Cross-Referrals and Complementary Services -- Sparks, Nevada

The goal of this informal collaboration in a mixed urban/rural area of Nevada is to promote independence and employability. The Northern District office of the Bureau of Vocational Rehabilitation and the Northern Nevada Center for Independent Living (NNCIL) work with each other depending on the needs of the consumer. NNCIL provides necessary assistance with training in activities of daily living and in benefits, housing issues, and accessibility to other programs. The VR agency, a program of the Department of Employment, Training, and Rehabilitation (DETR) complements these services with assessments, technology, and vocational training to improve and develop the employability of the consumer.

This collaboration is based on an informal agreement to provide services where there is a gap in a person's life. The VR agency and NNCIL have a mutual understanding of the potential benefits and complexities of each type of service and will refer to the agency most qualified to handle the issue. Six NNCIL staff devote substantial time to assisting VR consumers, and all eight VR counselors in the district office are involved regularly in developing rehabilitation programs for NNCIL consumers.

NNCIL and the VR office have conducted cross-referrals for several years, but the present level of close communication and collaboration has just developed since 1998.

Program Approach

The interagency effort is meant to maximize the quality of service consumers receive, ensuring higher success for the individual than he or she would attain from receiving services from only one agency. As a basic model of interagency cooperation, the NNCIL/VR relationship is characterized by:

• A joint focus on the consumer's vocational goals;
• Addressing mutually recognized local needs and gaps in services and barriers to employment;
• An explicit willingness to eliminate "red tape" in each other's agencies;
• An ongoing effort to avoid duplication of services; and
• A willingness and ability of staff at the VR agency and ILC to work together despite differing organizational goals and service delivery approaches.

Problem or Need Addressed

The collaboration addresses the problem of duplication of services between VR and NNCIL and competition between the two agencies. The goal is to eliminate competition by providing complementary services for individuals with disabilities that promote both independence and employability. Approximately 20% of individuals served by the project are identified as underserved, including Hispanic, Native American and African American minorities, as well as individuals with HIV/AIDS and individuals with autism. About 82% of consumers receiving collaborative services are individuals with severe levels of disability.

Program Processes

At present, there is no contract or other written agreement between VR and NNCIL specifying relations of the collaboration. Although the collaboration is informal, staff at both agencies are experienced in rehabilitation services and believe they have a very good understanding of what the other provides, and thus can make referrals to help consumers get the types of services they want or need.

Collaborative activities take place on multiple levels. The predominant activity is cross-referral for complementary services. For example, some VR consumers are actively seeking employment, but lack social and recreational skills; VR refers these consumers to NNCIL, which runs a recreation program. Individuals who have taken NNCIL's classes in basic computer literacy can use their new skills at VR's "one-stop shopping" center where they use computers to search for employment opportunities and receive additional computer skills training. Consumers who complete their IPEs and have their cases closed by VR after 90 days may be referred to NNCIL for job retention services.

Both agencies collaborate in outreach efforts by distributing each other's brochures at their offices. They take part in producing an annual "Abilities Fair." Individuals who attend this event can speak with staff from NNCIL, VR, and other participating community agencies.

Finally, VR has helped support NNCIL by holding a "silent auction" and donating the proceeds to the ILC, and by providing NNCIL with use of VR's recreation equipment and vehicles.

Consumer choice plays the major role in the individual's plans for both independent living services and VR services. In addition, consumers have the opportunity to participate at the level of program direction. Of the 18 Directors on the Board at NNCIL, six are consumers of the agency. DETR maintains a statewide Vocational Rehabilitation Council which is comprised of administrators and consumers who review goals and objectives of the VR office.

Both the VR agency and NNCIL conduct satisfaction surveys. VR sends out its survey, which includes measures of satisfaction with community provider services, from 30 to 60 days after services were rendered. NNCIL conducts its surveys after six months of services provided and also conducts an annual survey, then uses the collected information to establish goals for the next year.

To accommodate those consumers with the social barriers of immigration status and limited education, VR and NNCIL network with other community agencies, governmental agencies and school systems. The Deaf Resource Center maintains a digital camera that is linked to two other towns in the state so that Deaf or hearing impaired individuals have a way to communicate in long distance settings.

The collaboration serves approximately 20% of the VR agency's consumers who are members of the local target population, and about 25% of NNCIL's consumers.

Collaboration History and Funding

Collaborative relationships between the two agencies started several years ago and chiefly involved referral of consumers from one agency to the other. However, the relationship was not always an amiable one, as NNCIL and VR advocates and counselors often had differing opinions concerning their priorities for helping consumers. In 1994, DETR provided funding for an NNCIL staff position located directly in the VR office. This staff member was regarded as a liaison between the two agencies by speaking with consumers, helping them determine their barriers to employment, help resolve those issues, and then refer them to VR counselors. After DETR de-funded the position, NNCIL picked up the funding, although the staff member was no longer housed at the VR office.

Within the last year, both agencies have worked to resolve residual feelings of mistrust. Although the improved cooperation is attributed in part to a change in staffing at both agencies, it is also driven by a decrease in funding for both agencies. Both agencies see positive communication and teamwork as necessary to maintain a high level of services for consumers.

There is no budget for the informal collaboration. In-kind support of an estimated $10,000 annually comes from other public agencies such as SSA, the local welfare department, and the local Housing Authority, who provide information, training, and consultation to NNCIL staff at no charge.

Staffing

The collaboration involves several staff from both agencies. NNCIL contributes an independent living advocate who assists consumers with filling out benefits forms, helps students with transition plans, and provides ADA technical assistance, housing, and appeals processes among other services; transportation specialists who provide paratransit evaluations and mobility training; a deaf services advocate; a community advocacy coordinator; a recreation coordinator; and a home modification specialist. VR contributes a majority of staff to the collaboration with 8 part-time vocational rehabilitation counselors, a rehabilitation supervisor and a recreation coordinator.

Outcomes

From July 1998 through June 1999, approximately 50 consumers out of 150 served by collaborative activities were placed in jobs, a majority of them with full-time employment. After 90 days, 100% of these consumers still held their jobs.

Due to the informal nature of the collaboration, however, no statistics are available concerning the average number of hours worked per week or the median wage earned per hour.

Quality of Collaboration

Though in the past few years there was little trust or agreement between the staff at VR and NNCIL, efforts toward open communication and cooperation have created a stable collaborative relationship between the two agencies. Both currently acknowledge their confidence in the other's commitment to the collaboration and quarterly meetings are held during which representatives from both agencies discuss concerns and progress regarding their collaborative efforts.

At present neither agency anticipates a change in their level of staffing, though NNCIL hopes to add another independent living advocate to its staff sometime within the next year. The collaborative effort receives no direct funding. However, NNCIL has written a recreation grant request to RSA for possible funding over a 3-year period. Until news concerning the request is received, VR anticipates continuing in-kind support to NNCIL.

For more information, contact:

Mary Jean Thomsen
Community Advocacy Coordinator
Northern Nevada Center for Independent Living
999 Pyramid Way
Sparks, Nevada 89431

Voice/TTY: (775) 353-3599 /
1-800-552-5588 (in NV)
Fax: (775) 353-3588
mjnncil@yahoo.com

Sandra Kell, Vocational Rehabilitation
Supervisor
Department of Employment, Training, and Rehabilitation
1325 Corporate Blvd.
Reno, Nevada 89502

Voice: (775) 688-1480
Fax: (775) 688-2598