An Overview of the Department of Assistive and Rehabilitative Services (DARS)

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1 An Overview of the Department of Assistive and Rehabilitative Services (DARS) House Committee on Human Services Veronda L. Durden, Commissioner September 3, 2014

2 Mission and Responsibilities Mission To work in partnership with Texans with disabilities and families with children who have developmental delays to improve the quality of their lives and to enable their full participation in society DARS provided services to more than 560,000 Texans in FY of those, about 230,000 received direct services and another 330,000 were social security disability claimants. Our services are time limited and intended to eliminate or reduce the need for ongoing supports from other public benefits and services. We employ more than 2,800 staff who are located in 146 field offices around the state. 2

3 DARS Organization 3

4 DARS Programs Early Childhood Intervention Early Childhood Intervention (ECI) serves children birth to 36 months of age and their families in all Texas counties through 51 local contractors. ECI eligibility is based on a: Medically diagnosed condition, Developmental delay, or Hearing or visual impairment. ECI services enhance the development of infants and toddlers with disabilities and minimize their potential for developmental delay. The services: Are based on an individualized plan developed by a multidisciplinary team Are family-centered and delivered in familiar settings Include assistance to transition to the public school system Reduce educational costs by minimizing the need for special education services as children with disabilities reach school age 4

5 DARS Programs Autism Program Autism Spectrum Disorder (ASD) is the fastest-growing serious developmental disability in the United States. The Autism Program serves children with autism through contracts with community organizations in six areas of Texas Dallas, Ft. Worth, Houston, Rosenberg, Austin, and San Antonio. DARS will be expanding into El Paso and one other unserved area of the state in FY The Autism Program serves children who are: Three through fifteen years of age Have a diagnosis on the autism spectrum Are Texas residents Services include applied behavioral analysis (ABA) and other positive behavior support strategies in both individual or group settings. HHSC Executive Commissioner Janek directed transfer of the support for the Texas Council on Autism and Pervasive Developmental Disorders (Autism Council) and the Texas Autism Research and Resource Center (TARRC) from DADS to DARS effective September 1,

6 DARS Programs Autism Program The TARRC was created by H.B. 1574, 81 st Legislature, Regular Session, 2009, to coordinate resources for individuals with ASD and their families. The center s primary purposes are to: disseminate information and research on ASD; conduct training and development activities for persons who may interact with an individual with ASD in the course of their employment; coordinate with local entities that provide services; and provide support to families affected by ASD. DARS will create an Office of Autism Services which will bridge the gap between the services of the TARRC, DARS programs, and other state agencies serving Texans with ASD with the policy and service coordination mandates of the Autism Council. Consolidating autism services at DARS will increase the visibility of the function and consumer access to services. Current staffing and funding levels would remain the same. 6

7 DARS Programs Blind Children s Vocational Discovery and Development Program The Blind Children s Vocational Discovery and Development Program (BCVDDP) serves children, birth through age 22 who have a severe vision loss, and their families. The goal of the program is to ensure that children with a severe vision loss start early in developing the skills necessary to eventually lead independent and productive lives. The BCVDDP: Provides tools, equipment, and training to help children develop the confidence and competence needed to be an active part of their community Works closely with schools to monitor the child s progress Provides training in food preparation, money management, recreational activities, grooming, and other daily living activities Provides information and referral to families about other resources, including vocational rehabilitation 7

8 DARS Programs Vocational Rehabilitation The Vocational Rehabilitation (VR) Program assists Texans with preparing for, finding, and maintaining employment. The VR Program serves consumers who: Have a physical, mental, or visual disability that is a substantial impediment to employment Require VR services in order to obtain or keep a job Are presumed to be able to benefit from services VR services include: Counseling and guidance to plan and achieve vocational goals Training to learn job skills and appropriate work behaviors Training in skills of daily living for individuals who are blind or visually impaired Treatment and/or therapy to lessen or remove the disability Assistive and rehabilitation technology devices to improve functioning 693 VR Counselors, located in DARS field offices across the state, provide direct services to consumers. As part of the VR Program, counselors also provide transition planning services to eligible students with disabilities to assist with the transition from high school to work, training or higher education. The Criss Cole Rehabilitation Center (CCRC) is a residential facility in Austin providing intensive training for VR consumers who are blind or visually impaired to develop the confidence, skills, and techniques needed to prepare for, find or maintain employment. 8

