BESB: Policies and Procedures for Receiving Independent Living Rehabilitation Services in the Adult Services Division

State of Connecticut Board of Education and Services for the Blind (BESB)

 

 

 

 

Policies and Procedures for Receiving Independent Living Rehabilitation Services in the Adult Services Division

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Effective Date:  September, 2006

Updated:            November 1, 2010

 


TABLE OF CONTENTS

 

Table of Contents…………………………………………..2

 

Preamble……………………………………………………..5             

 

Mission Statements………………………………………..6

 

Program Description……………………………………….7     

 

Affirmative Action- Equal Access to Services….……..9

 

Legal Benefits………………………………………………12

 

Reports to the Department of Motor Vehicles…..……15

   

Confidentiality of Client Information and Availability

of Case Records…………………………………………….16                                                                   

Summary of Independent Living Rehabilitation Services..24

 

Intake and Information/Referral Services………………26

 

Awaiting Intake………………………………………………30

 

Referral to Vocational Rehabilitation…………………….31

 

Intake Completed……………………………………………33

 

Services Declined………………………………..………….36

 

Determination of Eligibility for Services………………..37   

 

Follow Up Services………………………………………….40

 

Determination of Ineligibility for Services………………41                    

   

Case Management Services……………………………….43                

 

Independent Living Plans………………………………….44

 

Independent Living Plan Amendments………………….48

 

Independent Living Plan Waivers ………………………..49   

 

Authorization for Purchased Services…….………….…50

 

Adaptive Equipment Provided by the Agency.…….…..54

 

Adjustment to Blindness Programs……………………...56

 

Secondary Disabilities….…………………………………..57

 

Social Work Services…………………………………….…59      

 

Rehabilitation Teaching Services………………………...61                                                 

Low Vision Services and Eye Care…………………….…64

 

Low Vision Specialists…….………………………………..68

 

Low Vision Aids and Devices……………………………...71

 

Corneal Transplants…..……………………………………..74                                                 

Orientation and Mobility Instruction……..……………….75

 

Case Record Documentation……………………………….79

 

Goals Achieved and Reactivation…………….……………80

 

Services to Individuals who are Deaf and Blind……..82                                          

Adult Services Appeals Procedures and Remedies…90                                                   

                                                                 


PREAMBLE

 

BESB gratefully acknowledges the contributions of the following individuals in developing the original version of this policy manual, noting their roles and titles held in 2006.

 

Alan Sylvestre, Chair, Agency Board

Eileen Akers, Chair, Agency Consumer Advisory Committee, Board member

Betty Woodward, Board member

Mary Brunoli, Board member

Carolyn Dodd, Board member

Christine Boisvert, Board member

Patricia Wilson-Coker, Board member- Ex Officio

David Banigan-White, O&M Instructor

Marsha Brown, OBG Manager & IL Consultant

Olivia D’Angelos, IL Training Group Consultant

Denise Foley, Social Worker

Lindie Gatling, Social Worker

Alice Jackson, Rehabilitation Teacher

Mary Anne Konicki, Social Worker

Chris Lassen, AS Supervisor

Pat Miller, Rehabilitation Teacher

Nancy Myerson, Rehabilitation Teacher

Karen Page, Processing Technician

Mark Rafferty, Rehabilitation Teacher

Chris Tabb, O&M Instructor

Lisa Tanguay, Office Supervisor

Johnny Vega, Social Worker

John Waiculonis, O&M Instructor

Bill Webb, O&M Instructor

Priscilla Williams, Social Services Assistant

 

And the many interested consumers and advocates whose recommendations and ideas are encompassed throughout.

MISSION STATEMENTS

 

BESB Mission Statement

 

The State of Connecticut Board of Education and Services for the Blind (BESB) is responsible for initiating, coordinating, and implementing the education and training of Connecticut's blind and visually impaired children in order to maintain their academic, physical, emotional, and social progress at age-level, grade level or diagnosed ability level.  BESB serves Connecticut's blind adults through ongoing educational, vocational, and living skills programs in order to empower them to achieve employment success in their chosen profession and to enhance their self-sufficiency.

 

 

Adult Services Mission Statement

 

The mission of the Adult Services Division is to improve the overall quality of life for adults who are legally blind and children who are legally blind or visually impaired. BESB does this by implementing specialized social, educational, and rehabilitation teaching services. These services assist clients in achieving and maintaining their highest level of independence and productivity.

 

 


PROGRAM DESCRIPTION

 

The Adult Services Division of the State of Connecticut Board of Education and Services for the Blind (BESB)  provides an array of independent living rehabilitation services to adults who meet the statutory definition of legal blindness and to children who meet the statutory definition of visual impairment or legal blindness. A major goal of the  Adult Services Division is to maximize the independent living skills of eligible clients.

Under Connecticut General Statutes 10-295(c), the Board of Education and Services for the Blind (BESB) may provide for the instruction of the adult blind in their homes, expending annually for this purpose such sums as the General Assembly may appropriate.

Under Connecticut General Statute 10-295(d), the agency may expend up to ten thousand dollars per fiscal year per person twenty-one years of age or over who is both blind or visually impaired and deaf for the purpose of providing services through specialized public and private entities from which such person can benefit.  The agency may determine the criteria and may adopt regulations necessary to carry out the provisions of this subsection.

 

Under Title VII, Chapter 1, Part B of the Rehabilitation Act (as amended), the agency receives federal funding for the provision of services to maximize the independent living skills and abilities of adults who are legally blind.

 

Under Title VII, Chapter 2, of the Rehabilitation Act (as amended), the agency receives federal funding for the provision of services to maximize the independent living skills and abilities of adults, age 55 or older who are legally blind.

 

BESB’s acceptance of funding under the Rehabilitation Act obligates the agency to undertake significant vision-related rehabilitation outreach to underserved populations in Connecticut. Outreach activities include but are not limited to distributing materials on agency services, providing training to community based public and private organizations on topics related to blindness and agency services, participating in health fairs, job fairs and other events where the public and interested individuals or organizations may be present.

 


 AFFIRMATIVE ACTION-EQUAL ACCESS TO SERVICES

 

BESB is an affirmative action employer and is committed to the policies and procedures that promote equal employment opportunity and equal access to services.  Affirmative Action and Equal Employment Opportunity have been established as immediate and imperative agency objectives.  The ultimate purposes of the affirmative action program are to ensure equality in the Board of Education and Services for the Blind (BESB), avoid discrimination – either intentional or inadvertent, develop a workforce and constituency base that is truly representative of all segments of the population, and improve the operation of the Agency’s services.

 

“Affirmative action” is a program of positive action, undertaken with conviction and effort, to overcome the present effects of past practices, policies or barriers to equal employment opportunity and access to services and to achieve the full and fair participation of women, Blacks and Hispanics and any other protected groups found to be underutilized in the work force or affected by policies and practices having an adverse impact.

 

“Equal Employment Opportunity” is employment of individuals without consideration of race, color, religious creed, age, sex, sexual orientation, marital status, national origin, ancestry, mental retardation, learning disability, physical disability (including but not limited to blindness) mental disorder (present or past history thereof) or prior conviction of a crime, unless the provisions of §46a-60(b), 46a-80(b) or 46a-81(b) of the Connecticut General Statutes are controlling or there is a bonafide occupational qualification excluding persons in one of the above protected groups.  Equal Employment Opportunity is the purpose and goal of Affirmative Action under §46a-68-31 through 46a-68-74 of the Regulations of Connecticut State Agencies.

 

All applicants and eligible individuals shall be afforded the same opportunity for access to services without consideration of race, color, religious creed, age, sex, sexual orientation, marital status, national origin, ancestry, mental retardation, learning disability, physical disability (including but not limited to blindness) mental disorder (present or past history thereof) or prior conviction of a crime.

 

To ensure equal access to all aspects of the Independent Living process, the Adult Services Division will take the following actions:

 

·       Direct service staff of the Division will receive training in cultural diversity;

·       Information and literature regarding community based resources for specific minority populations will be distributed to Division staff to facilitate access;

·       The agency will enter into Memoranda of Understanding with community based organizations that serve individuals from minority backgrounds to encourage information exchange, referrals to access each other’s services and outreach on topics related to vision loss;

·       All written materials provided to clients shall be made available to them in their preferred mode of communication and preferred language;

·       To the extent possible, and consistent with Affirmative Action hiring goals, the Division shall employ staff members who possess bilingual speaking and writing skills at sufficient levels necessary to address daily service delivery requests for clients who do not communicate in English;

·       Where staffing levels are not sufficient to ensure the immediate capacity to respond to inquiries from individuals who do not communicate in English, the Division shall contract with agencies and organizations that provide interpreter services in the preferred language of the individuals.

 


LEGAL BENEFITS

 

Legally blind residents of the State of Connecticut are eligible for the following benefits:

 

a)   Property Tax Exemption

 

A legally blind person in Connecticut is generally eligible for an exemption of $3,000 of assessed value on her or his property.  If the property is owned jointly with a spouse or is in the name of a spouse living with the legally blind person, the exemption would generally also be available (Sec. 12-81 [17] Connecticut General Statutes).

 

Public Act No. 85-165, provides for a $2,000 exemption on a financial need basis in addition to the $3,000 exemption.  However, each town legislative body must first adopt the benefit for it to be available in that town.

 

Financial needs requirements are given “Provided the total of such person’s adjusted gross income as determined for purposes of the Federal Income Tax plus any other income of such person” is not more than $14,000 if such person is married or not more than $12,000 if such person is not married.

 

 

b)   Income Tax Exemption

 

A legally blind person is eligible for an extra standard deduction on his or her Federal Income Tax.  The Board of Education and Services for the Blind (BESB) will issue a Certificate of Legal Blindness on request to persons on the Agency Registry.  This Certificate can be submitted with the income tax forms as necessary proof of deduction.  There is no additional deduction for State Income Tax.

 

c)   Identification Card (I.D. Card)

 

A legally blind person is eligible to receive a “Connecticut Identification Card,” similar to a photo operator’s license for identification purposes.  Applications are available through the State of Connecticut,  Department of Motor Vehicles.

 

d)  Fishing License

 

“No fee shall be charged for any sport fishing license issued under this chapter to any blind person.  Proof of such blindness shall be furnished; in the case of a veteran, by the United State Veterans Administration and, in the case of any other person, by the State Board of Education and Services for the Blind” (Section 26-29 Connecticut General Statutes).  The Board of Education and Services for the Blind (BESB) will issue a Certificate of Legal Blindness on request to persons on the Agency Registry.  The Certificate should be taken to the Town Clerk who will handle the issuance of a license.

