Survey Results of
Vocational Rehabilitation
&
AgrAbility Relationships
Presented by
Samuel N. Mathew
National AgrAbility Project
August 27, 2009
Basic Webinar Instructions
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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
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 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
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
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! - 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
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
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
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! - Wisconsin
Unique 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!
4?s