9 DARS Programs Business Enterprises of Texas Business Enterprises of Texas (BET) licenses persons who are blind to operate vending and food service facilities on federal, state, and other properties. The program is carried out under the authority of the Randolph- Sheppard Act (1936). BET operates approximately 120 businesses. Facilities include: Lackland Air Force Base (San Antonio) Internal Revenue Service snack bar (Austin) NASA Snack Bar (Houston) Alfred Hughes Prison Vending (Gatesville) 9

10 DARS Programs Independent Living Services The Independent Living Services (ILS) Program provides services to eligible Texans with significant physical or mental disabilities, including blindness, helping them improve their ability to function independently in their home and the community through: Counseling and guidance Durable medical equipment Rehabilitation technology Independent skills training Group training to encourage self-confidence One-on-one in-home adaptive skills training Peer support development Services are provided by DARS staff across the state. 10

11 DARS Programs Centers for Independent Living Centers for Independent Living are consumer-controlled, communitybased, cross-disability, non-residential, nonprofit organizations that: Assist consumers to live independently in their communities Decrease dependence on family members and long-term government funded programs Improve the ability to perform activities of daily living Core center services are: Information and referral Independent living skills training Peer counseling Individual and systems advocacy To be eligible for services from a center, a consumer must have a significant disability that substantially limits the ability to function independently in the home, family, or community. DARS provides funding for 15 of the network of 27 centers in Texas and currently provides services to people with disabilities in 157 counties. 11

12 DARS Programs Comprehensive Rehabilitation Services The Comprehensive Rehabilitative Services (CRS) Program helps survivors of traumatic brain and/or spinal cord injuries regain functionality and independence. CRS consumers must have a traumatic brain injury, a traumatic spinal cord injury, or both, and be: At least 16 years old A U.S. citizen and Texas resident for six months Medically stable Willing to participate in services CRS provides time-limited services through contracts with local providers and include: In-patient Comprehensive Medical Rehabilitation - Medical experts provide consumers with therapy, medical care, and other help. Outpatient Services - Therapists help consumers increase their ability to perform daily living activities. These therapies include: physical, occupational, speech, and/or cognitive rehabilitation. Post-Acute Traumatic Brain Injury Services - These services help consumers deal with forgetfulness or difficulties in solving problems and other mental or thought issues related to their injury. These services are offered on a residential (overnight stay) and non-residential basis. 12

13 DARS Programs Blindness Education, Screening, and Treatment Blindness, Education, Screening, and Treatment (BEST) provides blindness prevention services to adult Texans. BEST services include: Non-diagnostic vision screening services Treatment services for persons with qualifying eye conditions who do not have insurance or other resources to pay for services BEST eligibility treatment requirements: Referral from physician or optometrist for eye medical treatment Texas resident A qualifying eye disease Vision screenings are provided at locations across the state and, if necessary, individuals are referred to their eye care professional for treatment. 13

14 DARS Programs Deaf and Hard of Hearing Services The DARS Office for Deaf and Hard of Hearing (DHHS) works with Texans of all ages who are deaf or hard of hearing to eliminate communication barriers and ensure their equal access and participation in society. DARS contracts with community-based agencies for services around the state for individuals who are deaf or hard of hearing. These Resource Specialist Contractor services include: Providing information about and referral to community resources Helping consumers access technology and other services and programs they need to more fully participate in their communities and obtain or maintain employment Through the Board for Evaluation of Interpreters, DARS operates an interpreter certification program, which tests and rates sign language interpreters and issues certificates as appropriate. The DARS Specialized Telecommunications Assistance Program (STAP) provides financial assistance for the purchase of specialized assistive equipment or services for Texans whose disability interferes with their ability to access the telephone network. 14

15 DARS Programs Disability Determination Services Disability Determination Services (DDS) makes disability determinations for Texans with severe disabilities who apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). DDS is 100% funded by the Social Security Administration (SSA). Texans with physical and/or mental impairments apply for benefits at their local SSA field office, and their applications are forwarded to DDS, which determines whether the applicant is disabled, according to federal criteria. SSA makes the final decision about whether a person is eligible to receive benefits. 15

