Assistive Technology and Fee-for-Service Independent Living Skills Training -- Honolulu, Hawaii

Overview

This formal collaboration between the Hawaii Centers for Independent Living (HCIL) and the Hawaii State Division of Vocational Rehabilitation aims to build a model of integrated service delivery for people with severe disabilities preparing to enter the workforce. There are two components to the collaboration: a fee-for service component and the Statewide Independent Living/Independent Living Plan (SILC-ILP) program. Through the fee-for-service component, HCIL staff members provide independent living skills training for VR consumers to help them achieve better outcomes on their IPEs. After conducting an initial assessment, HCIL staff works with the consumer to develop a customized curriculum with desired outcomes specified for each skill area.

The SILC-ILP component also provides an array of independent living services, but focuses on assistive technology and home accessibility. It mostly serves consumers with very involved disabilities who have not yet entered the VR system, and is meant to prepare these consumers for participation in VR services when IL services are close to completion.

Eight part-time independent living specialists provide services for the two programs. The fee-for-service component has been operating for two years, while the SILC-ILP collaboration began a year and half ago. Most consumers served by the two programs are Asians and Pacific Islanders, all have severe disabilities, and half live in remote rural areas.

Program Approach

The interagency approach is to demonstrate how organizations using their resources in tandem can build on the resources of one another, better integrate their services, and cooperatively address service gaps for consumers with "hard to serve" disabilities. Significant features of this program are:

• Focusing on the total needs of the consumer; and
• Targeting hard to serve populations.

While the fee-for-service component addresses the concurrent independent living and vocational goals of VR consumers, the SILC-ILP component is concerned with helping individuals become prepared to participate in the VR program.

Problem or Need Addressed

The collaboration addresses a need for an integrative approach to providing independent living and vocational training services in order to overcome the disjointed single agency efforts that segment consumers. One hundred percent of the consumers served by the collaboration are identified as being underserved due to the minority ethnic backgrounds characterizing the target population, including Asian, Pacific Islander, Hispanic, and Latin American. Also, 100% percent of the consumers served are identified as having "significant disabilities."

Program Processes

Both components of the collaboration operate under contracts between DVR and HCIL In the fee-for-service program, the consumer and HCIL staff map out a training schedule with specific skills outcomes identified. The schedule is then presented to the DVR counselor with fee rates and is implemented following approval. The independent living program focuses on home accessibility and assistive technology, helping consumers obtain successful independent living and providing a foundation capacity for eventual vocational planning and return to work.

The majority of outreach conducted is through the extensive network between HCIL and other community agencies. HCIL relies mostly upon referral of new consumers from present or past consumers and other agencies' recommendations.

Consumers drive the delivery of services at HCIL in all phases. Not only do they largely self-direct their personal service delivery, but they also have the opportunity to serve in HCIL's consumer based management, which monitors the independent living program's contract. Consumers are provided with a satisfaction survey upon request and when goals are changed or accomplished. Survey results are used to discuss the quality of service provided.

To accommodate the needs of consumers who are not proficient in English, HCIL employs several staff with multi-lingual capabilities. In some instances, other non-profit organizations provide translation services.

The collaborative activities serves approximately 5% of the state VR agency's consumers who are members of the target population, and about 16% of HCIL's consumers.

Collaboration history and funding

Both DVR and HCIL believe the foundation for collaboration has existed since the inception of HCIL. DVR has supported HCIL's independent living activities by offering its administrative expertise, helping the organization get started, and by agreeing to support consumer choice. The fee-for-service program was initiated in 1997 in response to the recognition by both HCIL and DVR that consumer services were too segmented between the two agencies. To better coordinate consumers' concurrent needs for IL services and vocational services, the DVR Administrator developed an RFP for an independent agency to provide IL skills training for people undergoing vocational training. HCIL applied for and won a portion of the contract, provided in-service training for DVR counselors, and cultivated individual working relationships with staff.

The independent living program began six months later in order to address the needs of consumers who could not enter community pre-vocational programs due to basic skill deficiencies. The assistive technology component had operated as a DVR-run service under Title VII, Part B. DVR turned operation of the program over to HCIL in order to expand the program across the state. Later, HCIL was awarded a contract to address the needs of consumers who could not enter community pre-vocational programs due to basic skills deficiencies. This program's services utilize assistive technology and home accessibility modifications to help consumers become more independent in their daily lives and better prepared to enter pre-vocational training.

For 1999, total program funding was $315, 550, approximately 50% of which is used for direct service costs and purchases of goods and services for consumers of the collaboration. Annual in-kind support of about $25,000 is provided from other public agencies.

Staffing

In addition to several DVR counselors and administrators, the collaboration involves several part-time staff from HCIL including the executive director, deputy director and eight independent living specialists.

Outcomes

As this collaboration does not focus on directly placing consumers in employment positions, measures of success are defined as by consumers' functional increase in ability to sustain daily living activities as prescribed by the consumer-defined goal plan. The corollary goal is to transition consumers with significant disabilities into the VR program and success is measured by the participation in DVR's services. No data for independent living or employment outcomes are available.

Quality of Collaboration

Both HCIL and DVR believe the collaboration has achieved a level of coordination that results in a higher degree of integrated services. Despite differences in program philosophies and politics, HCIL reports a high level of trust in DVR's commitment to the efforts of the collaboration and complete fulfillment of DVR's responsibilities to the collaboration.

Although there was some wariness on the part of front-line VR staff in the collaboration's early phases, the collaboration is rooted in historically cooperative relationships, with DVR assisting HCIL in its formation. HCIL identifies DVR's willingness to support consumer choice as integral to their stable relationship, and DVR credits HCIL with a willingness to share administrative information and to listen to the needs of VR counselors. Both agencies express a respect for the other's work despite clear differences in program philosophy and service approach. They see their program goals and services as complementary, with HCIL regarding DVR as another "customer" for its services.

The collaborating agencies exchange information through quarterly meetings, which have been the source for increasing collaborative efforts. Communication is also maintained through telephone calls that occur, on average, four to five times per month. The collaboration anticipates that the level of staffing as well as primary funding will remain constant in the near future.

For more information, contact:

Mark T. Obatake
Executive Director
Hawaii Centers for Independent Living
414 Kuwili St., Suite 102
Honolulu, Hawaii 96817

Voice: (808) 522-5400
Fax: (808) 522-5427
mobatake@DiverseAbilities.org

Web site: http://www.hcil.org

Neil Shim
State Administrator
Hawaii State Division of Vocational Rehabilitation
601 Kamokila Blvd, 8515
Kapolei, Hawaii 96707

Voice: (808) 692-7719
Fax: (808) 692-7727
nshim@dhs.state.hi.us

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