1998 Community Assessment

Developmental Disabilities

A. Issue Summary

B. Background and Influencing Factors

C. Outcomes and Key Indicators

• Increased numbers of people with MR/DD getting timely transportation
• Increased numbers of people with MR/DD who begin using fixed bus routes or alternate transportation
• Increased numbers of people with MR/DD participating in fulfilling day activities
• Increased numbers of people with MR/DD employed in the community
• Increased number of people with MR/DD obtaining housing
• Increased number of people with MR/DD and their families receiving respite care services

D. Terms, Concepts and Definitions

A. ISSUE SUMMARY

Vision Statement: "Travis County will be a community where people with mental retardation and other developmental disabilities and their families have a comprehensive and flexible array of choices that support their ability to live and participate in the community with all rights and opportunities afforded to all people."

Strategies for Building a Stronger Community: A Community Guide

The key findings regarding the Mental Retardation/Developmental Disabilities are:

• Transportation Services for Special Populations. Eleven percent of Capital Metro riders use Special Transit System services. This percentage has remained constant over the last couple of years. However, this data does not include information on users of fixed routes.
• Employment Services for Individuals with Mental Retardation. Between 1995 and 1997, the Austin Travis County Mental Health and Mental Retardation Center (ATCMHMR) doubled the number of clients with mental retardation for whom employment and training programs were provided. The percentage of Texas Rehabilitation Commission (TRC) clients receiving employment services has declined since 1995 for most disability groups. TRC job placements have remained low for three fiscal years while the average weekly income increased 507%, from $53 to $269 for TRC clients.
• Housing for Special Populations. The number of Travis County residents who are disabled and live in public housing has remained virtually the same between 1995 and 1997. No information is available on individuals who live with family members or independently in conventional housing.

Although progress has been made in the communitys understanding of the overwhelming problem of helping those with mental retardation and developmental disabilities, more work needs to be done. Data from local public and private agencies can help to identify the problems, to assess the progress made and to solve the difficulties that remain.

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B. BACKGROUND AND INFLUENCING FACTORS

Importance to the Community

An estimated 18,661 individuals with mental retardation lived in Travis County in 1997 (ATCMHMR, 1997). Most have a diagnosis of mild retardation (15,927 persons); the remainder have a diagnosis of severe/profound or moderate mental retardation (2,734). Approximately 87% of persons who have mild retardation can, with appropriate support, live and work independently as adults. The remainder can lead satisfying lives with appropriate early intervention, education, and support, although they cannot function with complete independence as adults.

Unfortunately, Texas ranked 45th in 1990 (the last year for which figures are available) in providing integrated employment for individuals with MR/DD; with only 7.35% of individuals with MR/DD receiving integrated employment services. The Texas Department of Mental Health and Mental Retardation funds services for all persons with severe/profound mental retardation, for one out of four persons with moderate retardation, and for one out of ten persons with mild retardation. Statewide, approximately 33% of persons in the severe/profound population go unserved. In FY1996, ATCMHMR assisted a total of 1,395 individuals who fit this population, while approximately 400 individuals were on the waiting list for Home and Community-Based Waiver Services, a Medicaid waiver program which provides a comprehensive array of services and supports for individuals with mental retardation.

For Fiscal Year 1997, the Texas Rehabilitation Commission (TRC) served 547 individuals with autism, borderline intellectual functioning, cerebral palsy, and learning disabilities. Of these, 98 individuals were successfully employed for at least 60 days, and their TRC cases were closed. Yet the vast majority of developmentally disabled individuals who wish to be employed do not successfully find and keep a job.

A 1996 study by the Community Action Network found that individuals in the MR/DD population often felt frustrated by the red tape that impeded their access to services, by the lack of interpreters to communicate their needs, and by a sense of indifference from policymakers and caregivers. Barriers to service are a major problem for this population in their effort to live independently and productively.

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C. OUTCOMES AND KEY INDICATORS

The Community Action Network has developed the following key indicators to assess progress in this area:

• Increased number of people with MR/DD getting timely transportation
• Increased number of people with MR/DD who begin using fixed bus routes or alternate transportation
• Increased number of people with MR/DD participating in fulfilling day activities
• Increased number of people with MR/DD employed in the community
• Increased number of people with MR/DD obtaining housing
• Increased number of people with MR/DD and their families receiving respite care services
• Increased number of children with MR/DD showing improved development
• Increased satisfaction with services for people with MR/DD and their families
• Increased number of employers satisfied with the performance of employees with MR/DD
• Increased number of people with MR/DD with internships leading to paid employment
• Increased number of employers participating in job placement for those with MRDD
• Increased hours of employment for people with MR/DD
• Increased number of persons with MR/DD with adequate health insurance
• Improved crisis intervention time for persons with MR/DD
• Increased number of people with MR/DD participating in community social and recreational activities
• Increased wellness of persons with MR/DD (as reported by people with MR/DD, their families and physicians)
• Increased numbers of families with improved knowledge and skills (for use in caring for persons with MR/DD, especially for those with extreme behaviors)
• Increased numbers of people with MR/DD and their families with access to adequate support systems
• Improved child care services for families with children with MR/DD
• Increased numbers of people with MR/DD who receive housing-related services