 

e)   Travel

 

Local Bus Discount - A legally blind person is eligible for travel at half fare on Connecticut Transit buses and other local bus systems under contract to the State.  AMTRAK offers a 15% discount from regular train fare.

 

Metro North Commuter Railroad - An individual with a disability can use the Connecticut Transit Handicapped I.D. discount card to receive reduced fares on Metro North.

 

f)  Parking Privilege

 

A legally blind person is eligible for a special parking identification card, which permits use of places reserved for handicapped parking.  Applications are available from the Department of Motor Vehicles.  There is an application fee.  A Certificate of Legal Blindness from the Board of Education and Services for the Blind (BESB) can be used as proof of blindness.

 

 


REPORTS TO THE DEPARTMENT OF MOTOR VEHICLES

 

Public Act 06-130 requires the agency to provide to the Department of Motor Vehicles the names of all individuals sixteen years of age or older who, on or after October 1, 2005, have been determined to be blind by a physician or optometrist, as provided in section 10-305 of the Connecticut General Statutes.  The agency is further required to provide simultaneous written notification to any individual whose name is being provided to the Department of Motor Vehicles.

 

At the beginning of each fiscal quarter (July, October, January and April), the agency transmits to the Department of Motor Vehicles a list of each individual, who has been determined to be legally blind for the preceding fiscal quarter, and who is age sixteen or older. The list will contain the name, address and date of birth for each individual reported.

 

A Memorandum of Understanding between the agency and the Department of Motor Vehicles ensures the confidentiality of the information and that it shall only be used for purposes of enabling the Department of Motor Vehicles to notify individuals who are still in possession of a Connecticut Driver’s license that it is no longer valid.

 

Alternative picture identification cards are available through the Department of Motor Vehicles for individuals whose driver’s licenses are no longer valid.

 

 


CONFIDENTIALITY OF CLIENT INFORMATION AND AVAILABILITY OF CASE RECORDS

 

4.1         Agency goal and applicable federal laws:

 

The goal of the agency’s confidentiality policy is to ensure that the dignity and privacy of all clients is   maintained.  All client information whether written, electronic or verbal is subject to federal and state laws and regulations that govern confidentiality. 

 

Applicable federal laws include but are not limited to Title VII, Chapters 1 and 2, of the Rehabilitation Act of 1973 (as amended). 

 

4.2         Confidential Blind Registry:

 

The agency maintains a confidential blind registry.  Section 10-305 of the Connecticut General Statute states:  “Each physician and optometrist shall report in writing to the Board of Education and Services for the Blind within thirty days each blind person coming under his private or institutional care within this state.  The report of such blind person shall include the name, address and degree of vision.  Such reports shall not be open to the public.  This includes (1) all cases where vision with best correction is 20/200 or less in the better eye or (2) all cases regardless of visual acuity if the visual field is reduced to a diameter of 20 degrees or less OU (both eyes).” 

 

4.3         Applicability of policy:

 

The agency’s confidentiality policy applies to all BESB staff, contractors, volunteers and others who have access to information regarding clients.  The policy does not apply to eye reports sent to BESB by eye doctors or physicians for purposes specified in Section 10-305 of the Connecticut General Statutes, but does apply to reports sent by BESB to eye doctors and physicians including follow-up information on eye reports. 

 

Confidential information includes but is not limited to any information received and maintained about any individual who has been (1) referred to the agency or to a contractor for independent living services; (2) clients who have applied for independent living services; or (3) clients who are currently receiving or have received independent living services.  These services include but are not limited to services funded under the Independent Living Services Program for Older Adults Who are Blind authorized under Title VII, Chapter 2, of the Rehabilitation Act (as amended) and Title VII, Chapter 1, State Grants for Independent Living Services (Part B).

 

4.4         Written Assurances:

 

All BESB staff including contractors and volunteers must sign and date statements that they will ensure that confidentiality of information, both medical and personal, is maintained at all times.  

 

4.5   Release of Information:

 

Clients or legal guardians/conservators of the person must sign a written release of information in order for client information to be released.  Use of such information will be limited to purposes directly connected with the coordination and provision of independent living services. The signed release will expire one year from the date that it is signed unless otherwise specified on the Release of Information form.   

 

            4.6 Provision of confidential information to clients at time of application for services:

 

All clients or legally appointed guardians or conservators shall receive information in writing concerning the scope of the agency’s confidentiality policies including the right of the client to review his or her records. This information shall be provided in the client’s preferred language and/ or preferred format (e.g. Braille, large print, electronic format) at the time of application for independent living services. 

 

4.7         Disclosure of information without consent:

 

Information will not be disclosed, directly or indirectly, to any individual, agency or organization without the written consent of the individual or legally appointed guardian or conservator unless:  (1) sharing or releasing of information is needed to protect the individual or another person from possible physical harm or violence; (2) the agency is ordered to share the information by a court order or subpoena; or (3) the information is required by mandatory reporting laws from agencies and entities to which BESB reports including the State Auditors of Public Accounts and the Department of Motor Vehicles. 

 

 

4.8   Disclosure of information with consent:

 

When information is requested but is not required by law to be released, authorization to so release shall be obtained from the individual, or his or her legally appointed guardian or conservator prior to release of the information.

 

4.9         Disclosure of information deemed harmful to the individual :

 

Medical, psychological, or other information that the Adult Services Social Worker believes may be harmful to the individual shall not be released directly to the individual but may be provided to the client’s legally appointed guardian or conservator of the person, and/or a licensed physician, licensed psychotherapist or psychologist designated by the client. 

 

The determination of whether information in the record would be harmful to the client should be made by the Adult Services Social Worker with input from supervisory staff/and or appropriate consultants if necessary.

 

4.10   Disclosure of information from third parties:

 

When personal information has been obtained from a third party (e.g. another agency), it may be released only under the conditions established by that party.  If that source has indicated that the information is not to be re-released, then the requester is to be referred back to the original source.

 

 

 

4.11   Right to review records:

 

A client receiving independent living services from the agency or the client’s legally appointed guardian or conservator has the right to review the client’s own case record.  The request to review the record must be made in writing or an alternative method of communication such as electronic communication or Braille. 

 

The agency must schedule an appointment within ten working days of the request to review the record. 

 

Routine medical and eye reports may be reviewed; however, copies will be generally furnished only with the written permission of the physician or optometrist. 

 

A supervisory level staff member or designee of the  agency shall be present at all inspections of client records.  This person will interpret the client record if appropriate.  A record shall be kept of the people who have seen the case record of services.  The client or legally appointed guardian or conservator must sign the review form at the point of inspection of the record.  The client has the right to challenge the content of the record and request deletion or change and to receive notice on action in this matter within ten working days of the time of the request.    

           

          4.12   Copying of agency records:

           

              Any part of the record can be requested to be copied by the agency at cost to the client and must be furnished within ten working days after receipt of the request.   The assigned Adult Services Social Worker is responsible for ensuring that all information requested by the client is accessible to the client in the client’s preferred language or format (i.e. large print, Braille).  The client, legal guardian or court appointed conservator has the right to request and receive a copy (at cost) of any or all parts of the records.  The copy of requested documents will be furnished within ten business days after receipt of a written request.  A charge will be made based upon the prevailing rate for photocopying or other duplicating services.   A client who is financially unable to cover the cost of duplicating requested documents may ask the Executive Director to waive the photocopying fee.

 

Copies of medical and eye reports will be generally copied only with the written permission of the physician or optometrist.  Copies of medical, psychological, or other information that the Adult Services Social Worker believes may be harmful to the individual shall not be provided directly to the individual but may be provided to the client’s legally appointed guardian or conservator of the person, and/or a licensed physician, licensed psychotherapist or psychologist designated by the client. 

 

 

4.13   Appeals Process for Denial of Release of Records:

 

Clients, legal guardians or conservators of person must be advised in writing, or their preferred format (such as Braille or electronic format) of their right to appeal any denial of release of records.

 

4.14   Agency requirement regarding the transporting of confidential case record information:

 

Employees whose business functions make it essential to store or transport confidential information on a mobile computing device, or mobile storage device, must obtain advanced, written approval from the Executive Director on the “Mobile Data Control Form” prior to removing the information from the agency. Only upon written approval from the Executive Director, may the information be removed from the agency, and such removal shall be exclusively limited to the information designated and approved on the form, for the specific time frame noted. 

 

4.15  Securing and Disposal of Case Record Information:

 

The confidentiality of both electronic and physical case records is the responsibility of all employees. Case information should not be left in a viewable format on unattended staff computer screens, or left on desk tops of unattended work areas.  Physical client records, when not under the direct purview of staff, must be kept in locked areas. 

 

Fax cover sheets must contain the following information:

“This information is for the use of the addressee only and may contain confidential and privileged information.  Any dissemination, distribution or copying of this information other than by the intended recipient is strictly prohibited.  If you have received this facsimile in error please notify us immediately by telephone and destroy all copies of the communication.” 

 

All written client information should be shredded when it is disposed of.  Proper approval from State Records Retention must be obtained prior to disposing of client records.

 


SUMMARY OF INDEPENDENT LIVING REHABILITATION SERVICES

 

Individuals eligible for independent living rehabilitation services provided through Adult Services are deemed to require services to function independently in the residence or community at the time of eligibility determination.  These services may be provided in the residence, in the community, in a group setting or at the agency. BESB Adult Services staff provide services intended to enable the client to live in the least restrictive setting possible, thus preventing unnecessary institutionalization, including nursing home placement.  

 

Core independent living rehabilitation services provided by Adult Services include the following:

 

A)             Intake, information, and referral services

B)             Assessment of rehabilitation service needs

C)             Adjustment to blindness counseling

D)             Case management

E)              Instruction in the use of techniques and devices to maximize residual vision or compensate for the loss of functional vision

F)              Activities of daily living training to maximize independence

G)             Instruction in the use of a long white cane or short white support cane to travel safely in the residence and community, and other assistance with independent navigation

H)              Independent living skills training programs, to eligible individuals, and to community organizations.

I)                  Peer support groups and self-advocacy skills training.

J)               Consultation and referral services through the use of specialists with expertise in blindness and vision-related rehabilitation.

K)             Volunteer services, including assistance with reading mail, transportation assistance into the community and peer support.

L)              Referral services to community based organizations and social networks of and for the blind.

