Together, the Protection and Advocacy (P&A) System and Client Assistance Program (CAP) comprise a unique nationwide network of disability rights advocates. In the 1970s, the U.S. Congress recognized that if children and adults with disabilities were to have their basic civil rights recognized and upheld, they must be provided with assistance. To this end, the first P&A program for people with developmental disabilities was established.

Over the next 30-plus years, the P&A system was expanded to include designated federally funded, federally mandated, Protection and Advocacy (P&A) systems in every state that provide legally based advocacy services under the following programs: Protection & Advocacy for Persons with Developmental Disabilities (PADD); Protection & Advocacy for Individuals with Mental Illness (PAIMI); Protection & Advocacy for Individual Rights (PAIR); the Client Assistance Program (CAP); Protection & Advocacy for Assistive Technology (PAAT); Protection & Advocacy for Beneficiaries of Social Security (PABSS); Protection & Advocacy for Traumatic Brain Injury (PATBI); and Protection & Advocacy for Voting Accessibility (PAVA). 

These eight programs may be operated in one or more agency in each of the 57 states and territories, but no matter the structure, program priorities are developed on an annual basis with consumer input, ensuring that P&A/CAP efforts continue to be "value driven" - based on the very principles of right and wrong that characterize what is best about our nation. The values that drive the actions of the P&A/CAP System ensure that all individuals with disabilities have access to a society where they enjoy equal opportunities, exercise self-determination and choice, and experience full participation in community life. This is a society where individuals with disabilities are not inappropriately institutionalized or placed in nursing homes; where children with disabilities live with their families and go to school with their non-disabled peers; where adults with disabilities find jobs with a decent wage and health care benefits; where people with disabilities find decent, safe, affordable, and accessible housing; where those with disabilities can access employment, transportation, public buildings, and private enterprises; and where individuals both with and without disabilities are equally able to exercise their rights.

The P&A/CAP systems in each state help people with disabilities and their families as they struggle to live a life based on their value system - one that includes making a better life for themselves in the community. When the P&A System was first established, the focus was on the safety and security of people who lived in institutions. Today, that focus has expanded to encompass the inclusion, safety, and security of people in the community. The move to community-based supports and services reflects well on the efforts of the P&A System - efforts that helped close down institutions and ensure that people with disabilities were no longer relegated to being "out of sight, out of mind." While the current situation is still far from perfect, more and more people with disabilities are now part of their communities.

When it works to ensure that individuals with disabilities can live with their families as children, or in their communities as adults, the P&A system in each state adheres to the values of "independence," "stability," and the importance of having a "home." P&A activity also upholds these values when its advocates work to ensure that all people living with disabilities have access to the health care and long-term supports they need to help them become more independent.

The P&A system in each state adheres to the values of "knowledge" and "empowerment" when it works to ensure that children with disabilities are welcome in day-care and pre-school settings, and have access to critical early intervention services, assistive technology, and free appropriate public education. Each of these services enables children to grow up to become contributing members of their communities. The P&A/CAP programs not only help children, but empower parents - who often have to navigate a complex educational system to obtain what is best for their children.

The values of "self-sufficiency" and "full participation" are upheld when P&A programs assist young adults with disabilities in moving from public schools to post-secondary education or the world of work. Every action taken by the P&A/CAP systems to ensure that young adults have access to effective transition services, and adults to vocational rehabilitation or other job-training services, also addresses these values, as do P&A/CAP efforts to eliminate workplace discrimination and ensure proper accommodations so individuals can be successful. All of these advocacy efforts help individuals with disabilities become self-sufficient and productive community members, free from a life of dependency and poverty.

The P&A/CAP system was born because people with disabilities needed help in advocating for their rights, safety, and security - first in institutions and now in the community. The system's core value of "human dignity" remains central to their activity so long as children and adults still suffer from abuse and neglect; are still placed in restraints - both physical and chemical; and are still dying at the hands of others in institutions, jails, and other facilities, and sometimes in the community.

Unfortunately, change takes place slowly, and communities often are not prepared to address the needs of individuals with disabilities. This lack of services contributes to the reinsitutionalization of many individuals and with growing frequency in the criminal and juvenile justice systems. The efforts of the P&A systems to ensure appropriate supports and meaningful alternatives to incarceration reflect the value of "fairness."

In the 30-plus years since its inception, the collective P&A systems have become important advocates for the right of individuals with all types of disabilities to speak for themselves. P&As are focused on assisting people with disabilities to become self advocates, thus reflecting the value of "civic participation." Taking their advocacy one step further, the P&A system's efforts to break down barriers to voting for people with disabilities reflect the basic American value of "democracy."

In their pursuit of these important values, the state-based P&A systems work in close collaboration with numerous organizations, including consumer self-advocacy organizations, the state-based Developmental Disability Councils, University Centers for Excellence, .and a myriad number of disability advocacy groups representing consumers, parents, and providers. The following pages give just a sampling of the continuing value-driven work of the collective activity of the P&A/CAP system in promoting independence, stability, home, knowledge, empowerment, self-sufficiency, full participation, fairness, civic participation, democracy, and human dignity. 

Long-term services and supports provide the foundation upon which people with disabilities gain independence and stability. Unfortunately, our health care system is built on an out-dated model that often forces unnecessary dependence and segregation of people with disabilities in exchange for long-term supports. P&As are part of an ongoing battle to demonstrate that services and supports are more effective if they are community-based, coordinated with other systems, and designed to maximize independence.

P&A advocacy related to long-term supports is deeply connected to P&A enforcement of the landmark U.S Supreme Court ruling in Olmstead v Lois Curtis and Elaine Wilson. In Olmstead, the Court ruled that the ADA requires states to provide supports to people with disabilities in the community rather than institutions whenever appropriate. When P&As assist individuals in accessing long-term supports, it is often part of a larger effort to help individuals move from institutions, nursing facilities, and other segregated settings, into community settings with desired supports. As the examples below illustrate, this type of P&A advocacy involves: representation at discharge planning meanings; identification and coordination of community services; and assistance in finding affordable and accessible housing and a regular source of transportation to employment and services.

