Survey Results of Vocational Rehabilitation

& AgrAbility Relationships

Presented bySamuel N. Mathew

National AgrAbility ProjectAugust 27, 2009

Basic Webinar InstructionsNeed speakers or headphones to hear the presentationMeeting > Manage My Settings > My Connection Speed– Dial-up not recommended

Questions about presentation – use chat window or call 800# provided at the endProblems: use chat window or email racz@purdue.edu 4 quick survey questions at the end*Session recorded and archived at www.agrability.org at future date

Background

A study conducted by National AgrAbility Project in 1st Quarter 09

Interviews with State & Regional AgrAbility staff in January & February 2009 – 24 states participated but only 23 have active relationship with VR.

Background

Based on a questionnaire prepared in consultation with Dr. Bill Field, Director NAP and Paul Jones, Manager NAP

Questionnaire sent ahead to most of the participants

Background

Each phone conversations ranged from 40 minutes to 2 hours

In some states more than one person interviewed – depending on what the primary contact person suggested

Interviewees chosen from NAP contact list

Questions – Current VR Relationships

Funding - limits/typical funding

Pay for services for AgrAbility services

What services paid for customers by VR

Contractual status

Conflicts with VR

OOS

Opinion about VR

Negative and Positive opinions

Expectations as understood by AgrAbility– from VR side about AgrAbility – About VR from AgrAbility side

Future Relationship with VR

How to enhance relationship?– Who all are responsible?– Any specific steps?

We will share the successful experiences by a few of AgrAbility projects (if time permits)

Funding

20 out of 23 states receive help on home modifications

All states have funding for AT and farm equipment modifications

22 states have funding for small business operations

Funding limitations

12 states have no funding limitations

6 states have limits

3 states had conditional limitations

2 states are not aware of any limitations

Funding limitations

For those with funding limits, range was from $1300 to $15k most below $5k (This could be based on VR Counselor approval limits. Higher limits possible with management approval

For those without funding limits, funding varied from $2K to $40K.

Funding amounts

For 11 states – typical funding above 10K, – out of which 7 reported above $20K.

8 states reported under $10K.

3 states couldn’t provide a typical funding amount.

Funding – cost sharing

In 11 states VR expects customer to share cost based on income limits

One state accepted customer sharing cost could include labor, rent (e.g. welding equipment)

One state had sliding scale pay

4 states followed specific formula based on income tax return

Funding – cost sharing

Farmer customers generally get through since net income after expense keep income slow.

Some states encouraged low interestloans and directed customers towards that as cost sharing

Funding types

prosthesis

mileage

tuition + supplies

driver education

licensing

employment search

technical assistance

re-engineering

website marketing

buying computer and software

physical therapy

counseling services

grain bin modifications

medical restoration

short-term medical treatment

Pay for services

9 states received pay for services

14 states do not receive pay for services

All states with pay for services had current contract or MOU with VR. (One state MOU expired but they still are able to follow the same guidelines)

Highlighted point

Good and positive relationship with upper VR management highlighted by those who had pay for services

States with contract but no pay for services

3 states who had existing contractual relationship but didn’t receive pay for services due to the special relationship which they have with VR. (One of the states is starting to get pay for services from 10/1/09 under a new agreement)

Pay for service fees

Indiana has $335 per day and mileage charged separately

One state have $60 per hour of site work, and travel charge $25 with additional mileage of $ 0.25 per mile

Some other states had lump sum varying from $600 to $1200

Pay for services fees

One state received $2500 per case . This service included total coverage (vendor identification, providing quotes etc.) including one year review and follow up.

Some states are working on turning their services that can pay. All wanted to have pay for services.

Order of Selection (OOS)

11 states mentioned that their state in OOS

Nine states not in OOS

Two states did not know the status

One state didn’t declare OOS, but cut in funding even without declaring OOS

OOS status

Does not affect farmer customers because severity of disability is significant

A few states are in freeze and do not receive any applications

The situation may change because of ARRA

Several states had OOS on an ongoing basis

Positive opinion expressed by AgrAbility staff about VR

VR is a great funding source

VR offices spread around the state

VR has same goal as AgrAbility

VRC sincere in their work, impartial

VR values reports from AgrAbility

Positive opinion expressed by AgrAbility staff about VR (cont..)

