cooperation and coordination for provision of VR services  Funding and delivery of supported employment services  Funding of extended support services  Other (specify) 4 7 . Is the VR agency considering implementing any changes in the way the agency delivers VR services to individuals with intellectual or developmental disabilities?

 Yes (briefly describe changes the agency is considering):  No 48 . Wh at is the greatest challenge to improving services and outcomes for individuals with intel lectual or developmental disabilities?

**Coordination With State and Local Mental Health A gencies**  49 . Did the VR agency have a cooperative agreement or memorandum of understanding (MOU) with the state agency that administers mental health (MH) services in FFY 2012?  Yes

 No [SKIP TO ITEM 5 1 ]17

50 . Wh at was the focus of the agreement or MOU? [CHECK ALL THAT APPLY]

 Cooperation and coordination in referral for VR services  Cooperation and coordination for provision of VR services  Funding and delivery of supported employment services  Funding of extended support services  Other (specify) 5 1 . Is the VR agency considering implementing any changes in the way the agency delivers VR services to individuals with mental illness?

 Yes (briefly describe changes the agency is considering):  No 52 . Wh at is the greatest challenge to improving services and outcomes for individuals with mental illness?

**Coordination With Social Security A** **dministration –**  **SSI/SSDI Recipients** 53 . Did the VR agency have cooperative agreements or memoranda of u nderstanding (MOUs) with state, regional or local offices of the Social Security Administration (SSA) Employment Networks (ENs) in FFY 2012?

 Yes (specify the number of such agreements or MOUs ): _______  No [SKIP TO ITEM 55] 54 . Wh at was the focus of the agreements or MOUs? [CHECK ALL THAT APPLY]

 To expedite eligibility determination  To improve the employment rate of SSI/SSDI recipients  To improve the use of work incentives for Social Security disability beneficiaries  Other (specify)18

55 . Was the VR agency designated as an EN under the SSA’s Ticket to Wo rkp rogram in FFY 2012?

 Yes  No 56 . How did the VR agency provide benefits counseling services in FFY 2012 to individuals who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI)?

 VR agency did not provide benefits counseling services [SKIP TO ITEM 86]  VR agency provided benefits counseling services directly through agency-employed benefits counselors  VR agency provided benefits counseling services as a comparable benefit through SSA funded W IPA program  VR agency provided benefits counseling services as a comparable benefit through Centers for Independent Living  VR agency purchased benefits co unseling services from Community Rehabilitation Programs or individuals 57 . In the last five years, has the VR agency changed the manner through which it provides benefits counseling services?

 Yes (briefly describe):  No [SKIP TO ITEM 59] 58 . To what extent has this change in the manner through which the VR agency provides benefits counseling services led to improved quality of employment outcomes for SSA beneficiaries served by your agency (e.g., competitive employment; working above Substanti al Gainful Activity level )?

 Great extent  Some extent  Not at all  Too early to know 59 . We re benefits counseling services sufficiently available in the state to meet the needs of individuals served by the VR agency in FFY 2012?  Yes  No19

60 . Is the VR agency considering implementing any changes in the way the agency delivers VR services to individuals receiving SSA benefits?

 Yes (briefly describe changes the agency is considering):  No 6 1 . Wh at is the greatest challenge to improving services and outcomes for individuals who are SSI/SSDI recipients?

**Coordination With One -** **Stop Career Centers** 62 . Did the VR agency have a cooperative agreement or memorandum of understanding (MOU) with the state agency that administers one-stop career centers under the Wo rkforce Investment Act (W IA) in FFY 2012?

 Yes  No 63 . Did the VR agency have cost sharing agreements in place with the state agency that administers the one-stop career centers in FFY 2012?

 Yes  No 64 . Did the VR agency co- locate any VR counselors at one-stop career centers in F FY 2012?  Yes

 No [SKIP TO ITEM 65] 64a. Please indicate the number of VR counselors wh o were co- located at one-stop career centers on a full -time basis on September 30 , 2012:

_______ 64 b. Please indicate the number of VR counselors wh o were co- located at one-stop career centers on a part-time basis on September 30 , 2012:

_______20 64c. Please indicate the advantages to the VR agency of co- locating VR counselors at one-stop career centers. [CHECK ALL THAT APPLY]  No advantages  Increased number of referrals to VR  Increased employer awareness of VR  Ready access to labor market information  Other (specify) 64d. Please indicate the disadvantages to the VR agency, if a ny, of co- locating VR counselors at one-stop career centers. [CHECK ALL THAT APPLY]  No disadvantages  Concerns of client confidentiality  Costs  Other (specify) 65 . Wh at is the greatest challenge to improving service coordination with the state’s onestop career centers?21

**Other Collaborations** 66 . With which, if any, of the following other agencies/organizations did the VR agency have formal written agreements or memoranda of understanding (MOUs) to collaborate in serving individuals with disabilities in FFY 2012? For each agency, please briefly describe the focus of the collaboration.

 State Office for Department of Veterans Affairs (describe):  Public Housing Authority (describe):  State Department of Corrections/Juvenile Justice (describe):  Temporary Assistance for Needy Families (TANF) (describe):  Child Protective Services (describe):  American Indian VR Services Program (Section 121 program) (describe):  American Indian Tribe or Nation (describe):  State Employment Service Agency (describe):  State council or foundation on head and/or spinal injury (describe):  Independent Living Center:  Other agency (please specify):

6 7 . Wh at is the greatest challenge to improving collaboration with other state and local agencies?22 **IV. FISCA L A** **ND PROGRA M PLA** **NNING** 68 . How often does VR agency program staff meet with agency fiscal staff for financial planning purposes? (CHECK ONLY ONE)

___ at least weekly

___ at least monthly

___ at least quarterly

___ at least semi -annually

___ at least annually

___ Not Applicable 69 . How often does VR agency program staff meet with agency fiscal staff for reconciling VR program reporting and VR fiscal reporting? (CHECK ONLY ONE)

___ at least weekly

___ at least monthly

___ at least quarterly

___ at least semi -annually

___ at least annually

___ Not Applicable 70 . Is the VR agency’s case managem ent system used to track costs? Cost per client ___ Yes ___ No Cost per service category ___ Yes ___ No Vendor costs ___ Yes ___ No **END OF SURVEY Thank y** **ou for participation and completion of the survey .**