In order for individuals with disabilities to truly gain independence and security, community-based supports and services must be stable and of good quality. P&As often lead the fight to demand quality assurance in community programs. The fight becomes more important as the federal government continues a trend that divests the federal monitoring role to states and community providers. As the following examples illustrate, P&As are working to reverse this dangerous trend and to strengthen - not weaken - independent oversight of community programs relied upon by people with disabilities and senior citizens.

The Arizona P&A obtained a groundbreaking decision in federal court that will bring stability to individuals with disabilities relying on Medicaid-funded home- and community-based services in lieu of nursing home placement. The P&A represented hundreds of individuals who suffered through frequent, long-term gaps in health care without warning. As a result of the unreliable services, lives were in danger and individuals and families could not report to work and school. The District Court ordered the state Medicaid program to: provide services for each qualified individual without gaps in services; offer a rate of pay to health care workers to attract and retain workers so that services are adequately delivered; and monitor its entire program to detect gaps in service and deliver substitute services within four hours when a worker fails to show up.

The North Dakota P&A has been active on a Dental Access Board to improve access to appropriate dental care for individuals with mental illness or developmental disabilities. These populations have problems accessing dental care for numerous reasons, including the lack of providers willing to accept Medicaid; providers untrained or unwilling to take the extra time to serve some patients with disabilites; and fears of complications resulting from medications.

The Montana P&A represented an 8-year-old with autism and severe emotional disturbance. The state was considering taking the child into protective custody as a result of the mother's difficulty controlling her child's behavior. The P&A worked with the child's mother, social worker, teachers, and state Medicaid agency to design a comprehensive services plan that included making modifications to the home to make it safer, respite care for the mother, a crisis intervention plan, educational supports, and after-school activities and treatment. These services are paid for by pooled money from all the funding sources involved. The child now lives at home and attends local school, where her behaviors have improved enormously.

The Texas P&A has been very active chairing subcommittees and providing testimony to the state Olmstead Advisory Group. In part because of P&A leadership, Texas passed legislation requiring Olmstead planning efforts to include not just individuals with mental illness who have been hospitalized for more than a year, but also individuals hospitalized three or more times in a 180-day period. The P&A also led the fight for the Advisory Group to highlight the significantly longer length of stay in state hospitals experienced by adults who are deaf.

The Minnesota P&A worked with two different families of children with disabilities needing additional supports as a result of fathers in both families being deployed to Iraq. For both families, the P&A negotiated with the counties to increase the number of hours the children could receive under the Medicaid in home supports program. The extra hours were needed to partially fill a gap in supports that had been provided by the fathers. One of these families had the additional worry that the Medicaid waiver supporting the daughter was scheduled to be cut. The P&A assisted her in participating in legislative hearings on the issue. At the same time, the P&A helped her enroll in a different waiver program and worked with her county to keep services at the level needed while her husband was in Iraq.

The Idaho P&A represented a 13-year-old diagnosed with autism and mental illness. The boy had been placed under a commitment and admitted to the state hospital for short term treatment. While at the hospital, the boy began to develop severe aggressive behaviors and other new symptoms. The boy's mother contacted the P&A for assistance with proper treatment, community placement, and reunification. Over several months, the P&A engaged in extensive review of records, provided input into the behavior management plan, and attended treatment team meetings to advocate on the boy's behalf. As the hospital began to provide appropriate behavior supports, the boy's aggression subsided. As a result of P&A intervention, the commitment was lifted, reunification occurred, and the boy was placed back into his mother's home, where he continues to reside today.

The California P&A represented residents of a 1,200-bed nursing facility who had not been given mandated community-needs assessments, which would have identified the supports these residents need to be discharged to their homes and communities. After prolonged and arduous negotiations and mediation, the city of San Francisco agreed to develop a state-of-the-art Targeted Case Management (TCM) program to screen, assess, and develop individual services and discharge plans for residents and provide ongoing case management. In addition, the City will conduct trainings for residents and staff on community living options, start a Community Advisory Committee, and open a Community Resource Center at the nursing facility. Over the past year, the P&A has conducted monthly outreach and training to approximately 40 residents about community services and housing options.

The Illinois P&A represented a man who was placed in a nursing home following a stroke and was under full guardianship, but who wanted to move back to the community. After getting a judge to agree the client did not need a guardian, the P&A assisted him in finding an apartment of his own, as well as a personal care attendant to address his support needs. The gentleman now has a part-time job as a computer programmer.

The Michigan P&A represented a young man with traumatic brain injury (TBI) who was being denied services from the local Community Mental Health Agency (CMHA). The agency was interested in assisting the young man, but could not do so without a mental health diagnosis. The agency contacted the P&A for assistance, who was able to get state coverage for a psychiatric assessment. As a result, the client was found to have a serious mental illness, enabling him to get appropriate mental health treatment from the local CMHA. He was also assisted in securing housing and applying for public benefits.

The New Mexico P&A represented a young man who had been living in a residential treatment center until he was admitted to the in-patient psychiatric unit of a local hospital. Professional staff at the hospital said he had to be sent out of state for treatment. Neither the client nor his mother wanted that to happen. Even as his mental health treating professionals continued to look for an out-of-state placement for him, the P&A attempted to access local options. The crisis option most often utilized by people with dual diagnoses was administratively unavailable. Working with his mother, the P&A started to plan for his return home using all of the services available to him under the Developmental Disabilities Waiver: case management; behavior therapy; and respite. He was eventually discharged to his home and is doing well. His mother gets support to deal with his mental health needs. The son regularly sees a psychiatrist and a therapist at a local Counseling Center. He is attending his neighborhood middle school.

The Nevada P&A represented several clients with both mental retardation and mental illness who sought discharge from the state hospital to the community. To this end, the P&A worked closely with hospital staff to design appropriate discharge plans, and continues to monitor the services provided to its clients who have successfully moved to the community. The P&A also developed a system to track individuals who return to the state hospital within a short period of time after discharge. In these situations, the P&A reviews the individual's discharge plan, identifies deficiencies, and works with staff to improve discharge planning for the person and in general.

