Survey Results of Vocational Rehabilitation & AgrAbility Relationships

1. Survey Results of Vocational Rehabilitation & AgrAbility Relationships Presented by Samuel N. Mathew National AgrAbility Project August 27, 2009

2. Basic Webinar Instructions • Need speakers or headphones to hear the presentation • Meeting > Manage My Settings > My Connection Speed • Dial-up not recommended • Questions about presentation – use chat window or call 800# provided at the end • Problems: 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

3. 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.

4. 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

5. 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

6. 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

7. Opinion about VR • Negative and Positive opinions • Expectations as understood by AgrAbility • from VR side about AgrAbility • About VR from AgrAbility side

8. 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)

9. 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

10. 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

11. 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.

12. 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.

13. 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

14. 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

15. 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

16. 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)

17. Highlighted point • Good and positive relationship with upper VR management highlighted by those who had pay for services

18. 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)

19. 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

20. 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.

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. Specific resources that helped AgrAbility staff to interact with VR in the past • WebMD.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

33. Specific resources that helped AgrAbility staff to interact with VR in the past • One 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. Enhancing VR – AgrAbility Relationship • Highlight success stories to VR management • Leadership in AgrAbility and management team in VR to have more interaction

45. Success stories! - Colorado • Turned 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

46. Success stories! - Georgia • AgrAbility 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

47. Success stories! - Minnesota • Easterseals 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

48. 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.

49. 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 “

50. 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