Fiscal Year 2004 Proposed Budget

Proposed Budget Contents | Section H Contents | Aging and Disability Services Contents | Submit Comments

DEPARTMENT OF HUMAN SERVICES
SERVICES FOR ADULTS WITH MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

PROGRAM MISSION: To promote the highest reasonable level of self-sufficiency and independence for adults with mental retardation and developmental disabilities through services that promote consumers' skill building and optimal health, safety, and psycho-social functioning. This is achieved through the provision of individualized case management and support services intended to provide individual choice and linkages to community based programs.

• Client Services Coordination (Case Management) is the single point of entry for all Mental Retardation/Developmental Disabilities services. The goal of Client Services Coordination is to arrange, authorize, coordinate, and link supports and services for eligible Arlington County adults with mental retardation and developmental disabilities. Case managers monitor the delivery of services to individuals to assure that quality standards are met and assist eligible special education graduates from the schools to transition to the world of work or adult services.

• Vocational/Day Programs and Transportation Services enable adults with mental retardation and developmental disabilities to prepare for and engage in meaningful training, work and employment designed to increase their options for functional and economic self-sufficiency. These provide a range of service alternatives including sheltered workshops, competitive job placements and job coach supports; group supported employment enclaves in community business settings, mobile work crews, and day support services. Beginning in FY 2003, services previously provided through the Woodmont Center (with the exception of Woodmont Weavers) are being privatized. It is anticipated that the phase-in of privatization will be completed by October 2003. This privatization is in response to significant issues over the last few years regarding the feasibility of continuing to manage the program in-house, including service delivered as compared to "best practices,", and compliance with federal and state regulations. Persons previously served by the Woodmont program will be able to select from among several non-profit vendors with whom the County has a contract in place. The Woodmont Weavers have relocated to the Ballston Mall, and this program will continue to be operated by the County at this time.

• Residential Services prevent homelessness or institutionalization for adults with mental retardation through the development and provision of an array of community-based residential services and support. These services provide training which maximizes consumers' self-sufficiency and assists them in increasing community daily living skills. The level of supervision and support provided in each service model varies depending on the needs of the consumers. These range from 24-hour supervision in a group home setting to drop-in staff support in an apartment or private home. In addition to the $1.6 million vendors receive through the County, Medicaid Waiver revenue is also generated to support these services, and is paid directly by the state to the contract service providers.

• The Family Support Program provides financial assistance to families who care for a family member with mental retardation/developmental disabilities in their home. Families purchase items or services for which there are limited sources of community or private funding and which provide support to the families in the maintenance of the consumer in the home. Purchases may include respite care services, assistive technology, personal care services, certain health or therapeutic services, and other items or services that support the independence of the consumer or ease the caretaking requirements of the family.

SIGNIFICANT BUDGET HIGHLIGHTS:

• Because of state budget cuts, expenditures in this area were reduced by $209,939. Of this amount, $168,226 was restored using LPACAP funds. Because of improved service delivery and efficiencies in vocational services, the balance of the cut can be absorbed without impacting client services.

• The personnel expenses decreased due to contracting out Woodmont services.

• The non-personnel costs increased ($99,020) due to a reallocation to transportation costs from vocational services ($67,289) and the reallocation of operating expenses ($11,031), plus the transportation costs for the new graduates of $20,700.

• The expense for non-profits increases ($395,455) due to the addition of funding for vocational services for ten school graduates ($159,638) and increases for regional vocational contracts ($39,799) to maintain same service level, shifting of personnel and operating costs from the Woodmont program to non-profit vocational contractors ($224,382), salary merit adjustment of ($31,380), adjustment for liability insurance ($2,745), and rent adjustment of ($4,800) for residential contractors. Transferred vocational funds to offset additional transportation costs of $67,289 are reflected in non-personnel expenses.

• LPACAP funding was added to cover state cuts for family support services and vocational services (168,226).

• The Medicaid Waiver revenue was decreased due to contracting out the Woodmont services; the contractors will be receiving Waiver funding directly from the state.

• Other grants decline, reflecting vocational service revenue from outside agencies which will now flow directly to the contract service providers.