The Washington P&A greatly increased its outreach to homeless shelters in 2004. This outreach resulted in representation of numerous individuals with mental illness who were discharged to homeless shelters and needed assistance obtaining housing and long-term supports in the community. Many of these individuals' disabilities also increased their chances of becoming victims of violent crimes. While living in a homeless camp under a bridge, one such client with mental illness was so severely beaten that he suffered traumatic brain injury. The severe memory problems caused by the TBI interfered with his ability to keep appointments for mental health treatment and other benefits. The P&A helped him make a police report and assisted him in obtaining victim compensation and the supports he needed to keep medical appointments.

The North Carolina P&A investigated a 23-bed group home for persons with mental illness where conditions were deplorable: there were flies and garbage everywhere; and there was no ramp for residents who use wheelchairs. This home has a history of corrective action plans after receiving substandard scores for sanitation from the division of facility services. It is reported that the administrator goes to homeless shelters to "recruit" individuals he feels can qualify to receive assistance to live in his adult care home. An advocate worked with the local department of social services and went unannounced to the home, took pictures of the filth and interviewed the residents. Within a week of the advocate's visit, the owner voluntarily closed this home and the residents were placed in better living conditions.

The Guam P&A represented three individuals living in a mental health residential facility to obtain appropriate community supports. As a result of the P&A bringing Olmstead requirements to the attention of the court, the judge ruled that all 24-hour facilities providing care to individuals with mental illness must be evaluated to determine if they are providing appropriate community-service assessments and discharge planning.

The Hawaii P&A assisted a 15-year-old with Prader-Willi syndrome (PWS). The youth was living at home and attending public high school, but experienced frequent short-term stays in the hospital for compulsive eating and violent behaviors stemming from his disability. His parents had been through three meetings with the school to obtain a new Individualized Education Program (IEP), but changes were not made. The P&A was contacted when the young man was placed in a residential treatment facility after a failed suicide attempt. The P&A reviewed the past school and medical records and determined that he had never had a proper functional assessment by someone experienced in working with individuals with PWS. After obtaining the proper assessment and receiving specialized treatment recommendations, the P&A worked with the school, the Department of Developmental Disabilities, the Human Services Division of the Attorney General's Office, and several private non-profit providers to get funding for an intervention plan approved by all. As a result of P&A assistance, the young man moved back home, is attending school with supports, and is expected to graduate on schedule.

The Arizona P&A investigated the death of a 21-year-old Native American woman who committed suicide by driving a car into a freeway barricade. The woman had been homeless, had difficulty contacting providers and obtaining medication, and had self-medicated with illegal drugs. The P&A investigated whether the state hospital had met discharge planning requirements when releasing her to a homeless shelter shortly before the incident. The P&A investigation uncovered 23 violations, including problems with discharge from an inpatient setting to a homeless shelter; inadequate assistance with housing needs; inadequate support for substance abuse issues; inadequate coordination of medical care, including no follow-up on the woman's report that she had been raped in front of the homeless shelter; inadequate communication between team members; inadequate contacts by staff to the client; an inadequate and outdated service plan; failure to provide for continuity of medication regimen and timely appointments; and documentation problems. The P&A worked with the hospital to design a system for ensuring discharge planning and continued to monitor several rounds of corrective action plans undertaken by the hospital. Eventually, the State requirements were found to be satisfactory, including extensive retraining of staff and changes in policy.

Living independently in a home of one's own is a value cherished by everyone. Unfortunately, individuals with disabilities often have great difficult finding accessible and affordable housing, leaving homelessness and institutionalization as the only options available to many. Those with homes too often lose them when needs change, housing subsidies are reduced, or providers avoid their obligations. P&As assist many individuals with disabilities in obtaining or retaining housing in the community by advocating on their behalf for reasonable accommodations and modifications that allow full enjoyment of housing opportunities; securing accessible housing for those who need it; finding housing with subsidies or supportive services that make community living possible, and challenging local zoning decisions that limit housing options such as group homes for people with disabilities.

Retaining One's Home: Reasonable Accommodations and Modifications

The Kansas P&A assisted a woman with mental illness in keeping her home of 15 years. After she had been injured in a mugging and had surgery, she had a problem with incontinence and was using diapers. Workers doing repairs in her apartment reported a urine smell in the unit, which the manager concluded was caused by the resident's dog that lived with her as an emotional support animal. The client claimed the smell was caused by used diapers in the trash. The landlord initiated eviction proceedings and rejected informal efforts to resolve the matter. The P&A asserted a Fair Housing Act (FHA) counterclaim during the eviction proceedings, arguing that the alleged lease violations were minor and that the real reason for eviction was discrimination on the basis of mental illness. At the urging of the judge, the case was settled during trial and the client remains in her apartment due to the P&A's action.

The Massachusetts P&A intervened to prevent a man with mental illness from losing the home he had lived in for over 25 years. He received a notice of non-renewal of his lease, which the landlord claimed was because of neighbors' complaints of excessive noise. After filing a discrimination complaint with the state agency, the P&A negotiated a settlement in which the landlord agreed to renew the client's lease in exchange for dismissal of the discrimination complaint and agreement to abide by reasonable noise rules.

After a local community mental health center terminated services for approximately 400 of its indigent clients due to state budget cuts, the Colorado P&A contacted these individuals to see what assistance they needed and how the P&A might be able to help. One of the individuals that responded had bipolar, mood, psychotic, and post traumatic stress disorders, in addition to other physical health problems. Both he and his wife had been laid off from work, forcing them to move from their home of five years to a one-bedroom apartment, where they also cared for their adult son with mental health disabilities. At the time the P&A was contacted, the man's unemployment had been terminated, leaving the entire household income at $104 from a military retirement pension. The family received a three-day demand for payment or possession letter from the landlord and was in danger of losing their housing. The P&A was able to provide technical assistance, advising the family of community assistance programs, and helping the family obtain emergency funding while the requests for additional services were being processed.

The Ohio P&A assisted a 44-year-old veteran with mental illness in staying in his home with improved services to assist him. While in treatment for mental illness, he was threatened with eviction by his HUD-subsidized landlord for safety and hygiene rule violations, including excessive clutter in his apartment. Compounding the problem, the VA withdrew the client's community services funding for a home health aide, which the client needed to clean and maintain his apartment. The P&A negotiated extensively with the landlord, community service providers, and numerous VA offices to secure necessary services so the veteran could retain his housing. As a result of the P&A's efforts, the landlord agreed to withdraw eviction notice with a stipulated timeline to cure the violations, and a community service agency assisted the veteran in clearing and cleaning his apartment to the landlord's satisfaction. The VA eventually agreed to restore funding for a home health aide, but the client was also able to obtain additional services with the help of his Medicaid case worker.