‘When VR works, it really works’

Delay in VR is short compared to some other agencies

Lot of work achieved through mutual trust

If the VR rep. on AgrAbility advisory board is influential, that can be a very positive influence in relationships and working together

Negative opinion about VR

4 states had no negative opinion

Most common – delays in receiving services that prompted some farmer customers to walk away

Lack of uniformity in criteria

Lack of knowledge about farming and farm culture

Negative opinion about VR (cont…)

Turnover of VR counselors

Freeze in funding

Some counselors are not open-minded, especially those with long years with VR

Conflicts and resolutions

3 states had no conflicts in the past

5 states had one conflicts in the past – one not yet resolved

15 states had more than one in the past

Two states had more than one unresolved

Conflicts and resolutions

– Most conflicts out of misunderstanding or miscommunication. Resolved by talking

– Most conflicts resolved by talking to VRC and providing the necessary information

– Several states reported taking conflicts to CAP for resolution

Conflicts and resolutions

Specific examples– In some cases customer walked away and thus

the problem was dissolved– The customer had to approach state elected

officials to intervene– Educating VR counselor resolved the issue– The customer threatened the VR supervisor and

got his way

Conflicts and resolutions

Specific examples– VR appointed a VR manager as the point of

contact to resolve conflicts and this avoided the customer approaching CAP (VR doesn’t prefer going to CAP as this is viewed as a failure of the due process)

– VR director got involved rather than allowing escalation to CAP

How to resolve conflicts?

The best approach is to talk to VRC and resolve

Having a managerial person from VR in advisory board and having a rapport with him/her is seen as a catalyst in resolving issues.

Remember – VR does not like mediations or anybody approaching CAP

Specific resources that helped AgrAbility staff to interact with

VR in the pastWebMD.com

ToolBox

Training on VR by NAP in the past

Knowledge of VR policies

AgrAbility -VR contract was a resource

Local resources such as technology center

Specific resources that helped AgrAbility staff to interact with

VR in the pastOne state conducted a focus group among farmers, service providers and the data obtained helped them as a good resource

VR representative in the advisory board was mentioned as a good resource

AgrAbility expectations from VR

Two states did not respond with any expectations

Several common themes noted

Most common themes– Pay for services– MOU or contract with VR

AgrAbility expectations from VR

Some common themes– The counselors should know the farming

community better– Counselors should treat the farmer customers

just as any other customer and be fair to them– AgrAbility expects funding for the customers

as per recommendations given after assessments

AgrAbility expectations from VR

Some common themes– If funding is an issue, AgrAbility would like to

look out for other options for funding and hence they would like to be informed

– Assistance to the customer in a timely manner– Work as a team with the VR counselor

AgrAbility expectations from VR

Not so common themes• VR counselors should communicate effectively,

• Be open to discussions and not merely say ‘no’ and dispense the case

• VR counselors should visit the farm with AgrAbility

• Provide customers with options to choose from

• Trust AgrAbility and the assessments given by them

• One point of contact in VR who knows farming rather than a range of VRCs who don’t know farming culture

VR expectations from AgrAbility as understood by AgrAbility staff

3 states did not respond to this question

Most common theme - VR expects them to give quality assessment reports prepared in a timely manner and submitted with as much details and clear recommendations

VR expectations from AgrAbility

AgrAbility should know the VR limitations and make recommendations that can be acted upon easily

VR counselors expect AgrAbility staff to determine if a customer is a good fit for VR before making referrals/recommendations

VR expectations from AgrAbility

In some states VR expects AgrAbility staff to provide all services starting from referral, assessment, recommendations, vendor identification, estimates, inspections and customer follow up