16 Legislative Initiatives ECI Family Cost Share Senate Bill 1, Article II, DARS Rider 28 and Senate Bill 1060 require DARS to evaluate the cost-effectiveness of the family cost share provisions of the Early Childhood Intervention (ECI) program and make changes necessary to improve cost-effectiveness of the program. Implementation Activities DARS has initiated a cross-agency project to evaluate the family cost share system. The Family Cost Share Project team is: collecting data from contractors to assess their administrative costs related to the family cost share; and, analyzing additional information such as third party collection amounts and the number of children served by county. The agency is on target to issue a report on the evaluation by December 1, 2014, as required by the statute and rider. 16

17 Legislative Initiatives ECI Family Cost Share Senate Bill 1, Article II, DARS Rider 31 required DARS to promulgate ECI rule changes to modify the family cost share amount by families with an adjusted gross income over 400% FPL. On September 1, 2013, the rules were promulgated. Changes to the family cost share schedule were effective January 1, 2014 to allow for notification to contractors and families. Families with adjusted gross income over 400% FPL now pay the full cost of services, not to exceed 5% of their adjusted monthly gross income. 17

18 Legislative Initiatives Autism Program With guidance from Senate Bill 1, Article II, Special Provisions Related to All Health and Human Services Agencies, Section 57(a), DARS developed a plan to increase the number of children served in the program. As part of the plan, DARS worked with The University of Texas at Austin (UT) to: Research evidence-based treatment modalities Analyze outcome data for children in the Autism Program Make recommendations for changes to the Autism Program to serve more children with autism while continuing to make a measurable improvement in their behavior and development To supplement research done by UT, DARS: Held public hearings in El Paso, Dallas, and San Antonio in January 2014 to obtain public input Obtained input from current Autism Program providers Performed internal research on treatment for autism, and attended numerous research and professional conferences related to autism 18

19 Legislative Initiatives Autism Program Based on the report from UT ( and other stakeholder input, DARS has modified the Autism Program for FY 2015 to offer two distinct treatment services: Comprehensive ABA Services: Serve children ages three through five treatment hours per week Maximum of 24 consecutive months Focused ABA Services: Serve children ages three through treatment hours per month Maximum of 24 nonconsecutive months Children may access services at various milestones of development In addition, DARS will pilot an innovative treatment program in FY

20 Legislative Initiatives Centers for Independent Living In accordance with the General Appropriations Act (Article II, Department of Assistive and Rehabilitative Services, Rider 30, S.B. 1, 83rd Legislature, Regular Session, 2013), DARS submitted a report to the legislature that includes: Actual and estimated number of consumers served by each statefunded Center for Independent Living (CIL) during fiscal years 2014 and 2015 Types of services provided by each CIL in fiscal years 2014 and 2015 Strategies to improve the measurement, collection, and reporting of outcome data related to CILs The Rider 30 Report is available on the DARS website: 20

21 Legislative Initiatives Centers for Independent Living Strategies to Improve the Measurement, Collection, and Reporting of Outcome Data Related to CILs Coordinate and enhance the output and outcome of data collection, measurement and reporting Improve the instructions and guidance to promote consistency in federal reporting Assess requirements of the DARS-funded CILs to meet desired outcomes Evaluate DARS independent living services to ensure they optimally complement services provided by CILs DARS will incorporate these strategies into its work implementing Sunset management recommendations related to the IL programs, seeking input throughout from stakeholders, the State Independent Living Council (SILC), CILs, and other interested parties. 21

22 Legislative Initiatives Comprehensive Rehabilitation Services Senate Bill 1, Article II, Special Provisions Related to All Health and Human Services Agencies, Section 58, required DARS to reduce the waiting list for the Comprehensive Rehabilitation Services (CRS) program. From March 2013 through April 2014, DARS conducted a project to improve cost projections and budgeting processes, increase accountability, manage the waiting list and enhance data collection and outcome measurement for CRS. In June, DARS initiated a second phase of the project that will: Implement improvements to the service delivery structure Complete a comprehensive review of research-based treatments for TBI and SCI Better define service array based on the research review Develop a uniform rate setting methodology for the CRS service array Recommend a utilization review process Propose revised outcome measures 22