The six outcomes for which reliable, timely data could be obtained are listed below. They will be discussed in this section:

• Increased numbers of people with MR/DD getting timely transportation
• Increased numbers of people with MR/DD who begin using fixed bus routes or alternate transportation
• Increased numbers of people with MR/DD participating in fulfilling day activities
• Increased numbers of people with MR/DD employed in the community
• Increased number of people with MR/DD obtaining housing
• Increased number of people with MR/DD and their families receiving respite care services

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OUTCOME: Increased number of people with MR/DD who begin using fixed bus routes or alternate transportation

OUTCOME: Increased number of people with MR/DD getting timely transportation

Transportation issues directly affect the level of self-sufficiency of individuals with MR/DD. Capital Metro ridership statistics identify the number of people with developmental disabilities that obtain transportation services in a timely fashion. Special Transportation Services (STS) is a para-transit service for the mobility-impaired. STS is required for all transit authorities in the U.S., through the Americans with Disabilities Act (ADA). STS is intended to provide individuals with disabilities, including individuals with MR/DD, the same access to public transit services that non-disabled individuals have. While STS services take an individual from home to his final destination, they must be scheduled eight days in advance. This makes them inconvenient and totally unavailable for emergencies. On the other hand, door-to-door transportation offers fares that are identical to fixed route services (60 cents per ride). STS is operated in two different ways: van services (minibuses) and Capital Metro contracts with local cab companies.

Figure 4.10.1

Breakdown of Population Served by Capital Metro

Source: Oral communication from Capital Metro, 1997.

According to Capital Metro, 11% of riders with MR/DD use STS services in Austin. The percentage of total registered riders that fall into the MR/DD category has remained constant over the last couple of years. Regrettably, there is no data available on rider satisfaction with STSs services, timeliness, or cost.

Statistics in Figure 4.10.1 do not account for two subpopulations: 1) persons with MR/DD who have independent means (modified vans) or a support person to transport them to their final destination, or 2) persons with MR/DD who are transported through Independent Living Services by other agencies such as United Cerebral Palsy.

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OUTCOME: Increased number of people with MR/DD participating in appropriate, meaningful day activities

There is not adequate data to assess the outcome in this area. However, an indirect indicator has been identified that might help determine the levels of participation in meaningful day activities: people with MR/DD problems receiving supported employment services.

Figure 4.10.2

Number of Austin/Travis County Mental Health and Mental Retardations Clients Participating in Meaningful Day Activities

1997

Source: Austin/Travis County Mental Health Mental Retardation Services, IDEA Unit, 8/7/98.

Figure 4.10.2 identifies the number adults served in employment and training services. These services include both vocational activities for clients seeking work and nonvocational activities for clients who do not work. Clients are given vouchers for choosing programs in which they wish to participate.

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OUTCOME: Increased number of people with MR/DD employed in the community

The Texas Rehabilitation Commission (TRC) provides vocational rehabilitation, extended rehabilitation and independent living services, as well as assistance in obtaining Social Security disability benefits.

The Vocational Rehabilitation Program helps people who have physical or mental disabilities to seek and secure employment. This program helps people with disabilities increase their productivity and independence by teaching job interview and working skills and helping to obtain necessary accomodations.

Services are based on individual needs and include: a) Medical, psychological and vocational evaluation to assess the disability and the client's capabilities; b) Counseling and guidance to plan vocational goals and secure employment; c) Training for job skills; d) Medical treatment and therapy for the disability; e) Devices to improve function on the job or at home; f) Training to learn skills to find and keep jobs; h) Job placement assistance to find jobs that match the person's physical and mental abilities.

Figure 4.10.3

Texas Rehabilitation Commission Clients Receiving Supported Employment Initiatives

Travis County

* Clients screened and eligible for services
Source: Texas Rehabilitation Commission.

Figure 4.10.3 shows that the percent of TRC clients receiving supported employment has declined since 1995 for most disability groups, with the exception of clients with mental retardation. Among clients diagnosed with autism, the percent has returned to its 1995 status. However, the number of clients with autism that are being served is so small that any conclusions must be drawn with caution.

Figure 4.10.4

Number of TRC Clients Employed for 60 Days after Completion of Services

Travis County

* Successful closures in which the client has stayed on the job for 60 days.
Source: Texas Rehabilitation Commission.