 


INTAKE AND INFORMATION/REFERRAL SERVICES

                                                                                                  

Individuals may be referred to the Adult Services Division from a variety of sources that may include, but not be limited to the following:

 

·       Eye report from a licensed physician or optometrist

·       Self-referral

·       Family member or relative

·       Community based organization

·       Residential care facility

·       Friend, neighbor or advocate

·       BESB Children’s Services Division

·       BESB Vocational Rehabilitation Division

·       BESB Business Enterprises Program

 

Regardless of the source of referral, the initial step in the eligibility process is to establish the presence of legal blindness for adults, or visual impairment or legal blindness for children. The Adult Services Division will establish contact with the individual in circumstances where the referring source does not include written documentation from an optometrist or licensed physician that establishes the presence of required acuities or field restrictions. 

 

BESB shall not cover the cost of an eye examination to determine whether an individual is legally blind (or visually impaired if the individual is a child).  The Adult Services staff member establishing contact will explain the agency services and provide the applicable contact information so that the individual’s physician or optometrist will know where to send documentation of acuities or field restrictions. 

 

Upon receipt of an eye report from an optometrist or licensed physician, BESB staff or approved consultants will review the report for completeness and clear documentation of the acuities or field restriction that establishes the presence of legal blindness for adults, or visual impairment or legal blindness for children.  The eye report must also include the printed name of the optometrist or licensed physician, along with a signature and date.  Any report that lacks clearly defined acuities, or field restriction (if applicable), or that does not include a signature and date, will result in Adult Services staff contacting the office of the doctor to request that completed information be resubmitted.  While it is not a requirement that the information be provided to the agency on a BESB prescribed form, the agency shall encourage the use of the form to assist with ensuring that complete information is submitted.

 

There shall be no date range restriction on the declaration of legal blindness as determined by an optometrist or licensed physician, unless the declaration of legal blindness has resulted from an eye condition that has a stated, written medical prognosis of improvement noted.  In all other instances, the agency shall rely upon existing eye report documentation of blindness, regardless of the age of the eye report or the state within which the optometrist or physician is licensed or certified to make such a declaration.

 

In circumstances where there is a stated prognosis of improvement noted on the eye report documentation, the agency shall request the applicant for services to obtain an updated declaration of legal blindness from an optometrist or licensed physician, at his or her own expense, for any report that is over twelve (12) months older than the date of receipt into the agency.

 

After confirming the presence of the required information, the BESB staff person or consultant assigned will make a  notation on the form or letter that encompasses one of the following categories:

 

·       LB -  This notation indicates the presence of “legal blindness” as defined by Connecticut General Statutes 10-294a(a). A person is blind if his or her central visual acuity does not exceed 20/200 in the better eye with correcting lenses, or if his or her visual acuity is greater than 20/200 but is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than twenty degrees.

·       VI-  This notation indicates the presence of “visual impairment” as defined by Connecticut General Statutes 10-294a(b). A person has visual impairment if his or her central visual acuity does not exceed 20/70 in the better eye with correcting lenses.

·       NVI- This notation indicates that the individual’s acuities and/or field restrictions do not meet the statutory definition of legal blindness for an adult or visual impairment or legal blindness for a child thus the individual is considered to be “not visually impaired.”

·       VIP- This notation indicates that the individual’s eye report from the licensed physician or optometrist documents the presence of an eye condition that is rapidly progressive and degenerative, where listed acuities and/or field restrictions are close to the statutory thresholds for legal blindness in adults or visual impairment or legal blindness in children.  In these instances, the eye report, with the notation of “VIP” (for Visually Impaired-Progressive) shall be forwarded to the agency Executive Director for review. The Executive Director shall sign and date the report if she or he concurs that the medical documentation provided substantiates the presence of a rapidly degenerative eye condition, or strike the notation and replace with “NVI” if in disagreement.


AWAITING INTAKE

 

Once an individual is determined to meet the statutory definition of legal blindness for an adult, or visual impairment or legal blindness for a child, the individual’s demographic and personal data will be entered into the agency confidential registry. The individual’s status will be established at that time as “awaiting intake.”

 

At that time, individuals who are under the age of 21 are forwarded to the Children’s Services Division for intake purposes. Children’s Services shall assign a staff member to contact the parent or legal guardian of the child, or contact the individual directly if she or he is their own guardian, to establish eligibility for Children’s Services based upon criteria established in the Children’s Services policy and procedure manual.  During this initial contact, the agency services will be explained so that the individual can make an informed decision as to whether she or he desires to proceed with completion of the intake process. The individual shall be informed that there is no cost to receive agency services.  Subsequent referral for independent living services to the Adult Services Division for eligible children may be initiated by staff members of Children’s Services, if applicable. 

 

If an individual is age 16 or older, meets the statutory definition of legal blindness, and is no longer receiving services under an Individualized Education Program (IEP) or Individualized Service Plan (ISP), the individual may be placed in “awaiting intake” status within the Adult Services Division, for assignment to an Adult Services staff member to establish contact and complete the intake process. 


 

REFERRAL TO VOCATIONAL REHABILITATION

 

For an adult who has been determined to meet the statutory definition of legal blindness, simultaneous to the assignment of the individual into “awaiting intake” status, a referral to the Vocational Rehabilitation Division of BESB will be initiated so that a Vocational Rehabilitation Counselor can contact the client to explain services that are available through that Division of the agency.

 

The determination as to whether a client is determined to be eligible for Vocational Rehabilitation services shall not be used to delay or defer the initiation of independent living services through the Adult Services Division upon reaching of an eligibility determination.  Furthermore, there shall be no presumption that any services authorized through Adult Services for an individual determined to be eligible for independent living services shall be reimbursed or transferred to the Vocational Rehabilitation Division for subsequent funding or staff assignment. 

 

To maximize the coordination of services and to avoid the unintentional duplication of services, Vocational Rehabilitation shall provide prompt notification to Adult Services of individuals referred by the Adult Services Division who are determined to be eligible for Vocational Rehabilitation services.

 

Upon notification by the Vocational Rehabilitation Division that an individual referred by Adult Services has been determined to be eligible for Vocational Rehabilitation services, the assigned Social Worker and the assigned Vocational Rehabilitation Counselor shall discuss the coordination of services that will be addressed by each program.


 

INTAKE COMPLETED

 

Children:

 

For individuals who are under the age of 3, or are receiving services through an Individualized Family Services Plan (IFSP), Individualized Education Program (IEP), or Individualized Service Plan (ISP), within one month after the child is coded as “awaiting intake,” a clerical staff person from BESB Children’s Services shall contact the individual if he or she is over the age of 18, or the child's parent or legal guardian if under the age of 18, in order to explain services.  If the individual, or if applicable his or her parent or legal guardian desires to apply for services, the staff member assists with completing the intake form over the telephone.  Upon completion of the telephone intake conversation, the Application for Services, along with a written summary of agency services is sent to the individual or the parent or legal guardian for signature to be obtained.

 

When the agency has received the completed and signed Application for Services back from the individual, or the parent or legal guardian, the Children’s Services clerical staff member assigned to the intake process shall change the status of the child to “intake completed” in the agency case management system. 

 

Adults:

 

For a new adult client, previously unknown to the agency, after the individual is coded as “awaiting intake”, a BESB Adult Services Social Worker will establish contact to explain services that are available. A written summary of the services available will be provided. During this initial contact, the individual shall be informed that there is no cost to receive agency services.  If the individual expresses an interest in receiving independent living rehabilitation services from BESB, the social worker completes an intake interview, recording the results of this interview on the agency intake form for inclusion in the case record of services. The client will sign the intake form, noting the intention to seek independent living services from the agency.

 

A Release of Information form will be completed, signed and dated by the individual or their authorized representative before any information may be requested from or provided to any third party by the agency.  Only information that is required for purposes of determining eligibility or for the delivery of independent living rehabilitation services shall be obtained by the agency.

 

During the intake process, the individual shall be informed of their rights, remedies and responsibilities and a written document outlining this information will be provided in an accessible format.  The client’s signature on the application for services shall confirm that this information has been provided and explained. 

 

The BESB staff member who completes the intake shall also sign and date the application for services.  The signed intake, and the signed release of information form will be maintained in the individual’s case record of services.

 

The status of the individual within the agency case management system will be changed from “awaiting intake” to “intake completed” upon completion of this process.  Unless there are unforeseen circumstances that are documented in the case record of services for the individual, the maximum time frame from “awaiting intake” to “intake completed” shall not exceed 30 calendar days.   


SERVICES DECLINED

 

The decision to become a recipient of services through the Adult Services Division shall be the personal choice of the client, their guardian or court appointed conservator, if applicable. During the initial contact, the BESB staff member shall provide an overview of the services that are available, and the process by which services are delivered and coordinated, ensuring that the individual clearly is informed that there is no cost to receive agency services.

 

Should the client decline to participate in agency services, a follow up letter shall be sent to the individual subsequent to the contact where services were declined. The follow up letter shall confirm that agency services have been offered, and that services have been declined. The letter will further contain a brief outline of services offered by the Adult Services Division, and a contact telephone number for the individual to reference if services are desired at a future date.
DETERMINATION OF ELIGIBILITY FOR SERVICES

 

 

Eligibility for services within the Adult Services Division is based upon the following criteria:

 

A)   Adults must meet the statutory definition of legal blindness, with best corrected vision of 20/200 or worse in the better eye, or a visual field restriction, where no greater than 20 degrees of visual field  remains within the better eye.

B)   Children must meet the statutory definition of visual impairment, with best corrected vision of 20/70 or worse in the better eye, or meet the statutory definition of legal blindness, with best corrected vision of 20/200 or worse in the better eye, or a visual field restriction, where no greater than 20 degrees of visual field remains within the better eye. For purposes of eligibility for independent living services through the Adult Services Division, a child must be age 21 or younger, and be an eligible recipient of services within the Children’s Services Division of the agency.

C)   The individual must require independent living services to achieve a greater degree of independent functioning within the place of residence or within the community.

 

In situations where clear and compelling documentation provided by an optometrist or licensed physician indicates that an eye condition is rapidly progressive and degenerative, with legal blindness imminent, upon the written signature of the agency Executive Director, the individual may be deemed to meet the definition of legal blindness for purposes of determining eligibility.

 

Documentation of eligibility for services will be noted through attainment of a written report from an optometrist or licensed physician, that states the applicable acuities or visual field restriction, resulting in a confirmation of legal blindness for adults, or visual impairment or blindness for children.