23 Legislative Initiatives Deaf and Hard of Hearing Services Senate Bill 1, Article II Special Provisions Related to All Health and Human Services Agencies, 57(b) requires DARS to develop a plan with processes and procedures for how additional appropriated funds will be utilized in the DARS Office for Deaf and Hard of Hearing Services. Plan activities updates: Awarded two additional hearing loss resource specialists contracts, one each in Gulf Coast and Lower Rio Grande Valley HHS Regions. Increased the number of trainings for individuals who are interested in becoming certified interpreters and for certified interpreters interested in achieving higher levels of certification or specialty certification. Contracted with the University of Arizona to develop a court interpreter performance test and medical interpreter test in FY

24 Legislative Initiatives STAP The Specialized Telecommunications Assistance Program (STAP) provides financial assistance to individuals in the form of a voucher to purchase specialized equipment or services to access the telephone network. Prior to September 1 st, the program had been jointly operated by DARS and the Texas Public Utilities Commission (PUC). S.B. 512 transferred the responsibility of the STAP vendor activities from PUC to DARS. All implementation activities have been completed and successful transfer of operational responsibility occurred on September 1, DARS is currently promulgating new rules for operating STAP vendor activities. 24

25 FY 2016/2017 Exceptional Items EXCEPTIONAL ITEM FY 2016 FY 2017 BIENNIAL TOTAL GR All Funds GR All Funds GR All Funds 1 Maintain ECI Caseload at FY15 Levels $ 477,970 $ 708,225 $ 16,471,005 $ 24,384,453 $ 16,948,975 $ 25,092,678 2 Fund ECI Caseload FY16/FY17 Forecasted $ 5,720,091 $ 8,473,429 $ 11,765,003 $ 17,416,944 $ 17,485,094 $ 25,890,373 3 Support Texans with Autism $ 3,525,000 $ 3,525,000 $ 4,315,000 $ 4,315,000 $ 7,840,000 $ 7,840,000 3a Expand Autism Program $ 1,650,000 $ 1,650,000 $ 2,200,000 $ 2,200,000 $ 3,850,000 $ 3,850,000 3b Autism Innovative Treatment Projects $ 900,000 $ 900,000 $ 900,000 $ 900,000 $ 1,800,000 $ 1,800,000 3c Create Office of Autism Services $ 675,000 $ 675,000 $ 1,115,000 $ 1,115,000 $ 1,790,000 $ 1,790,000 3d Autism Database Enhancements $ 300,000 $ 300,000 $ 100,000 $ 100,000 $ 400,000 $ 400,000 Investing in Independence and Blindness 4 $ 2,499,728 $ 2,530,762 $ 2,939,254 $ 3,001,347 $ 5,438,982 $ 5,532,109 Prevention Expand Blind Children's Vocational 4a $ 743,228 $ 774,262 $ 970,254 $ 1,032,347 $ 1,713,482 $ 1,806,609 Discovery and Development Program 4b Expand Independent Living - Blind $ 669,000 $ 669,000 $ 669,000 $ 669,000 $ 1,338,000 $ 1,338,000 Expand Blindness Education, Screening 4c $ 937,500 $ 937,500 $ 1,250,000 $ 1,250,000 $ 2,187,500 $ 2,187,500 and Treatment (BEST) Program 4d BEST Database Enhancements $ 150,000 $ 150,000 $ 50,000 $ 50,000 $ 200,000 $ 200,000 Ensure Communication Access for People 5 $ 600,000 $ 1,300,000 $ 600,000 $ 800,000 $ 1,200,000 $ 2,100,000 who are Deaf 5a Increase Deafness Resource Specialists $ 500,000 $ 500,000 $ 500,000 $ 500,000 $ 1,000,000 $ 1,000,000 Specialized Telecommunications 5b Assistance Program (STAP) Database Redesign Board for the Evaluation of Interpreters 5c (BEI) Registry Database Enhancements Reduce the Independent Living Services General Waiting List $ - $ 700,000 $ - $ 200,000 $ - $ 900,000 $ 100,000 $ 100,000 $ 100,000 $ 100,000 $ 200,000 $ 200,000 6 $ 445,000 $ 445,000 $ 493,000 $ 493,000 $ 938,000 $ 938,000 Reduce the Comprehensive Rehabilitation 7 $ 1,325,664 $ 1,325,664 $ 1,325,664 $ 1,325,664 $ 2,651,328 $ 2,651,328 Services Waiting List Total DARS Exceptional Requests $ 14,593,453 $ 18,308,080 $ 37,908,926 $ 51,736,408 $ 52,502,379 $ 70,044,488 25