• FTEs decrease due to the elimination of 2.7 FTEs at the Woodmont program due to contracting out the Woodmont services, and the addition of 0.3 FTE for case management services associated with the ten new school graduates who will also receive vocational services. These changes result in a net decrease of 2.4 FTEs.

• DHS staff and the Arlington Community Services Board are undergoing a comprehensive review of all mental health, mental retardation and substance abuse service client fees, and will be developing a new fee scale based on current service costs. The review will be completed by early February.

PERFORMANCE MEASURES:

Client Services Coordination/Case Management Objectives:To support adults with mental retardation and developmental disabilities in achieving their optimal level of independence by empowering and integrating them into the Arlington community. This is achieved through individualized case management and the provision of support services providing choice and linkages to community based programs.

• The Case Management satisfaction surveys were sent to 227 consumer/families, 74 of which were returned, thus the rate of return was 32%.

• In FY 2004 no new Medicaid Waiver funding is anticipated to be available.

• The Family Support Program served 37 families during Fiscal Year 2002, including children and adults with developmental disabilities and mental retardation. Seventeen (46%) responded to the consumer satisfaction survey; 94% of these were satisfied with services received.

Vocational/Day Programs/Transportation Services Objectives: To maximize functional skills and independence of adults with mental retardation/developmental disabilities through supports, training, and/or employment, while optimizing individual choices of types of service and settings in which services are available.

• Seventy-one of 123 client files were sampled, representing all contract agencies, to determine percentage of client goals and objectives met.

• Satisfaction surveys were sent to consumers, families and or advocates who receive Vocational Services.

• Satisfaction surveys were sent to all 73 consumers who received Transportation Services in FY 2002. Of these, twenty-four (24) responded for a return rate of 34%. Ninety-two percent expressed satisfaction with transportation services provided.

• Two large vendors of sheltered and group supported employment changed tracking software during FY 2002. Therefore, we are unable to give complete average hourly earnings in these categories. This will be available again in FY 2003. Earning rates, which are less than minimum wage for some placement types, are computed in accordance with Department of Labor standards for percentage or rate of productivity compared to productivity norms for the task being performed. Consumers average less than full time employment (ranging from 14.5 to 30 hours weekly) because of varying subcontract work available.

• Target for average hourly earnings for individual supported employment is based on national averages compiled by the National Industries for the Severely Handicapped (NISH). Other standards were generated internally, as NISH and the Department of Labor (DOL) were unable to provide benchmarks for group supported and sheltered employment.

Residential Services Objectives: To enable adults with mental retardation/developmental disabilities to live in the community by providing housing and supportive services in the least restrictive setting.

• Total Clients Served represents an unduplicated count of the number of consumers served in all residential services. Two Intermediate Care Facilities for the Mentally Retarded (ICF/MRs) will open late in FY 2003, funded by Medicaid.

• Percentage of Bed Days Utilized represents the number of days out of the year that available spaces are occupied (i.e., beds). This measure is in part a reflection of the providers' ability to place new consumers after openings arise, and of referrals by County case managers to ensure the best possible match.

• Client Objectives Met is based on a sample of 57 consumers representing seven of seven contract agencies; percentages indicate the success that consumers have had in meeting objectives of their Individual Service Plans.

• Satisfaction Ratings are derived from a Consumer Satisfaction Survey provided to families, guardians, and advocates of consumers who received residential services. The survey contains questions related to service quality, staff knowledge and helpfulness, recommendation of the service to others, meeting of needs, and comfort in expressing concerns about the program. Thirty-one of the ninety-four surveys were returned.

FUTURE BUDGET CONSIDERATIONS:

• Arlington has 55 consumers who are in need of residential services. Thirty are considered to be at "very high" risk for losing their primary caretaker, a parent over the age of 70. The aging of consumers and/or their caretaker parents present unique challenges that demand more in home residential and health care supports. Moreover, when a family crisis occurs that prevents the caretakers from continuing their role, there is no available permanent residential alternative for their adult child. The use of state institutions as an emergency placement is no longer an alternative.

Proposed Budget Contents | Section H Contents | Aging and Disability Services Contents