 

A Certificate of Eligibility, noting the independent living needs of the eligible individual, stating the services that are required to address the individual rehabilitation goals of the individual shall be completed and maintained in the case management system.  A copy of the Certificate of Eligibility will be sent to the client in an accessible format.

         

Due to limitations of funding and staffing resources within the Adult Services Division, services shall be provided first to individuals over the age of 21, who are no longer eligible to receive services or funding through the agency Children’s Services Division.

 

Additionally, for adults who are legally blind and who are eligible for services through the agency Vocational Rehabilitation Division, maximum utilization of comparable benefits through vocational rehabilitation funding for all employment related services shall first be utilized before  Adult Services funding or staffing shall be considered. 

 

However, participation of a client in the Vocational Rehabilitation Program or the Children’s Services Program shall not be used as a basis for a determination of ineligibility for the provision of independent living services through the Adult Services Division.

 

Residency in Connecticut on a permanent or temporary basis is a condition of receiving independent living rehabilitation services.  An individual need not be a citizen to be eligible to receive services from the agency, provided that the individual has a valid visa, or other qualifying status to be legally present within the state. 

 

Services provided by BESB are done without regard to income guidelines, and eligible individuals shall not be required to disclose annual earnings for purposes of determining eligibility. 

 


FOLLOW UP SERVICES

 

Once a client has been a recipient of services through Adult Services, and an eligibility determination has been made that the individual meets the statutory definition of legal blindness if an adult, or visual impairment or legal blindness if a child, then subsequent requests for follow up services do not require a new determination of eligibility.

 

Examples of follow up services include requests for information on resources, referral services to community based organizations and governmental agencies, certificates of legal blindness, letters of reference for participation in Guide Dog and service animal schools, reassessment of independent living need based upon a change in personal circumstances, additional low vision device training from BESB Rehabilitation Teachers, replacement magnifiers, requests for additional orientation and mobility instruction or a replacement cane, and requests for additional rehabilitation teaching and daily living aids.

 

In these situations, the Adult Services Division may assign a Social Services Case Aid to contact the person by telephone to assess the situation.  If the telephone contact indicates that the services requested are in follow up to previously provided agency services, the Case Aid may initiate a referral for the additional follow up service without the need to initiate a new intake and eligibility determination process.

 


DETERMINATION OF INELIGIBILITY FOR SERVICES

 

Persons who are determined to be ineligible for independent living rehabilitation services because they do not meet the definition of legal blindness (or visual impairment for children), or because they are deemed to not require independent living services, may receive information and referral services from the agency.  A letter will be sent to each applicant that explains the reasons for the determination of ineligibility, in addition to information on other resources that are available to persons who have severe vision loss but are not legally blind.   The agency appeals procedure shall also be included in the letter of ineligibility sent to the individual.

 

A person who disagrees with BESB’s determination of ineligibility can file an appeal within the framework of the agency’s internal appeals procedures.  The applicant can also seek a second medical opinion at her or his expense.

 

Prior to reaching a determination that an individual does not require independent living services to achieve a greater degree of independent functioning within the place of residence or within the community, the Social Worker shall consult with the Supervisor of Adult Services. The Supervisor shall review the case documentation to determine if additional evaluations are necessary to further assess if there could be a finding of eligibility based upon new evaluative information. Only in circumstances where there is clear and compelling written documentation that an individual does not require independent living services to achieve a greater degree of independent functioning within the place of residence or within the community shall a determination of ineligibility for this reason be made. 

 

A Certificate of Ineligibility for services will be completed by the Social Worker, noting the reasons for the determination.      


 

CASE MANAGEMENT SERVICES

 

Once assigned, the client’s BESB Social Worker will act as the client’s case manager until the completion of requested services.  The case manager will have the following responsibilities:

(1)           Determining Eligibility

(2)           Establishing the initial plan of service with the client,  and amending subsequent plans

(3)           Referring the client for independent living rehabilitation services provided by BESB or outside agencies or organizations

(4)           Providing fire safety and emergency preparedness information

(5)           Service completion:  determining with the client whether or not her or his goals have been achieved. 

 

Case management services may include referrals to other  BESB resources, such as rehabilitation teaching and orientation and mobility (O&M) instruction, or it may include the purchasing of services through approved vendors, such as low vision services through third party practitioners. 

 

Case management services may also include referrals to other service providers outside BESB (e.g., CRIS Radio, NFB Newsline, SBC for free directory assistance, or books on tape from the Library for the Blind and Physically Handicapped), as well as referrals to organizations of and for the blind. 

 


INDEPENDENT LIVING PLANS

 

In the capacity as primary case managers for eligible individuals, Social Workers will work directly with assigned clients to develop individualized Independent Living Plans. The plan will include the goals and objectives, and a list of anticipated services required to achieve each objective associated with the goal.  The client has a choice of developing a documented plan of service or can sign a waiver to the documented plan.  A copy of any service plan developed, or subsequently amended will be provided to the client in an accessible format. 

 

Procedures for Developing Independent Living Plans:

 

Unless a client signs a waiver form declining the development of a written plan, in order to be provided with Independent Living services, an individual must have a signed Independent Living Plan (ILP) outlining the goals that are to be addressed, the objectives that will be addressed to achieve the goal, and the services that will be provided, or are anticipated to be provided, within an anticipated time frame. 

 

The Social Worker will work with the client to complete the Independent Living Plan outlining the long-term goal, the service(s) required, the vendor(s) of the service(s) and the short-term objective for the service provision.  The Independent Living Plan will be signed and dated by the individual and BESB representative.  The individual will be provided with a copy of the plan in their preferred communication format.

 

Prior to developing the Independent Living Plan, the Social Worker may initiate assessments if it is determined that additional information is necessary prior to formulating an Independent Living Plan. Such assessments may include but not be limited to:

 

·       Rehabilitation Teaching evaluation to determine if the provision of independent living training and daily living aids will increase the independent functioning of the client in the residential environment;

·       Orientation and Mobility evaluation to determine if provision of a long white cane or short white support cane or training in safe travel technique will increase independent travel skills;

·       Low Vision evaluation to determine if prescribed aids or non-prescribed magnifying devices will enhance residual vision for use with independent living activities;

·       Other assessments, as determined by the Social Worker to be necessary to identify the services needed to achieve the independent living goals of the individual.

 

While such assessments may be determined by the Social Worker to be necessary for the development of an Independent Living Plan, it is also important to note that the Social Worker shall rely on existing data, to the greatest extent possible, for formulation of the goals, objectives and services that are needed for inclusion in the plan.

 

Existing data that may be relied upon includes social worker observation of the residential and community environment, personal interview with the consumer and review of reports available through other providers, as appropriate. Since health and safety concerns may be involved in the provision of services, such as providing instruction in safe cooking technique or street crossing, the Social Worker shall not impose any requirements for assessments prior to determining the independent living needs of the individual if it can be determined through existing data and observation that the provision of independent living services can benefit the individual.

 

In developing the goal(s) for the individual, the Social Worker will consider the broad areas of activity that will enable the client to achieve a greater degree of independence. Examples of goals include categories such as:

 

·       Increasing home management activities

·       Increasing community involvement

·       Increasing self care skills

·       Increasing activities that promote health and safety

·       Increasing access to recreational and leisure activities

 

For each independent living goal that is mutually agreed to by the client and the Social Worker, the specific objectives that will address the goal are then listed. Typical examples of objectives associated with independent living goals include:

 

·       Teach methods to use the stove safely

·       Teach methods for using laundry machines

·       Teach long white cane and short white support cane travel technique for street crossings

·       Provide information on transportation options

·       Refer consumer to senior center for group recreational activities

·       Secure low vision aids to enable client to read mail

·       Provide fire safety and emergency preparedness information

·       Facilitate participation in health management program

 

Upon identification of the specific objectives that will assist the client in meeting her or his independent living goals, the services and providers are then listed such as:

 

·       Rehabilitation Teaching by BESB

 

·       Low Vision Services by : specify Doctor’s name.

·       Mobility Instruction by BESB

·       Materials on Fire Safety and 911 Registration provided by BESB

 

An anticipated service completion date is then listed on the Independent Living Plan.

 

Upon completion of the plan, the Social Worker and client sign the plan and a copy is provided in an accessible format. Information on the appeals procedure and the Client Assistance Program is provided at the time of the Plan signature.

 

INDEPENDENT LIVING PLAN AMENDMENTS

 

Occasionally, there may be the need to include additional services once a plan has been developed and signed. In these instances, an amendment letter will be sent to the client indicating the additions to the plan that have been mutually agreed to. It is not necessary to develop a subsequent written and signed Independent Living Plan for such circumstances, unless specifically requested by the client.

 

The Independent Living Plan Amendment letter will acknowledge the conversation between the client and the Social Worker and list the changes that are being made to the original Independent Living Plan.

 

 


INDEPENDENT LIVING PLAN WAIVERS

 

A client may opt to waive the development of a written Independent Living Plan. Waiving the option to have a written plan in place does not cancel or waive the right of the client to appeal any decision, seek remedies through the Client Assistance Program or preclude access from any services that would otherwise be available if the client choose to develop a written Independent Living Plan.

 

The choice to waive the development of a written Independent Living Plan shall be exclusively made by the client or her or his legal guardian, or court appointed conservator. In consulting with the client as to the option for waiving the development of a written Independent Living Plan, the Social Worker shall advise the client that all services available through a written plan would also be available through a waiver.  However, the client should also be notified that waiving the option for developing a written Independent Living Plan will remove the provision of detailed goals, objectives, services, providers, and anticipated duration of services from a written document.

 

For clients that select to waive the development of a written Independent Living Plan, a signed waiver shall be obtained and placed in the case record of services. The reason(s) for choosing to waive the development of a written Independent Living Plan shall be recorded onto the waiver form.

 

Information on the appeals process and the Client Assistance Program shall be included with the written waiver, and a copy of the waiver and the appeals information shall be provided to the client in an accessible format.

 

AUTHORIZATION FOR PURCHASED SERVICES

 

The Adult Services funding sources are limited. It is therefore essential to make maximum utilization of comparable benefits from third parties such as private insurance carriers prior to committing agency funds for any required purchased services.

 

Purchased services and/or commodities must be through state approved vendors at fee schedule rates. Any deviation from this must be approved by the Purchasing Supervisor at the agency in advance of committing funds.

 

All purchased services and/or commodities must be directly related to the independent living goals and objective of individuals under a written Independent Living Plan, or be documented in the agency case management system for situations where no written Independent Living Plan is in place, and a waiver has been selected.