The Oregon P&A helped a client with mental illness keep her home after she received an eviction notice for housekeeping violations. Neighbors had complained about smells caused by her companion animals. The P&A intervened and obtained additional time for the client to cure the problem and contacted the case manager at the county disability office who arranged for the apartment to be cleaned. The P&A then convened a meeting with the client, property managers, and the client's caregiver to develop a plan for accommodation to avoid future problems. The P&A's intervention secured the accommodations for the client and allowed her to remain in her home in the community.

The Maine P&A helped an elderly woman stay in her home. She was threatened with eviction just a few weeks after moving into an apartment because of a mental illness-related outburst, during which she made some unsavory comments to employees at a hair salon in the building. At the P&A's request, the landlord granted a reasonable accommodation and withdrew his eviction notice.

The Arizona P&A obtained a favorable ruling in state court on behalf of a family that sought to reside in a 55-or-older housing community. The parents were age eligible, but sought to live in the community with their 28-year-old, who has severe mental retardation. The court ruled that the housing association's refusal to waive the age rule constituted a denial of reasonable accommodation in violation of state and federal fair housing laws.

The New York P&A assisted a client with mental illness in resolving a dispute with a rural housing authority attempting to impose a variety of additional lease obligations on the tenant, including requirements that he attend "mandatory" tenant meetings; accept unannounced visits to his home; and pay a mandatory cable TV fee, even if he chose not to subscribe to that service. As a result of the P&A's negotiations, the housing authority agreed to extend the client's lease for one year; make accommodations for his disability, including providing communications in writing; and pay compensatory damages. The housing authority also agreed to adopt non-discriminatory rental criteria with input from the P&A and provide written instructions and training for staff on FHA requirements and on ways to work appropriately with individuals with mental illness. This case resulted in a change of the housing authority's practices towards tenants with mental illness, and the case may serve as a model and warning to other small rural housing authorities dispersed throughout the service area.

The Alaska P&A assisted a woman with mental illness and mobility impairments avoid becoming homeless. The woman was in the process of getting a divorce and was living in the family home which was subject to a foreclosure action because her husband had stopped making mortgage payments. The foreclosure would not only have made the woman homeless but would also have jeopardized her ability to argue for custody of her children in the divorce action. The P&A intervened and negotiated a short postponement of the foreclosure action, and also secured a Section 8 certificate from the housing authority which had previously had the client low on its waiting list because she was not yet homeless.

After losing a Section 8 voucher due to alleged rules violations, the Delaware P&A assisted a tenant with mental illness and mental retardation in retaining housing in the community. The P&A sued and obtained a settlement that included $1,800 in compensation and a Section 8 voucher through a different local government that enabled the tenant to move into another subsidized apartment.

The Michigan P&A assisted a woman with adult-onset hearing loss obtain a visual fire alarm in her condominium unit. The condominium association originally denied the request, but the P&A negotiated with the local fire department and the condominium property management and board to get the device installed.

P&As in Maine, Illinois, Wyoming, West Virginia, and Hawaii, successfully advocated on behalf of persons with mental illness who sought to keep support animals in their apartments. The P&As resisted efforts to charge deposits for the animals or require burdensome documentation of disability or certifications of training for the animals.

The Wyoming P&A intervened with a local public housing authority after receiving a complaint about poor communication and lack of assistance for an individual with a disability who applied for a voucher. The P&A had received similar complaints in the past and, in its meeting with the housing authority attorney, the P&A raised general concerns and obtained an agreement that the housing authority would review its application process and implement procedures that will assist applicants with disabilities complete the process. After the meeting, the application at issue was immediately approved. The P&A will continue to monitor systemic problems for persons with disabilities applying with the agency.

The Native American P&A continues to investigate the policies and procedures used by the Navajo Housing Authority (NHA), the Navajo Housing Services Program (NHSP), and the Hopi Housing Authority (HHA) to insure they provide basic due process protections - as defined by tribal law - and appropriate modifications and accommodations to meet the needs of individuals with disabilities. Due to the P&A's advocacy efforts, the NHA has adopted procedures to provide reasonable accommodations and the NHSP considers disability status in determining the need of a family for a new home. The investigation and review of relevant housing policies continues.

Accessible Housing

The New York P&A assisted a private pro bono attorney in litigating a federal FHA case against the Buffalo Housing Authority, which had refused to provide an accessible unit to a woman and her family after she had a stroke and needed to use a wheelchair for mobility. The individual's mother and teenage son had to carry her upstairs to use the bathroom, and she had to sleep in the living room, since none of the bedrooms were accessible. The private attorney contacted the P&A for assistance in the case and, with that help, was able to obtain a $100,000 settlement.

The Alaska P&A assisted an individual who is quadriplegic in obtaining temporary and permanent accessible housing. The housing authority initially declined to provide a temporary accessible apartment during a year-and-a-half renovation project which required the tenant to move out. After the P&A intervened, the client obtained temporary accessible housing and was permitted to put up shelving needed to hold equipment and computers for his at-home consulting business and continuing education - an accommodation also made in the new permanent housing. The P&A negotiated with the housing authority to drop its claim for damages to carpeting caused by the client's wheelchair, although the client did pay a small amount for damage to the walls caused by the shelving installed in the temporary apartment.

The Wisconsin P&A is representing a family in their efforts to make their home more accessible. Their child has a degenerative physical disability, which has ultimately led to his need to use a wheelchair. Currently, he must crawl up the steps leading to the door of the family duplex. Funds were raised in the community to pay for a wheelchair lift at the steps, and the child's mother asked the landlord to allow for installation. When there was no response, she contacted the P&A, which assisted her in making a more formal request. The landlord replied, suggesting that she get contractor bids, but also consider moving, as it would be less expensive. The P&A helped the client file a complaint with the State Equal Rights Division, which issued a cause finding within a week. The case is now set for trial.

The Guam P&A filed administrative complaints on behalf of several individuals with disabilities living in public housing. Within six months of the filing, numerous accessibility improvements were made, including modifications of sidewalks, community facilities, and individual units.