VR wants AgrAbility to understand that the farmer is one of the customers and there are others to be also served

VR expectations from AgrAbility

Give training to rural VR counselors;

Provide advocacy and customer followup;

Treat VR with respect;

Keep contractual obligations;

Continue the current relationship of referral and recommendations

VR expectations from AgrAbility

It is apparent that having a contract or memorandum of understanding (MOU) may pave the path towards more effective collaboration between VR and AgrAbility and carry out the work more smoothly

Enhancing VR – AgrAbility Relationship

Work as a team where VR counselors visit the farm along with AgrAbility staff

Training for VR counselors

Have an MOU or contract

AgrAbility be considered as the preferred partner for AT services

Enhancing VR – AgrAbility Relationship

Highlight success stories to VR management

Leadership in AgrAbility and management team in VR to have more interaction

Success stories! - ColoradoTurned around the VR relationship into a positive one through several years of persevering interaction

Visited other states with successful operations to understand

Invited management level VR rep. on advisory board

VR rep. an advocate for AgrAbility

Easterseals Director of Employment Services and State VR Director keeps good relationship

AgrAbility presents workshops across state for VR counselors, professionals and farmers where VR counselors are also involved

Pay from VR for services of AgrAbility staff

AgrAbility staff maintains strong healthy relationship with VR – conducts farm visits together

Success stories! - GeorgiaAgrAbility conducts workshops where professionals and farmers are invited– VR counselors make presentations on VR process

– AT specialists make presentations on AT

– AgrAbility staff on AgrAbility functions

– Interaction through this process a win-win for all stakeholders

Unique experience of customer appeal http://www.farmagain.com/bobberry.html– VR counselor and AT specialist were supportive to win the case– Committee had taken an earlier decision without knowing all the facts and

director AT services came to support the customer.– Relationship did not strain because of appeal

Success stories! - MinnesotaEasterseals and Goodwill part of one organizational structure

Relationship with VR formalized through MOU in 2008

The previous good relationship formalized through MOU.

Smooth relationship

Strength in working as a team – VR, AgrAbility, farmer all on same page from start

Success stories! - Missouri

MOU signed. Fee for services in effect from 2009 onwards

VR contact point at manager level who looks into all AgrAbility customers and resolves issues

AgrAbility conducted focus group of AgrAbility staff, farmers, VR personnel, OT, PT and social workers about relationships and the report discussed with VR management.

Success stories! - Oklahoma– AgrAbility legislated in the state funding (OK AgrAbility

Act of 2007) appropriation and funds are expected to be channeled through VR

– MOU is in effect for 4 years

– Pay for services from October 1 through a contract in place with VR.

– Point of contact in VR.

– Committee of 2 VRCs & VSCs, VS AT Specialist and AgrAbility staff

– Two documents under preparation for VR Intranet• ‘“Guidance on VR services for Farmers and Ranchers” • “Agriculture for life “

Success stories! - Vermont

40 years of work with VR – RAVR, partnership funded by VR and part of UVM Extension program in Vermont from 1968 onwards

Agricultural clients routed through RAVR for VR services

AgrAbility and RAVR has close cooperation and

Three state offices for RAVR & staffed by professionals

RAVR and AgrAbility staff meet regularly to discuss customer issues and solutions

Success stories! - WisconsinUnique model under operation

Four levels of AgrAbility staff

– Intake and client file management - Extension outreach specialist

– Case management - Experienced ex-VR counselors work part time as coordinators for AgrAbility customers (organize documentation, procedural steps, follow up). Works from home with laptops and cell phones. Do not visit sites, but recommends assessment if needed

– Worksite assessments & reports - Rehabilitation specialists doing on-site evaluation, inspection

– Evaluation – Staff conducting surveys and data analysis.

Networking and educational activities

Resolving conflicts on an ongoing basis

Provides staff with resources to work

– weekly agricultural newspapers/digests to keep staff updated

– Uses medical websites like webmd.com to understand customer disabilities

Thank you!

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