 

In reviewing requests for purchased services, the Supervisor of Adult Services will consider if there are other resources such as grants, private insurance, or other funding sources that are available to cover in part or in full, the cost of the requested service(s).

 

Additionally, the Supervisor of Adult Services will further consider if there are other devices, services or aids at less cost that will enable the client to accomplish the independent living task(s).

 

All requests for purchased services require the approval of the Executive Director prior to submission of a purchase order request. The Executive Director is authorized to request secondary assessments to determine if other options exist for accomplishing the independent living goals or objectives.

 

All requests to commit agency funds must carry the final approval of the Supervisor of Procurement or designee, before agency funds can be committed through a purchase order or BESB Form 6 letter. For this reason, it is important that the agency requestor of the services or items clearly communicate to the client and the vendor that services or delivery of items cannot be initiated until such time as a bona fide purchase order or BESB Form 6 commitment letter from the agency has been received by the vendor. There can be no presumption of agency commitment of funds until such time as the purchase order or BESB Form 6 letter has been received by the vendor.

 

In monitoring the Division budget, the agency head will determine if projected costs for providing services will exceed the allotted level of funding in each fiscal year. If there is a determination that funding will be insufficient to meet the anticipated cost of purchased services for all Adult Services clients in a fiscal year, based upon year to date projections, then a waiting list for purchased services shall be established. In such circumstances, the documented date of the specific requested service by the Social Worker, or where applicable, the Rehabilitation Teacher or Orientation and Mobility Instructor shall be used as the determination for purchasing approval, with the oldest request being processed first, in date order.

 

Situations where the delay of a particular purchased service will result in the extreme likelihood of a risk of injury, as  documented in writing by a physician or optometrist, shall be exempted from the waiting list restriction and shall receive the highest priority for purchasing of services within available funding.

 

Funding selection will be made at the Supervisory level for each requisition, based upon the following criteria.

 

·       For individuals age 55 and older, federal Older Blind funds shall be the first choice for the purchase of services. These funds may not be utilized for the purchasing of services for individuals under the age of 55.

·       For individuals under the age of 55, for services costing less than $300, state appropriated funds will be the first choice for the purchase of services

·       For individuals under the age of 55, where the cost of purchased services is over $1000, federal Independent Living Title VII, Part B funds will be utilized first.

 

The Supervisor of Adult Services will notify the Executive Director of any projected shortfall in these accounts. The Executive Director may allocate such other sums as are available within a fiscal year from other agency funds to supplement the funding of purchased services for independent living after any of the above referenced funding sources are projected to be insufficient to cover purchased service requests for the fiscal year.

 

Once the service has been provided, a case note shall be entered into the case management system, to document the outcome of the service. 

 

The BESB staff person who authorized the purchased service will review supporting documentation submitted by the vendor to the agency, and verify that services have been rendered to the client prior to signing the billing invoice to approve payment of funds.

 


 

ADAPTIVE EQUIPMENT PROVIDED BY THE AGENCY

 

The type of adaptive device needed for independent living activities should be included in an Independent Living Plan in order to access the provision of the item(s), unless the client is receiving services through a written plan waiver. A case note shall be entered into the case management system by the BESB staff person who is dispensing the item(s).

 

Training in the use of these items shall be documented in the case management system.

 

Adaptive devices maintained in the Adult Services inventory, valued at greater than $300 shall not be removed unless supervisory approval is first obtained. The staff person requesting the item(s) shall enter a case note in the case management system.  An email copy of the case note, or message referencing the presence of the case note shall be forwarded to the immediate supervisor for review.

 

The supervisor will confirm the presence of an Independent Living Plan that covers the item(s), or that a written waiver of an Independent Living Plan is in place. The supervisor will email the staff member back, either approving the request or providing an explanation if the request is being denied.  In reviewing requests for items over $300 in value, the Supervisor of Adult Services will consider if there are other resources such as grants, private insurance, or other funding sources that are available to cover in part or in full, the cost of the requested item(s). Upon receipt of supervisory approval, the requesting staff member shall obtain the device(s) from the stock room through the Division

designee(s).

 

Purchase of adaptive devices requires the written approval of the Division Supervisor and the Executive Director through a requisition. In considering the approval of such items, the Supervisor and the Executive Director shall first consider if other devices can accomplish the independent living task at less cost.

 

Due to the limited funding within the Adult Services Division, it may become necessary to establish a priority list for adaptive devices that are in stock. In these instances, situations where there is extreme likelihood of a risk of injury, as documented in writing by a physician or optometrist shall receive the highest priority.

 

Agency staff will assist clients in seeking alternative funding resources that may be available to cover in part or in total the cost of adaptive devices in circumstances where agency funding is unavailable, or where the independent living goals for the individual do not include the provision of adaptive devices, but where the client desires such equipment for personal use.

 

Any adaptive equipment provided by the agency to the client shall be the property of the client. The cost of maintenance or repair of the equipment shall rest with the client.  In circumstances where a client requests, the agency shall reimburse the client for the documented cost of the repair and applicable shipping of said equipment to and from the repair location. Temporary loan of equipment to clients to address short-term needs (such as a loan while the client’s equipment is being repaired) shall be assigned through the agency loan agreement process and will not transfer in ownership.

 

 

  ADJUSTMENT TO BLINDNESS PROGRAMS

 

Adjustment to blindness programs refer to community based rehabilitation facilities that offer comprehensive skill training in techniques for utilizing alternative approaches to visual cues for performing activities of daily living such as, but not limited to cooking, travel, self care, and home maintenance.  Such programs typically provide a residential component, with supervision available, to offer opportunities for direct and immediate application of skills learned in a structured, focused and sequential process.

 

Due to limited funding within the Adult Services Division, funding for participation in Adjustment to Blindness Programs can only be provided in circumstances where there is clear and compelling documentation by a BESB Social Worker, Rehabilitation Teacher or Orientation and Mobility Instructor that such a structured independent living program is essential to avoid exposing the client to imminent danger due to a lack of independent living skills. Such documentation must detail the reason(s) that BESB staff cannot address the independent living training needs of the individual through direct agency services or referrals to support services within the community of the individual.  Under such circumstances, the Supervisor of Adult Services shall make recommendation to the Executive Director to pursue discretionary funding, as available, to address the imminent safety needs of the individual.


SECONDARY DISABILITIES

 

While the primary focus of the Adult Services Division is to address the independent living rehabilitation needs of individuals relative to legal blindness, it is recognized that other disabling conditions may be present that have a direct impact on the capacity of the individual to benefit from services provided by the agency. In such circumstances, it is incumbent upon the Social Worker, as the primary case manager assigned to the individual, to fully consider the medical implications that secondary disabilities may have on the achievement of goals and objectives established in the Independent Living Plan of the client.

 

The Social Worker may authorize for the purchase of medical equipment and initial inventory consistent with required purchasing procedures and approval levels in circumstances where the client lacks medical insurance to cover in part or in total the cost of such equipment and/or initial inventory. The medical equipment or supplies purchased must be essential to ensure participation in the Independent Living Plan of the individual, and must be detailed in the plan, or in the case of a Waiver of an Independent Living Plan, shall be outlined in a letter to the client. 

 

Examples of medical equipment that can be covered by the agency, as applicable to ensure full participation in the Independent Living Plan are:

 

·      Diabetes management and blood glucose monitoring equipment,   along with an initial supply of monitoring strips

·       Hearing aids for individuals who are deaf-blind

·       Manual wheelchairs for individuals with mobility impairments

 

Due to limited funding within the Adult Services Division, it is necessary for the Social Worker to first obtain written confirmation that existing insurance of the individual will not cover any portion of the cost of the items needed. In circumstances where a client lacks medical insurance, the Social Worker must document the client’s ineligibility to obtain medical insurance through Medicaid or Medicare.  Such documentation must be in the form of a bona fide denial of eligibility letter from Medicaid or Medicare. Additionally, a medical prescription from a licensed physician shall be required prior to the agency committing funds for the purchase.

 

The agency is not able to cover the cost in part or in full, of prescription medications, power driven wheel chairs or scooters, hospitalizations, surgeries (with the exception of cornea transplants in limited circumstances), medical procedures and tests, physical examinations, physical therapy, massage therapy, modifications to vehicles or physical structures, or the purchase of furniture such as but not limited to beds or recliner chairs.

 

Additionally, the agency shall not commit funds to cover any unpaid balance or patient deductible that is required, except in circumstances of low vision examinations as outlined in that section of the Adult Services Policy manual.


SOCIAL WORK SERVICES

 

 

Social Workers through the Adult Services Division are assigned as the primary case managers and service coordinators for recipients of services through the Division. In the capacity as a case manager, Social Workers perform the following tasks:

 

·       Determining Eligibility

·       Establishing the initial plan of service with the client, and amending subsequent plans

·       Referring the client for independent living rehabilitation services provided by BESB or outside agencies or organizations

·       Providing fire safety and emergency preparedness information

·       Service completion:  determining with the client whether or not her or his goals have been achieved. 

 

 

In addition to case management activities, Social Workers also provide short-term guidance and counseling to clients. Short-term guidance and counseling may include such activities as crisis intervention, housing assistance, benefit coordination assistance, and health care information.

 

The primary purpose of guidance and counseling is to assess each situation, and initiate referrals to social service organizations and agencies, both public and private, that can provide comprehensive services within the specific category of need. Therefore, while agency Social Workers are not available to complete applications for particular programs or services on behalf of individuals, the Social Worker can initiate referrals to other public and private social service providers on behalf of the client, after obtaining a signed release of information that permits the disclosure of information necessary to initiate the referral. 

 

In situations of mental health concern, the agency may assign a Social Worker for ongoing counseling activity, to the extent that staffing resources enable such assignments, or the Social Worker may refer the individual to community based mental health organizations.

 

In situations where referrals to community mental health organizations are initiated by the Social Worker, coordination of benefit coverage assistance will be provided. If it is determined that the client has insufficient medical coverage to permit participation in mental health counseling, the Social Worker may authorize the use of agency funds for mental health counseling through approved State of Connecticut health care providers, utilizing Department of Social Services fee schedules for counseling services.  In order to access agency funding for mental health counseling, the client will need to sign a release of information, permitting the Social Worker to gain access to progress reports that confirm participation and enable the Social Worker to assess if additional services may be required as part of the case management process.