The New York P&A assisted a client with a mobility impairment in retaining her housing and staying in college. The individual's landlord threatened to evict her due to his fear of liability if she were to fall. The client had been unable to find an accessible apartment. If evicted, she would have been homeless and had to leave college. The P&A intervened and obtained agreement from the landlord to give an additional 90 days for the client to find a new apartment. The P&A assisted the client in transitioning to an accessible apartment with a Section 8 subsidy, enabling her to continue her college education. The New York P&A also procured the installation of a permanent ramp at the entrance of a 12-story cooperative apartment building. Because of the previous inaccessibility of the entrance, several residents with mobility impairments had been limited in their ability to enter and leave their homes.

Housing with Subsidies and Appropriate Supportive Services

The Texas P&A assisted individuals with mental illness in relocating to suitable housing after the mental health center operating the home they were living in lost its contract. At the P&A's recommendation, these consumers were relocated to a new home. Together with the local mental health center, the P&A worked to insure quality living standards. New furniture was provided, the kitchen was updated, and all rooms were painted. Consumers chose their own roommates, and were involved in creating all house rules.

The District of Columbia P&A worked with consumers, private apartment managers, and local government, home health, and public benefits agencies to assist ten individuals with disabilities move out of nursing homes into private subsidized housing with appropriate supports. The objective is to develop 50 additional private accessible housing units.

The Maine P&A helped a man with mental illness get financial support to secure housing in the community. This individual was slated for discharge from a state psychiatric hospital, but was facing homelessness because he was determined ineligible for a state subsidy program. He had previously received benefits from the program and allegedly failed to make restitution for damage to an apartment. Since the client was incarcerated at the time of the damage, however, it was likely caused by his roommate. The P&A secured an agreement for emergency housing assistance while the dispute was negotiated. After three weeks, the client transitioned to permanent housing with financial support.

The Delaware P&A settled a federal lawsuit against a county government that had initially denied a permit for a group home for persons with mental illness and/or TBI. The settlement was prompted by new state legislation (authored by the P&A), which exempts group homes from local zoning restrictions. The settlement allowed the group home to operate, provided damages and attorney's fees, and guaranteed no retaliation against the home or its residents. The governor and other public figures attended an open house at the home after residents moved in.

After being evicted from a community living program for failing to take her medication, the Alaska P&A assisted a woman living in a motel obtain services and continue her integration into the community on her own terms. At her family's request, the P&A located her, secured the renewal of services back in the community without the requirement that she take medication, and assisted her in applying for a Section 8 certificate.

The Maine P&A helped a 44-year-old woman with mental illness resolve a housing dispute. At the time of her call, she was a tenant in a building owned by a mental health agency, which required her to have a roommate. Because the client did not want a roommate and did not get along well with the one assigned, she resided there only two months. The P&A advocate assisted the client in preparing a grievance and obtained reimbursement for the two months' rent. The client then worked with her case manager and located an independent apartment.

The Texas P&A assisted a 52-year-old veteran hospitalized with major depressive disorder in obtaining housing for his family. This individual lost his job due to his disability and applied for Section 8 housing when his family was about to lose their home, but he needed help with utilities and rent money. The P&A was able to locate appropriate low-rent housing, and assisted in getting community organizations to help with the rent and utilities

The Kansas P&A provided assistance to an individual with a developmental disability to find safe and decent housing and obtain support services to enable him to live independently in the community. The client had been living in a house that was in serious disrepair: with no refrigerator, stove, or bed; and with running water only in a bathtub. The house had been condemned by the city, but the landlord refused to make repairs. With P&A assistance, the individual was able to secure community-based services and a new apartment.

The Massachusetts P&A has been working in coalition with other disability advocates to ensure proposed zoning changes do not decrease or limit housing opportunities for people with disabilities. Involving various key people, the P&A organized a conference to oppose a legislative effort to weaken state law protections within the zoning law. P&A staff testified at the legislative hearing, and was successful in preventing passage of the bill.

In concert with other disability rights advocates, the Louisiana P&A convinced the New Orleans housing authority to set aside 100 Section 8 vouchers for persons with disabilities.

In December 2004, Congress reauthorized the Individuals with Disabilities Education Improvement Act (IDEA), with the majority of the Act going into effect July 1, 2005. In the 2004 fiscal year, the 1997 IDEA was still in effect and P&As around the country continued to advocate for improved services and full implementation of the centerpiece of the original IDEA law passed 25 years ago: a free appropriate public education (FAPE) provided in the least restrictive environment (LRE).

EMPOWERMENT

The right to public education is one of the hallmarks of American society. Children and parents alike are empowered when they are successful in obtaining education provided by trained staff, within an environment free of restraint and seclusion, and with the general community of peers.

Children Should be Free from Unnecessary Restraint and Seclusion in School

In Kentucky, the P&A successfully derailed the school system's plan to restrain a 4-year-old child on the bus. In addition, the Early Intervention Program (EIP) sought to limit the child's school day due to the child's behavior. After the P&A advocated for training on how to use proper behavior strategies, the school provided such training to its personnel, and the student now attends a full day of school, transported on the bus with an attendant and without restraints.

The Michigan P&A investigated alleged abuse resulting in an autistic child's death while being restrained in school. As a result of the investigation, recommendations were made for policy changes at the school, state, and legislative levels.

Oklahoma P&A investigations into school practices regarding restraints of students in public schools revealed that the State Department of Human Services will not investigate any complaint of abuse or neglect on school grounds. While it is common for schools to engage in restraint and seclusion practices that would not be allowed in a mental health facility, there is no agency in Oklahoma that investigates or restricts such practices. Children are frequently secluded in windowless 6.x 6-foot rooms without adequate supervision. The P&A identified these practices and took action to advocate in individual school districts for removal of students from these situations. As a result, behavior plans were developed that enabled two students to return to school when they had previously been arrested, confined, and ultimately removed completely from school. The plans are serving as models to achieve the same result for other students.