One of the most important performance measures set by TRC is the percentage of clients placed on a job who remain working over 60 days. This measure is found in Figure 4.10.4 for three fiscal years, 1995, 1996 and 1997. Job placements for eligible clients for whom a plan was initiated has remained low for the last three fiscal years. Individuals with severe disorders such as autism show zero placements. Individuals with Cerebral Palsy, on the other hand, have shown a slight increase in successful placements since 1995. In general, the percent of clients with learning disabilities and mental retardation that were placed in jobs remained relatively steady between 1995 and 1997.

According to the United Cerebral Palsy Association of the Capitol Area, Inc., it costs approximately $10,000 to vocationally train someone with severe and multiple handicaps, to find them a job, to make the physical modifications to their workspace to allow them to work, to coach them on that job, and to keep them employed at least sixty days. The low success rate for keeping clients on a job for more than 60 days is a special source of concern. It suggests that much more remains to be done this area.

A second measure of success is the average weekly income earned before and after vocational rehabilitation services are rendered. In 1995, TRC clients residing in Travis County increased their earning by 407%. Before services were rendered, the average weekly income was $53. After services, the average weekly income was $269.

ATCMHMRs NOW Services offers an array of employment services to individuals with mental retardation or autism. Such services provide work orientation, skills training, job placement, and community-integrated employment sites. Figure 4.10.5 shows the number of Travis County residents who are satisfied with the services they received through ATCMHMR.

Figure 4.10.5

ATCMHMRs Clients Satisfied with Employment Services, 1995 and 1997

Travis County

Source: ATCMHMR, Quality Management, Program Evaluation and Research, Customer Satisfaction Report for FY95 and FY97. No data are available for 1996.
* Period: September 1994 - August 1995
** Period: January - December 1997

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OUTCOME: Increased number of people with MR/DD obtaining housing

Figure 4.10.6

Individuals with Disabilities Living in Public Housing Units

Source: Housing Authority of the City of Austin.

The number of disabled or handicapped Travis Co. residents living in conventional public housing showed a small increase between 1995 and 1997. However, just looking at the number of individuals with handicaps who live in public housing oversimplifies the problems these individuals have finding living space. Many individuals must live with family or friends; a substantial number of others live on their own in unsubsidized housing. This group is impossible to track, as no data is available on them.

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OUTCOME: Increased number of people with MR/DD and/or families receiving respite care services

Very little data is available to show trends or current conditions of respite care services provided to Travis County residents with MR/DD. The data that exists is from ATCMHMR for clients with mental retardation.

Figure 4.10.7

Respite Care in Travis County for Persons with MR/DD, FY1998

Source: Oral communication with The ARC of Texas, 8/10/98.

Although respite services are very much in demand, the supply is extremely limited. For example, ATCMHMR stated that the waiting list for their respite services FY97 (9/1/96-8/31/97) was 493 children and adults. In FY98 (9/1/97-8/6/98), it was 145 children and adults. However, in FY98, ATCMHMR was only able to provide respite services to 72 individuals, at a cost of $72,000.

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D. TERMS, CONCEPTS AND DEFINITIONS

Mental retardation: a diagnosis of mental retardation based upon the assessment of subaverage general intellectual function, adaptive behavior limitations and developmental deficits that appear during the first 18 years of development.

Developmental disabilities: severe, chronic disabilities attributable to a mental or physical impairment or combination of mental or physical impairments that result in substantial limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency.

Adaptive behavior: degree to which a person meets the standards of personal independence and social responsibility expected of the persons age and cultural group.

Development period: Period before the age of eighteen.

TRC's Independent Living Services: Independent Living Services at the Texas Rehabilitation Commission is a program which involves people with disabilities in making choices about living how they live, with the goal of teaching them to live independently. People with all kinds of severe disabilities (except for the blind or visually impaired who are served by the Texas Commission for the Blind) are eligible for Independent Living Services at TRC. Services are available through Texas Rehabilitation Commission offices in Amarillo, Austin, Crockett, Dallas, El Paso, Fort Worth, Houston, the Lower Rio Grande Valley, Lubbock and San Antonio.

Goals for people with disabilities in Texas seeking independent living services include, but are not limited to:

• Independent living in an apartment
• Decreased dependence upon family members
• Decreased need for attendant services
• Decreased need for supervision in daily living activities
• Increase in self-directed life-style
• Improved ability to perform activities of daily living
• Improved mobility
• Improved communication ability
• Improved personal/social adjustment

Some independent living services at TRC contribute directly to independent living objectives, while others help to support direct services. Independent living services include:

• Counseling and guidance
• Training and tutorial services
• Adult basic education
• Rehabilitative training
• Technological aids for people who are deaf
• Vehicle modification
• Artificial limbs, braces, wheelchairs, hearing aids and other devices to stabilize or improve function
• Other services needed to achieve independent living objectives, such as transportation, interpreters and maintenance sources

Vocational Rehabilitation (VR): Services that help people with disabilities to find and keep jobs. A persons eligibility for services depends upon his or her individual needs. The client is helped to choose appropriate services, service providers and attain desired vocational objectives.

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