 


REHABILITATION TEACHING SERVICES

 

 

In many instances, it is essential to provide the client with specific instruction in the areas of communication, skills of daily living, and home management techniques.  These services are provided through the rehabilitation teaching staff at this Agency. Services available through Rehabilitation Teachers from BESB include:

 

·       Communication skill training in Braille, handwriting, tape recording, use of low vision magnifying devices and aids, use of adaptive technology devices, and computer access technology;

·       Self-care training in grooming and hygiene, medication measurement identification and socialization skills;

·       Home management training for bill paying, reading mail, house cleaning, repairs;

·       Activities of daily living training such as cooking, laundry and sewing, grocery shopping, money identification techniques, safety strategies;

·       Leisure time activity consultations to increase participation in hobbies, sports and recreation;

·       Training in the use of daily living aids and devices;

·       Providing information to clients on adaptive technology products that are available for home management, medical management and activities of daily living.

 

Rehabilitation teaching services are to be identified as part of the Independent Living Plan of the individual, unless the individual has a written waiver for a plan in place. A case note shall be entered in the case management system for each residential or community visit where rehabilitation teaching assessment or training is provided. Upon achievement of the independent living goals and objectives for which rehabilitation teaching services were provided, a summary case note will be completed, detailing the outcomes achieved. This case note shall be entered into the case management system.

 

Due to the limited rehabilitation teaching staffing levels within Adult Services, the following criteria shall apply:

 

·       First priority for the provision of rehabilitation teaching services shall be to adults who are at extreme risk of injury as determined by the Social Worker or Rehabilitation Teacher, and for whom there is no other resource for this service available;

·       Children who are eligible for rehabilitation teaching services through the agency Children’s Services division shall be referred to that program first, and shall only receive individualized rehabilitation teaching services through Adult Services staff if there is supervisory approval and assignment made;

·       Adults who are eligible for Vocational Rehabilitation services and who are being provided with Rehabilitation Teaching services through that division for career and vocational training needs, shall only access Adult Services rehabilitation teaching services for independent living training that is clearly separate and unrelated to the vocational services being provided. Adult Services supervisory approval of the assignment is required prior to initiating rehabilitation teaching for adults served through an Individualized Plan for Employment (IPE) in the Vocational Rehabilitation Division;

·       Rehabilitation teaching assessment and training sessions in excess of three residential or community individualized sessions shall be subject to review by the Adult Services Supervisor.

 

Daily living aids that are in stock, and are valued at $300 or less, as recommended by the Rehabilitation Teacher, may be provided at the time of training. The Rehabilitation Teacher shall document the provision of daily living aids and instruction in their use in case notes or on a training report. 

 

Daily living aids that need to be purchased can be requested by the Rehabilitation Teacher by following the policies outlined in the “Authorization for Purchased Services” section of this manual.

 

The agency will replace daily living aids that break through normal wear, within available funding. However, the agency reserves the right to withhold the replacement of daily living aids in situations where there is compelling reason to conclude that the item(s) were broken as a result of neglect, abuse or mishandling. In reaching such a determination, the agency staff member shall consider the frequency with which prior requests for replacement aids have been made by the individual or their legal guardian. No more than one of the same replacement daily living aids can be provided to a client within a calendar year.

 
 


LOW VISION SERVICES AND EYE CARE

 

Low vision services include an evaluation by a qualified low vision specialist of the degree of visual disability present that can be helped by aids and devices that maximize the use of one’s remaining visual capabilities.

 

Low vision eye care refers to the services offered by low vision specialists in the habilitation or rehabilitation of people with vision impairments. Such services typically include:

 

·    Obtaining ocular and medical history

·    Obtaining functional history of vision use

·    Identifying client goals and expectations

·    Assessment of visual acuity and visual field

·    Functional testing for reading rate, glare, contrast, color vision and depth perception

·    magnification evaluation

·    optical and electronic device recommendations

·    non-optical recommendations

·    dispensing and training

·    orientation and mobility considerations

·    psycho-social considerations

·    medication management considerations

·    community and state resource recommendations

·    follow-up care

 

For individuals who have some degree of functional vision, it is important that maximum benefit from that vision be obtained for performing independent living tasks.  The provision of a low vision evaluation should be considered when changes in the functional vision of a client are reported or observed. For individuals who are experiencing ongoing degenerative eye conditions, it is important to recognize that low vision devices provided at one point in time may become ineffective for the client to use over time.  It is therefore advisable to consider follow up assessments in these circumstances to ensure that independent living skills will be maintained.

 

The Board of Education and Services of the Blind (BESB) can cover the cost of low vision eye care in the form of a complete low vision evaluation, including an initial visit to a BESB approved ophthalmologist or optometrist, one follow-up training visit, and the purchase of up to two-hundred dollars ($200.00) in optical aids prescribed and/or dispensed by the eye doctor, at a frequency of every two years, unless a degenerative eye condition or significant, noticeable reduction in functional vision within the residential or community setting requires an interim visit. 

 

For clients who have medical insurance through public or private sources, the eye doctor shall first seek payment for the cost of the low vision examination through the third party insurance before seeking payment from the agency. BESB will cover the cost of the client deductable for the examination as well as the cost not paid by third party insurance as noted on the Explanation of Benefits report submitted to the agency by the eye doctor. The total agency reimbursement, in combination with any amount received by the eye doctor from third party insurance, shall not exceed the agency fee schedule.

 

In situations where third party medical insurance covers part of the cost of eyeglasses or magnifying devices, the eye doctor shall submit the Explanation of Benefits report for the covered item(s) to the agency. BESB reimbursement, in combination with any amount received by the eye doctor from third party insurance, shall not exceed two-hundred dollars ($200.00) in total for these items.

 

Low vision assessments may be initiated prior to the development of an Independent Living Plan if the Social Worker determines that the results of such an assessment are necessary for the development of Independent Living Plan goals, objectives or services. However, it is not a requirement that such an assessment be obtained prior to development of an Independent Living Plan if the Social Worker, through observation or client self reporting, can determine that the client will likely benefit from these services.

 

Clients are to be given a copy of the approved low vision provider list to review. Client choice shall be the basis for selecting the low vision doctor from the approved list, and the Social Worker shall note this personal choice in the case management system upon initiating the request for the low vision examination.

 

For clients with third party medical insurance, a written request to perform the eye examination will be sent to the eye doctor by the agency, with instructions to bill the third party insurance provider prior to seeking agency funding. For clients who do not have third party medical insurance, a purchase order will be issued to the eye doctor to cover the cost of the low vision examination. A written notification form is sent by the agency to the client, with contact information for the doctor’s office so that an appointment can be scheduled.

 

Low vision eye care does not include vision therapy services, standard eye examinations for health care assessment and maintenance, or medical procedures or surgeries that may be beneficial or necessary. BESB Social Workers may facilitate referrals and provide information under a signed release of information from the client, guardian or court appointed conservator to third parties that assists with the client securing services that are outside of the scope of low vision eye care.

 

Although electronic magnification machines (commonly referred to as a CCTV) may be recommended by eye doctors, this section of agency policy does not address the provision of these devices to clients, and therefore the cost cap for low vision devices is not applicable for a CCTV. Refer to the “Adaptive Equipment Provided by the Agency” section of this policy manual for CCTV guidelines.

 

 


LOW VISION SPECIALISTS

 

 

A BESB approved Low Vision Specialist is an individual who is licensed in the State in which he or she practices as a physician specializing in Ophthalmology, or as an Optometrist, where at least one of the following conditions apply:

 

a.      The individual has provided to BESB documentation from the head or authorized designee of the Ophthalmology residency training program, Optometry degree program or Optometry residency program that indicates a field placement of at least 10 weeks in a low vision facility which primarily serves individuals who are blind and visually impaired, with a minimum of 20 hours in clinical training; or

 

b.      The individual has within the three (3) year period immediately preceding application to BESB for Low Vision Specialist status, completed an ophthalmology residency program, graduated from an optometry degree program or completed an optometry residency program, and can document that such program included the equivalent of three graduate semester hours of study in the field of low vision.  The individual must further provide to BESB proof of participating in the care of or providing the care for at least three patients with low vision needs who have at least met the statutory definition of visually impaired.  This care could have been provided while in residency or college or in the three (3) years preceding application to BESB and must include evaluative and rehabilitative components.  This may be documented in writing through an administrator of his or her residency or college or be submitted to BESB in case report form (names redacted) for review; or

 

c.      The individual has provided to BESB documentation of no less than 10 hours of continuing education credits specifically in the area of vision rehabilitation within the twenty-four (24) month period immediately preceding application to BESB for Low Vision Specialist status, and the individual has further provided to BESB bona fide low vision examination reports (names redacted), completed within the twenty-four (24) month period immediately preceding application to BESB that illustrate the evaluation and rehabilitation of three patients with low vision needs who have at least met the statutory definition of visually impaired; or

 

d.      The individual has attained Low Vision Diplomate status (optometrists only) as required by the American Academy of Optometry.

 

e. The individual has been an approved BESB Low Vision Provider as of September 22, 2005, meeting the standards previously in effect by the agency.

 

Additional requirements for initial BESB approval and continuing annual approval include:

 

a.   Maintenance of BESB’s minimum diagnostic inventory.

b.   Agreement to participate in at least 6 hours of continuing education in the field of low vision each year.  These credits must, for optometrists, be COPE approved, or approved by the Connecticut Board of Examiners for Optometrists.  At least 3 of these hours must directly deal with low vision rehabilitation.  BESB agrees to make available and sponsor at least 3 hours of COPE or Connecticut Board of Examiners for Optometrists approved Continuing Education in low vision rehabilitation each year. An Optometrist or Ophthalmologist who has acquired three years of experience as a BESB approved low vision specialist/provider, shall be deemed to have satisfied this requirement.

c.   Agreement to follow all BESB fee schedules, protocols and procedures.

 
 


LOW VISION AIDS AND DEVICES

 

Low vision devices are prescribed and non-prescribed aids that enable an individual to enhance remaining functional vision for activities of independent living. Aids and devices include items such as prescription lenses, telescopic lenses, hand held magnifying devices, table mounted magnifying devices, and special lighting used in combination with magnification devices. Additionally, training in the use of prescribed and non-prescribed low vision devices is available to ensure the maximum level of benefit is achieved.

 

The provision of low vision devices must be directly related to the independent living goals and objectives of the individual under a written Independent Living Plan, or be documented in the agency case management system for situations where no written Independent Living Plan is in place, and a waiver has been selected.