Children Should be Educated in the Least Restrictive Environment

In Massachusetts, the P&A advocated on behalf of a 9-year-old boy diagnosed with bipolar disorder, attention deficit hypersensitivity disorder (ADHD), pyromania, obsessive-compulsive disorder (OCD), and oppositional defiant disorder (ODD), who was "stuck" in Acute Residential Treatment for 11 months after he was clinically ready for release. Discharge to a step-down program did not occur because the Local Education Agency (LEA) did not agree to fund or cost share a residential setting with the Department of Social Services (DSS). The P&A filed a request for a hearing and, during negotiations, DSS and the LEA agreed to cost share a residential placement for one year. This allowed the student to finally transition from the acute-care facility to a school near his family home.

Through the California P&A's advocacy efforts this year, the number of students with disabilities who are integrated into the public school system increased. In one case, a 4-year-old received services until he was three, but once he transitioned to preschool, the school failed to include the services in their program for a full year. The California P&A negotiated with the school district and obtained a placement for the child in an integrated school campus with the necessary related services and supports. Through their class action work, the California P&A was also successful in advocating for a modified consent decree that reduced the number of special education students placed in segregated school settings and increased the amount of time students who are in special classes spend in general education classes.

The Idaho P&A ensured that an 8-year-old boy diagnosed with bipolar disorder and schizophrenia was not relegated to a residential treatment facility or another institutional setting. The parents and student were under intense pressure from school administrators to leave the rural public school setting, with the child's mother even being informed that, "if they had to," the school would push the child to ensure he would "have a melt down" to get him out of their school and into an institution. After the P&A talked with school personnel and reviewed potential IDEA violations, an IEP meeting was held. The final IEP contained all the proper supports and services the child needs to benefit from his education at the day school. As a result of P&A intervention, the child remained in his regular school and continues successfully.

Independence Begins with School Access

With the assistance of the Illinois P&A, a 14-year-old girl who uses a wheelchair was successful in obtaining accessibility modifications and accommodations in her high school. In order to get to multiple classes, the student had to navigate between floors at numerous times throughout the school day. Because the school lacks an elevator, this required use of an uncomfortable stair-climber. Additionally, the bathroom doors were too heavy for her to open independently. The school assigned other students to open the door for the girl, creating an unnecessarily awkward situation for the girl and hampering her ability to be independent. After the Illinois P&A attended an IEP meeting for the student, the school installed electric door openers for the restroom on the ground floor, allowing independent access for the student and others with disabilities unable to open the doors. In addition, the school installed electric door openers on the doors the student uses to access the school building. Finally, the school agreed to: widen the stalls in the restrooms, add padding to the stair-climber, and arrange the client's schedule to minimize travel between floors.

Similarly, the Tennessee P&A intervened to make school bathrooms in a rural county school building accessible for a 15-year-old student. The student's wheelchair did not fit within the bathroom properly to allow her to use the facilities with the level of privacy afforded to all other students. After the P&A's intervention, the school modified the facilities to meet ADA specifications and requirements.

Students Are Empowered When Their Rights Are Successfully Enforced

In Ohio, a school system denied a 7-year-old child with bipolar disorder and severe learning disabilities special education and extended school-year services. The Ohio P&A attended an IEP meeting for the child and further negotiated with school personnel to ensure the student received the services and supports he required. As a result of the Ohio P&A's advocacy and intervention, the school district agreed to 30 hours of extended school-year services by a tutor of the parents' choice, six weeks of participation in a reading program, and tutoring once a week during school hours.

In Mississippi, the P&A advocated for the rights of an 18-year-old student with medical and emotional issues to stay in school and receive her high school diploma. The student performed well in class, but suffered from severe test anxiety. The principal of the school attempted to persuade the student to drop out and seek her GED instead of a diploma. Through the intervention of the Mississippi P&A, IEP meetings were convened and the family and school worked out a plan to help the student remain in school. She is scheduled to graduate in Spring 2005.

The North Dakota P&A was successful in obtaining proper services for a child with disabilities who had not received required services for six years. The child was continually "in trouble" for inappropriate behavior and referred to the juvenile court system for consideration of an out-of-home placement. The school system did not determine the cause of the student's behavior. Once the P&A intervened, the student was identified, evaluated, and now receives appropriate services and supports in the school. In addition, the case resulted in increased monitoring of IEP meetings by the school special education staff.

KNOWLEDGE

Parents must have knowledge about both their and their child's rights in order to obtain proper services and supports. P&As have successfully provided training and information to parents and advocates to expand their understanding of their rights in the special education process. As a result of P&A advocacy and intervention, students with disabilities were provided the types of services and supports needed to meet their goals.

Proper Training Provides the Gateway to Appropriate Supports and Services

In Texas, the school forbade a student with behavior issues from attending field trips and other school activities with his peers. The student is non-verbal and was often disciplined even when his behavior was related to his disability. After the Texas P&A advised the school on how to properly provide services, a positive behavior plan was developed for the student. The child, whose behavior improved after implementation of the plan, now joins his class on field trips and other school activities.

The Tennessee P&A successfully ensured that a high school student with TBI and quadriplegia was provided with an Assistive Technology (AT) device and services to support the use of the device in school. The school failed to implement the IEP, not allowing the student use of his communication device in school nor sending school personnel to free trainings on how to use the equipment. With the assistance of the Tennessee P&A, the student is now permitted to use his communication device in school, and school personnel have completed trainings on how to use the device. Additionally, the student received Assistive Technology, occupational, speech, behavioral, and cognitive evaluations. Because of the P&A's intervention, the student began his 2004-05 school year with all the needed supports and services in place and, most importantly, with increased independence-one of the cornerstones of the IDEA.

Training Increases Understanding of Rights of Children with Disabilities in the School System

The District of Columbia P&A partnered with the DC Parent Training center and provided guidance to parents of students with disabilities on issues of Assistive Technology, how to begin the IEP process, and how to present issues at an IEP meeting.

In Pennsylvania, the P&A conducted parent education/professional development trainings. One was offered to approximately 300 parents and advocates who volunteer to help students with disabilities in Pennsylvania public schools. The training reached six different locations across Pennsylvania and covered basic entitlements for children with disabilities under state and federal special education laws. Another training focused on the implications for children with disabilities and their families of the No Child Left Behind Act (NCLB), addressing questions on topics such as: assessment; testing accommodations; measuring and reporting progress of IEP and Adequate Yearly Progress (AYP); graduation requirements; and eligibility for supplemental education services. These trainings expand the group of informed parents and professionals in communities who can work with families in special education and early intervention matters - reviewing records, attending meetings, providing emotional support - to help parents ensure their child's rights are realized.