 

Low vision devices (including corrective lenses, frames, magnifiers and lighting) shall be reviewed with the Supervisor of Adult Services prior to initiating a purchase order request. In reviewing purchase requests for low vision devices, the Supervisor of Adult Services will consider if there are other resources such as grants, private insurance, or other funding sources that are available to cover in part or in full, the cost of the requested device(s). All purchases of low vision devices are subject to the requirements noted in the “Low Vision Services and Eye Care” section of this policy manual.

 

Additionally, the Supervisor of Adult Services will further consider if there are other devices, services or aids at less cost that will enable the client to accomplish the independent living task(s).

 

 

If there are questions regarding the provision of particular glasses, aids or devices, then the staff member initiating the request for low vision devices will first consult with a Rehabilitation Teacher or other BESB authorized designee to review the recommendations, prior to requesting commitment of agency funds for the purchase. When available through BESB, requests for daily living aids shall be referred to Rehabilitation Teaching services at the agency for dispensing and training.

 

Upon supervisory approval, a BESB Form 6 letter will be sent to the examiner for the aids to be dispensed.  The time span for issuing written authorization for the provision of low vision aids to the examiner shall not exceed ten (10) business days from the date of receipt by the agency, except in circumstances where erroneous or incomplete information precludes the agency from making a determination that the requested devices are consistent with the independent living  goals of the individual. In such instances, a written communication to the practitioner will be issued within ten (10) business days of the receipt of the request, outlining any necessary additional information that is required to further assess the request.

 

In situations where the agency has insufficient funds to process requests, written notification shall be provided to the client and the practitioner, outlining the anticipated time frame when funding will become available to process the request. 

 

Upon receipt of a BESB Form 6 letter, the examiner will contact the individual when the devices are available for dispensing and training to occur.  A subsequent office visit will occur, where the examiner will teach the client how to use the devices.

 

It will be the responsibility of the Adult Services staff member requesting the purchase of low vision aids to verify the provision of the low vision aids to the client before the agency will release funds to cover the costs of the devices. Payment of funds can only be for those low vision devices that are actually provided to the client. Devices that are ordered for the client but are not taken, cannot be paid for through agency funds unless the eye doctor can provide documentation that such devices were specially made to order for the client and that there is not a refund process available to the doctor to recoup their cost for the item(s).

 

The agency will replace low vision devices that break through normal wear, within available funding. However, the agency reserves the right to withhold funding for replacement magnifiers, glasses or devices in situations where there is compelling reason to conclude that the device(s) were broken as a result of neglect, abuse or mishandling. In reaching such a determination, the agency staff member shall consider the frequency with which prior requests for replacement devices have been made by the individual or their legal guardian. No more than one of the same replacement devices can be purchased or provided to an individual within a calendar year. 

 

Subsequent to the dispensing of prescribed and/or non-prescribed aids by the optometrist or ophthalmologist, additional orientation and follow up training is available through BESB Rehabilitation Teachers.


 

CORNEAL TRANSPLANTS

 

The agency maintains a limited funding source for the provision of surgical services and hospitalization to cover in part the cost of cornea transplants.  Individuals who wish to request access to this limited funding may submit a letter to the agency Executive Director, outlining the circumstances, and providing contact information for the primary care physician. A listing of all insurance coverage the client has available shall also be submitted. The agency reserves access to these funds to situations where the client has insufficient medical coverage for the surgery, is ineligible to obtain medical insurance (or additional medical insurance) for the surgery, and where there is clear documentation provided by a licensed physician that the client has a positive prognosis in terms of benefiting from the surgery. The maximum level of agency funding available for each client shall not exceed $3000, subject to availablity. Commitment of funds will occur after documentation is provided by the hospital or medical facility confirming that with the provision of BESB funding in the maximum amount available through this policy, there will be sufficient coverage to enable the surgery to occur. Payment of the funds will occur subsequent to the surgical procedure occurring.

 
 


ORIENTATION AND MOBILITY INSTRUCTION

 

The Board of Education and Services for the Blind (BESB) employs Orientation and Mobility Specialists whose function is to assist and train adults who are legally blind (and where applicable, children who are visually impaired or legally blind) to move more confidently and safely through the residential environment and in the community.

 

Services provided by Orientation and Mobility Instructors include:

 

·       Training for safe and independent travel in the residence and in the community;

·       Teaching the ability to relate to the environment non-visually;

·       Training in the use of a long white cane, short white support cane, or other device for identification and safety;

·       Teaching a client to utilize public transportation options including teaching travel routes to bus stops, teaching techniques for identifying the correct bus stop and how to orient to a location;

·       Providing information on other transportation options that are available such as ADA para-transit, Dial-A-Ride, senior volunteers, etc.

·       Instructing in the use of other sensory modalities, such as auditory and tactual cues;

·       Developing the use of residual vision to facilitate safe and independent travel;

·       Consultation, follow up and community education assistance for guide dog users;

·       Providing information about schools and training programs to clients who desire to obtain a guide dog;

·       Developing the ability to use multiple devices where ambulation requires the use of supports;

·       Training in the use of low vision devices that enhance access to visual cues, such as utilization of monocular telescopes to identify pedestrian signals;

·       Providing training and orientation to transit district drivers of buses and para-transit vehicles on blindness related topics;

·       Representing the agency at Transit District meetings within assigned geographic territories, to bring forward concerns related to transportation for individuals who are blind.

 

Orientation and mobility services are to be identified as part of the Independent Living Plan of the individual, unless the individual has a written waiver for a plan in place. A case note shall be entered in the case management system for each residential or community visit where an orientation and mobility assessment or training is provided. Upon achievement of the independent living goals and objectives for which orientation and mobility services were provided, a summary case note will be completed, detailing the outcomes achieved. This case note shall be entered into the case management system.

 

Due to the limited orientation and mobility staffing levels within Adult Services, the following criteria shall apply:

 

·       First priority for the provision of orientation and mobility services shall be to adults who are at extreme risk of injury as determined by the Social Worker or Mobility Instructor, and for whom there is no other resource for this service available.

·       Children who are eligible for orientation and mobility  services through the agency Children’s Services division shall be referred to that program first, and shall only receive individualized orientation and mobility services through Adult Services staff if there is supervisory approval and assignment made.

·       Adults who are eligible for Vocational Rehabilitation services and who are being provided with orientation and mobility services through that division for career and vocational training needs, shall only access Adult Services orientation and mobility services for independent living training that is clearly separate and unrelated to the vocational services being provided. Adult Services supervisory approval of the assignment is required prior to initiating orientation and mobility services for adults served through an Individualized Plan for Employment (IPE) in the Vocational Rehabilitation Division.

·       Orientation and mobility assessment and training sessions in excess of three residential or community individualized sessions are subject to review by the Adult Services Supervisor.

 

Long white canes and short white support canes, and mobility aids and devices may be provided to the client through agency stock by the Mobility Instructor during the training program. At the completion of each evaluation or training session, a case note shall be completed and entered into the case management system, noting the provision of the cane and/or other mobility aid or device, if applicable.

 

The agency will replace canes that break through normal wear, within available funding. However, the agency reserves the right to withhold the replacement of long white canes or short white support canes in situations where there is compelling reason to conclude that the cane was broken as a result of neglect, abuse or mishandling. In reaching such a determination, the agency staff member shall consider the frequency with which prior requests for replacement canes have been made by the individual or their legal guardian. No more than one replacement cane can be provided to a client within a calendar year.

 


 

CASE RECORD DOCUMENTATION

 

In general, any meeting that occurs between a BESB staff member and a client of the agency shall be documented in the agency case management system. The case note shall detail the purpose of the meeting, and any agreed to action plan.

 

In addition, any service that is initiated for a client to receive shall be noted in the agency case management system.

 

While working with the client, BESB staff members will enter case notes as appropriate to fully document services.  Staff will document assessments, trainings, and follow up visits and will record the equipment that is provided as well as the gains the client realizes following the provision of services and/or equipment. 

 

As the case manager, the BESB Social Worker assigned to the client is primarily responsible for documenting services provided to the client.  All services authorized, equipment delivered, evaluation or training reports need to be reviewed by the assigned staff person to ensure that the goal of the Independent Living Plan has been met. 

 


 

GOALS ACHIEVED AND REACTIVATION

 

Upon the client and the Social Worker mutually agreeing that all requested services have been completed, the Social Worker shall provide written notification to the client of the intent to place their case within Goals Achieved status. The letter will inform the client that their case may be reactivated by contacting the agency if their circumstances change and additional services are desired. Included with the Goals Achieved letter will be a listing of follow up services available to the individual, information on the agency appeals procedure and the Client Assistance Program.

 

Once a case has been placed within Goals Achieved status within Adult Services, the following services may be provided upon request of the client, without the need to have the case reactivated for a subsequent determination of eligibility:

 

·       Certificate of Legal Blindness (CLB);

·       Replacement low vision devices up to one of the same device previously provided per calendar year;

·       Replacement cane up to one per calendar year;

·       Information and referral services;

·       Follow up rehabilitation teaching, social work or orientation and mobility sessions for short term resolution of a change in circumstances;

·       Replacement of daily living aids up to one of the same device previously provided per calendar year;

·       Information on resources and funding options through scholarships, awards or loan programs;

·       Referral services to community based organizations and governmental agencies;

·       Letters of reference for participation in Guide Dog and service animal schools;

·       Reassessment of independent living need based upon a change in personal circumstances.

 

Purchased services require the reactivation of case services and a redetermination of eligibility.

 


 

SERVICES TO INDIVIDUALS WHO ARE DEAF AND BLIND (Deafblind or Deaf-Blind)

 

NOTE: Individuals who are deafblind (deaf-blind or deaf and blind) may receive independent living services, education services and vocational rehabilitation services through other funding sources available through the agency. Please refer to the “Independent Living Plans” and “Secondary Disabilities” sections of this policy manual, as well as the agency policy manuals for Vocational Rehabilitation and Children’s Services.

 

The Board of Education and Services for the Blind (BESB) administers the Deaf-Blind Grant Program, which provides funding to create opportunities for recreation, communication, socialization and other services that further community inclusion for adults age 21 or older who are deaf-blind as outlined in Section 10-295(d) of the Connecticut General Statutes.  An individual is considered to be deaf-blind if his or her vision meets the statutory definition of legal blindness or impaired vision, as detailed in Section 10-294a of the Connecticut General Statutes, and the individual’s hearing is non-functional for the purpose of understanding ordinary conversation with optimum amplification.  Priority of funding proposals is given to those select individuals identified in the original 1977 deaf-blind pilot study.  Priority of funding shall also be directed toward activities that prepare for and engage individuals in more independent living.