People with disabilities are entitled to be employed in the same manner as others, providing the economic empowerment and self-sufficiency that comes not only from real jobs with real wages, but also from real opportunities for pay increases and advancement. Vocational training and employment supports are often needed to allow persons with disabilities to prepare for jobs - jobs driven by personal choice and interest. Vocational Rehabilitation (VR) can provide individualized services someone with a disability needs to obtain, maintain, or advance in employment.

The Minnesota CAP intervened on behalf of a transition-aged client who had goals of attending a vocational school or college after he completed high school. The client's vocational rehabilitation counselor denied him schooling and insisted that he obtain employment. CAP was able to get a new counselor who developed an Individualized Plan for Employment (IPE) that included training at a technical college. The Minnesota CAP also represented a 61-year-old man who is blind and self-employed. The client requested computer training so he could do his business accounting himself instead of paying an accountant each month. As a result of the CAP's advocacy on his behalf, the training was provided and the man is able to retain more of his earned income.

The Ohio P&A's PABSS program assisted a client with multiple sclerosis whose promised computer upgrade and in-home tutoring services were denied after his VR counselor was hospitalized. The P&A negotiated with the new counselor, securing the services as agreed and enabling the client to continue pursuit of his employment goals.

P&As/CAPs consistently worked with the public rehabilitation agency to advance the rights of clients to receive vocational services consistent with informed choice and competitive employment outcomes. The Florida CAP successfully intervened on behalf of a client with traumatic brain injury after he contacted them to dispute an administrative-review decision letter on a number of services that were denied. CAP advocated for physical and speech therapy, along with the provision of an augmentative communication device called the ISAAC computer system, which is recommended for those with brain damage that has resulted in memory loss. Records revealed that the ISAAC device had been ordered previously, but was misplaced in another office after the counselor transferred from one district to another.

The Maryland CAP assisted a middle-age male who was eligible for VR services due to substance abuse/addictions and vision impairment. The individual signed an IPE to become employed as an HVAC technician. Although he was homeless, the individual attended a local trade school to receive training in this field, graduated, and then was employed as a janitor. Subsequent to the counselor closing his case, he requested the Department of Rehabilitation Services (DORS) purchase tools so he could become employed as an HVAC technician. When denied, CAP wrote to the VR supervisor and counselor, addressed the policy of informed choice, closure issues related to employment goals listed on IPEs, and post-employment services. The VR counselor and supervisor approved the request and the individual was able to purchase $2,500 worth of HVAC tools, allowing him to compete for jobs in his chosen field. The Michigan CAP was able to get VR to provide a post office box and voicemail to a homeless client so he could provide prospective employers with contact information during his job search.

The Wyoming CAP assisted a male with orthopedic impairments obtain surgical interventions and vocational training to enable him to re-enter the workforce as a commercial welder. Arizona CAP assisted a former vocational rehabilitation client in obtaining training to become a radiologic technician, even though the agency had once provided him training in computer graphics. The new vocation was less stressful to the client and afforded greater earning potential.

During FY 2004, the Louisiana P&A operated a state-funded Transition Program in collaboration with the Louisiana Business Leadership Network (LBLN) to assist individuals in navigating the "One-Stop System" and Louisiana Rehabilitation Services. For individuals wanting to pursue "traditional" non-disability services and supports, the P&A transition liaison, LBLN, and One-Stop staff provided one-on-one assistance with information, referral, and basic guidance in resume development, job-seeking skills, and interviewing tips. Individuals needing more intense assistance were referred to Youth One-Stop Services. Students received on-going support during the summer and participated in group discussions related to self-confidence and advocacy skills. Students were also provided referrals and contact information on several employment-related services and programs.

There are many barriers to self-sufficiency and, oftentimes, the biggest obstacles are posed by the programs and services charged with "helping." The Massachusetts CAP settled a court case challenging the Massachusetts Rehabilitation Commission's termination of the case of a long-time consumer for failure to cooperate in the VR processes. The hearing officer found there had not been any overt failure to cooperate. As a result, the case was remanded and services reinstated to the consumer. Similarly, the Nevada P&A assisted a 52-year-old woman with TBI whose VR counselor was attempting to close the case file, despite the fact that she still needed VR services to achieve her employment goal.

The Maine P&A assisted an 18-year-old with a developmental delay with concerns regarding his transition plan from school to work. At the client's evaluation team meeting, a plan was negotiated allowing the client to use half of his day during his senior year performing a part-time job. The local school and state VR Bureau agreed to share costs and to contract with an employment agency to develop a position and supportive services. When nothing more was done, the advocate had to intervene to get the plan moving along. Within two weeks of the intervention, the client obtained employment consistent with his plan.

After studying how Oregon Vocational Rehabilitation Services (OVRS) uses job developers in the state, the Oregon P&A recognized the  shortage of effective job developers and that many are insufficiently trained to match VR client's capabilities and functional limitations to an existing or created job. At the same time, VR counselors rely on the reports of these job developers to determine whether the client is "cooperating" and making progress toward their employment goal. The P&A is working with OVRS to develop a formal mechanism to improve effectiveness in obtaining jobs in the clients' chosen fields and allow clients to rate their job developer. The Oregon CAP assisted a client previously found ineligible for services in presenting his goals to OVRS. With the CAPs intervention, OVRS reversed their decision and eventually supported the client's employment goal to work as a tow truck operator - a position the client holds today.

Fifteen years after passage of the Americans with Disabilities Act (ADA), full employment of individuals with disabilities is still an unfulfilled goal due in part to continued stereotypes and ongoing discrimination. The Ohio P&A represented an employee of a county agency that demanded a fitness-for-duty exam. The employer, concerned that the client's hearing impairment was adversely affecting her job performance, demanded that the client sign releases for all medical records and treatment she had received. The P&A wrote the client's employer and explained that, under Title I of the ADA, the scope of disclosure must be limited to the issue that was affecting the client's performance, that is, her hearing impairment. The employer dropped its demand.

The Nebraska P&A successfully represented a female doctor with traumatic brain injury to secure reasonable accommodation in a critical exam needed for her medical license. The accommodation allowed her to complete the exam and continue with her second-year practice clinicals.

The Arizona P&A engaged in a number of efforts to provide people with mental illness information on how to request reasonable accommodations in the workplace. The Employment Advice Line advises callers about when an accommodation is required; how to make a request; what types of medical documentation may be appropriate to provide in response to an employer's request for justification; and the availability of outside resources to generate possible reasonable accommodations. Job developers, VR counselors, special educators, and job coaches also called to ask questions on behalf of their clients with disabilities. For example, an attorney helped file a charge of discrimination after a client's job developer reported that she was denied a reasonable accommodation in the application process.

The Massachusetts P&A is involved in a Discharge Planning Initiative, focusing efforts on those institutionalized individuals with mental illness (receiving personal needs allowances from the Social Security Administration) whose discharge plans contain a work component. Where appropriate, advocates will assist individuals in using their Ticket to Work to access vocational rehabilitation and job preparedness services, providing services to an under-served population. In addition, P&A staff was successful in settling an employment discrimination case on behalf of a man with a psychiatric disability who was suspended and subsequently fired after making a statement when in a highly agitated state that was incorrectly construed as a possible threat against his co-workers. This situation occurred when the individual was disclosing that he had a psychiatric disability for which he was requesting a reasonable accommodation. The settlement included compensation for the client and a neutral letter of reference since he did not want to return to that particular workplace after the incident occurred.

The Iowa P&A represented a man with mental illness who was notified that he would be laid off from his job due to employer restructuring. He was one of two employees chosen to be laid off because he had a reprimand in his file. He believed the company laid him off once he disclosed he had a mental illness. The P&A negotiated with the employer and obtained severance pay for the employee who chose not to return to that employer.

The Texas P&A assisted an employee in need of van lift repair avoid an unnecessary six-month delay in services because the counselor "did not have any money" and had other clients waiting for services. When the P&A pointed out that Texas was not on an "order of selection" and, therefore could not delay services on approved plans, the van was quickly repaired enabling the individual to retain his employment.

Full participation in the mainstream of American life is the core value of the Americans with Disabilities Act (ADA). The ADA guarantees people with disabilities equal access to the services and facilities offered by state and local governments and private businesses open to the public, but too often that promise goes unfulfilled. P&As are actively engaged in securing the rights of individuals with disabilities to have equal access to government buildings, programs, and services; transportation services; places of higher education; health care facilities; and restaurants, places of entertainment, and retail stores. Some examples of these efforts are set forth below.

Government Facilities and Services

The Montana P&A launched a major effort to increase accessibility to courthouses throughout the state. The P&A conducted surveys and provided the results to all county officials, except for the one county which had previously negotiated an agreement with the P&A to make accessibility improvements. Numerous counties have responded that they have already begun, or intend to begin, work to improve accessibility. Several counties plan to install elevators, or are already in the process of doing so. The Montana P&A plans to continue monitoring the activities of each county and prepare for litigation, if necessary, against any counties which fail to cooperate.

After a woman with mental illness learned that her library membership record included a notation that she "suffers from mental illness," the Ohio P&A negotiated a change in the public library's policies. The P&A advised the library that it was violating the ADA, as well as the professional librarian code of ethics, and demanded corrective action. The library removed the notation from the client's library record, made requested corrective policy changes, and apologized to the client.

The Kansas P&A filed a successful suit under Title II of the ADA on behalf of a 7-year old boy with cerebral palsy who wanted to play baseball, but was rejected by the city recreation commission. After an injunction was entered affording preliminary relief and allowing the boy to play, the P&A negotiated a settlement that will insure he can continue playing for the remainder of his eligibility in the program.

The Illinois P&A provided information to an individual who uses a wheelchair and wished to attend a city-sponsored children's theater performance that was held in an inaccessible building. The client used this information in meetings with the city council and ADA coordinator. Not only did the City agree to move the children's theater to an accessible location, but the case also had a systemic result in that the City will no longer fund events unless the venue provides proof of accessibility.

On behalf of a client with TBI, the Oregon P&A secured accessibility modifications to a swimming pool facility that was being used by Special Olympics participants. The facility lacked guard rails and had restrooms without grab bars and whose doors were too narrow. The P&A contacted the director of the facility, who agreed to install the necessary fixtures to be in compliance with the ADA and make the pool accessible for people who use wheelchairs.

Transportation

As a result of the Louisiana P&A's continued monitoring of a consent decree for paratransit and fixed route transportation services, the New Orleans paratransit system obtained full ADA compliance for the first time ever, affecting an estimated 4,000 paratransit riders. Additionally, over $1 million in accessibility improvements were made to a new streetcar line after the P&A identified potential problems.

The District of Columbia P&A successfully challenged discriminatory practices of a transportation service that provides free curb-to-curb van transportation for senior citizens. The company refused to transport individuals who used motorized wheelchairs and required persons who used manual wheelchairs to have escorts. In addition to notifying the company that its policies violated Title III of the ADA, the P&A also contacted the DC Office on Aging, which oversees the service. As a result of the P&A's intervention, the company's policies and procedures were completely overhauled, and the P&A conducted extensive outreach at senior citizen centers, residential buildings, and medical clinics to notify consumers of the change.

The District of Columbia P&A also negotiated with the Department of Motor Vehicles (DMV) to make it easier for persons with disabilities and those with a record of disabilities to obtain licenses and parking placards. The P&A challenged the DMV's extensive inquiries into the medical background of driver's license applicants. Now, instead of asking whether an applicant "ever experienced" certain conditions, the DMV will confine its inquiry to conditions that have occurred in the past five years and "would impair [their] ability to safely operate a motor vehicle." In addition, the DMV not only eliminated its requirement for in-person application for disabled license plates, registrations, and parking placards, but also agreed to extend the time period for temporary and disabled parking placards and license plates.

The California P&A assisted residents of a nursing facility in obtaining access to paratransit services. The transit authority required an in-person interview as part of the application process, but residents of the nursing facility were unable to get to the interview site because they could not use public transportation. As a result of the P&A's assistance, the transit authority agreed to modify its procedures and now makes regular visits to the nursing facility to conduct the in-person interviews.

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