 

Individuals who are deaf-blind (or their legal guardians) may request funds for programs they design to provide them access to recreation, communication, socialization and other services that further community inclusion.  Additionally, organizations, providers, individuals and other entities may request funds to provide services to individuals or to groups of individuals who are deaf-blind.

 

Persons to be served:

 

Available funding shall first be allocated on an annual basis to serve those persons who are deaf-blind and who were identified in the original 1977 deaf-blind pilot study as the select individuals. After select individuals have had funds allocated through this grant program, BESB shall use the remaining grant program funds to serve other individuals. The maximum level of funding available per individual, per fiscal year cannot exceed $10,000. 

 

The final determination regarding the awarding by BESB of grants under this program is subject to the availability of funds appropriated by the Connecticut State Legislature for this program.

 

Client Service Plan:

 

A Client Service Plan shall be developed for each client to be served through this grant. The Client Service Plan shall include all of the following:

 

·       outcomes and performance measures for the services outlined in the proposal for the upcoming year,

·       an assessment covering the outcomes and performance measures for the services provided under the plan (if any) for the preceding year,

·       the names and qualifications of the persons who shall be providing the services described under the plan (if known),

·       itemized costs of proposed services.

 

When requesting funding, the proposing individual or agency shall describe the process that will be used to identify and hire qualified individuals to provide services to the individual(s) who are deaf-blind.  BESB shall assume no responsibility for the selection of an agency or person directly hired by the proposing individual for the provision of services under this grant program.

 

Deaf-Blind Advisory Committee

 

The agency shall have a Deaf-Blind Advisory Committee that shall assist the agency in the administration of this Program, and review all major policy and planning issues and decisions.  The Advisory Committee shall be composed of:  

 

a.               The Executive Director of the Board of Education and Services for the Blind (BESB) or a designee shall serve as an ex-officio, non-voting member;

 

b.               The Adult Services Supervisor from BESB shall serve as an ex-officio, non-voting member;

 

c.      A representative of the BESB Vocational Rehabilitation Division at the agency shall serve as an ex-officio, non-voting member;

 

d.      A representative of the BESB Children’s Services Division at the agency shall serve as an ex-officio, non-voting member;

 

e.     A representative of the Bureau of Rehabilitation Services;

 

f.       A representative of the Connecticut Institute for the Blind, Inc. DBA Oak Hill;

 

g.   The Commissioner of the Department of Developmental Services or his or her designee;

 

h.   The Director of Southbury Training School or his or her designee;

 

i.       A representative from the Commission on the Deaf and Hearing Impaired, or a designee;

 

j.       A representative from a National or Regional organization that is primarily concerned with services to individuals who are deafblind;

 

k.   Three (3) individuals subject to the pilot study authorized by Special Act 77-81 of the Connecticut Statutes, or their guardians or persons duly designated by said guardians;

 

l.       A representative from the Helen Keller National Center;

 

m.            A representative from a community based organization representing individuals who are deaf or hard of hearing;

 

n.   A voting member of the BESB Board; 

 

o.   A representative of the Department of Social Services;

 

p.   A representative of the Department of Mental Health and Addiction Services;

 

q.   An individual who is deafblind.

 

No fewer than three (3) of the members of the Advisory Committee shall be consumers or their guardians. 

 

The Committee shall elect a Chair who shall convene meetings at least three times per year, or at any such time as is requested by three other members of the Committee.

 

The Committee shall operate under the principals of Roberts Rules of Order, and conduct business through majority vote, maintaining minutes of all meetings.  No member of the Committee may participate in discussions, or vote for any funding proposal, program, service or initiative for which the member, a family member, or relative of the Committee member could benefit financially. All members of the committee must disclose in advance of any discussion on a proposal any potential conflict of interest that exists or that could potentially exist.  In these circumstances, the member shall not participate in the discussion and the remaining members shall decide the matter through simple majority vote of the remaining voting members.

 

Client Service Plan Review Committee

 

There shall be a standing subcommittee of the BESB Deaf-Blind Advisory Committee that shall be charged with reviewing all requests for funding and making recommendations to the full Committee for approval of funding requests. This Standing Subcommittee shall be referred to as the Client Service Plan Review Committee.

 

In reviewing proposals, the Client Service Plan Review Committee may consider all factors, including but not limited to the following:

a.   the client’s established interests, preferences, and relationships;

b.   the client’s ability to make choices;

c.   the client’s ability to participate in and benefit from the proposed services;

d.   the amount of supervision ordinarily required by the client;

e.   the benefits derived by the client through the services offered;

f.      whether and to what degree the benefit of the proposed services can be measured and tracked;

g.   whether similar services are available absent the funding requested; and

h.   the shortage or availability of funds otherwise available after the provision of services to select individuals.

 

Upon receiving a service proposal, the Client Service Plan Review Committee may request that the proposing individual revise the proposal if public funds are otherwise available from specifically identified additional sources to pay for the services described in the service plan as originally submitted.

 

No member of the Client Service Plan Review Committee may participate in discussions, or vote for any funding proposal for which the member, a family member, or relative will benefit financially.  All members of the committee must disclose in advance of any discussion on a proposal for funding any potential conflict of interest that exists or that could potentially exist.  In these circumstances, the member shall not participate in the review of the proposal and the remaining members shall decide through simple majority vote whether the proposal should go before the full Advisory Committee for vote.

        

Scope of Services Eligible for Funding 

 

Services that are eligible to receive funding, subject to Advisory Committee approval and available funding up to the maximum of $10,000 per individual per fiscal year may include:

 

a.       Enrichment of the client’s life by community experiences to decrease social isolation while promoting social interaction to help the client realize greater participation in the community through self-empowerment.

 

b.       Serving as a qualified communicator or facilitator between the client and the public to facilitate the client’s involvement in the community.

 

c.       Helping the client to discover, develop, and adapt independent living skills that fit the client’s abilities. 

 

Individuals selected to provide services through this program must have demonstrated that they have secured or will obtain the services of qualified persons with particular skills in serving clients who are deaf-blind.  All proposing individuals who are approved to enter into contract(s) with BESB for the provision of specific services under this grant program shall agree to submit activity reports documenting the services provided (including the date and the number of hours of service) and written progress summaries on forms provided by BESB. 

 

Individuals who are deaf-blind, and/or their legal guardians may also submit proposals for funding, subject to available funding, not to exceed $10,000 per individual per fiscal year. In submitting such proposals, the individual or their legal guardian shall outline the services that will be provided, and how the individual or their legal guardian shall hire and monitor the delivery of services by other individuals or third party agencies as outlined in the Client Service Plan.

 

All contracts shall be awarded in a manner consistent with State of Connecticut procurement policies and procedures. The agency shall coordinate activities with the Department of Administrative Services for the issuance of Requests for Proposals as required. 

 

There shall be a Memorandum of Understanding between the Board of Education and Services for the Blind (BESB) and the Department of Social Services, Bureau of Rehabilitation Services (BRS) that outlines the services that are available for individuals who are determined to meet the categorical definition of deaf-blind, and for whom vocational rehabilitation services are requested by the individual. The written agreement shall include a provision for determining the circumstances under which each agency will provide vocational rehabilitation funding for eligible individuals who are deaf and blind for purposes of preparing for, entering into and maintaining employment.

 


 

ADULT SERVICES APPEALS PROCEDURES AND REMEDIES

 

Any client who is legally blind or deaf-blind, (or the parent or legal guardian of a child who is visually impaired or legally blind) who is dissatisfied with any determinations made by the Adult Services assigned staff member(s) concerning the furnishing or denial of services may request a timely review of those determinations.

 

The client, or their legal guardian must make a written request for a review of the decision that was made by the Adult Services staff person, and state in the written request the nature of the matters to be addressed in the review.  The Agency may not institute a suspension, reduction, or termination of services being provided under an Independent Living Plan, Waiver or Client Service Plan pending a review, unless the client or their legal guardian so requests, or the Agency has evidence that services have been obtained through misrepresentation, fraud, collusion, or criminal conduct on the part of the client or legal guardian.

 

Review Options

 

1.   Informal Resolution:

 

A client or their legal guardian may seek an informal review of a decision by sending a written request to the Supervisor of Adult Services.  This review will be conducted within twenty business days of receipt of the written request for such a review.

 

2.   Subsequent Review:

 

A client or legal guardian may seek a formal review of a decision by sending a written request to the Executive Director of the agency.  This review will be conducted within twenty business days of receipt of the written request for such a review.  The purpose of this subsequent review is to offer the client or the legal guardian an option to provide written documentation of their concerns for timely resolution of disputed decisions that could not be resolved in the informal review process.

 

3. Client Assistance Program (CAP):

 

The Client Assistance Program (CAP) was established by the Rehabilitation Act Amendments of 1984.  Persons eligible for assistance under this program are those who are receiving or seeking services under the Rehabilitation Act of 1973, as amended.  CAP is free of charge and available to all persons applying for or receiving independent living rehabilitation services, as authorized under the Rehabilitation Act.

 

CAP is a unit of the Office of Protection and Advocacy.  It provides applicants/clients of vocational rehabilitation and independent living services with information and referral, as well as assistance in pursuing legal, administrative, and other available remedies to insure rights under the Rehabilitation Act.

 

The Client Assistance Program is available at any time in the independent living rehabilitation process when it is felt that the person can benefit from the services offered by CAP which include: 

 

·       Helping the applicant or client to understand the rehabilitation process.

·       Advising applicants and clients of all benefits available to them through Federal and State rehabilitation programs, and their respective rights and responsibilities.

·       Assisting applicants and clients in their relationships with projects, programs, and facilities.

·       Mediating disputes between applicants and clients and the agency prior to any other action.

·       Helping applicants and clients in pursuing legal, administrative, and other available remedies.

·       Advising state and other agencies of identified systemic problem areas in the delivery of rehabilitation services to individuals with disabilities and suggesting methods and means to improve agency performance.

·       Assisting or advising BESB staff in providing services to clients.

 

Clients may contact CAP at:

 

            Client Assistance Program

            60-B Weston Street

            Hartford, CT  06120

            297-4300 or 1-800-842-7303

 

All clients must be informed of services available from CAP at each of the following stages in the independent living rehabilitation process:

        - Application/Initial Interview

        - Independent Living Plan Development or Waiver

        - Goals Achieved notification

 





Content Last Modified on 12/27/2011 4:17:43 PM