Transcription – Potomac Watershed Poster

Transcription – Thomas Golden and Sue Beecher Interview May 2005

Thomas: Sue let’s begin by having you share with our audience today who you are and ah what you do for the Indiana Protection Advocacy Agency.

Sue: I’m Sue Beecher and I’m an assistant director for Indiana Protection and Advocacy Services. My staff and I are responsible for actually four of the grant programs. We ah have nine grant programs but my staff work in the Client Assistance Program, the Protection and Advocacy for Beneficiaries of Social Security Program, the Protection and Advocacy for Individuals with Traumatic Brain Injury and Protection and Advocacy for Assistive Technology Programs.

Thomas: right…. So Sue, tell us a little bit about um what you do there in Indianapolis, Indiana.

Sue: I work for Indiana Protection and Advocacy Services. It’s um the Protection Advocacy Agency for Indiana. We operate under a nine grant programs including Protection and Advocacy for Beneficiaries of Social Security and I’m an assistant director and I manage the PAPS program as well as the client assistance program and the program for individuals with traumatic brain injury.

Thomas: Quite a bit of hats to wear. Tell us a little bit more about the PAPS program specifically. What is the PAPS program do? What are the priorities for that program?

Sue: The um PAPS program was intended to help individuals with disabilities return to work. Either maintain their current jobs, regain employment if they’ve been employed before or simply to receive training to go into not only a job but a career.

Thomas: How interesting and so as a, a what would you call it as a lawyer in the PAPS program or an advocate, what typically would a would an advocate do then if a beneficiary calls you let’s say um on the phone and they ask you for support what is it that the PAPS program would do for them?

Sue: Primarily in Indiana most of those calls center around disagreements with the largest employment network which is Indiana Vocational Rehabilitation Services. Usually the disagreements are over choice of career, choice of services, um sometimes eligibility, um but it can be a (meriate sp? 30) of problems.

Thomas: So obviously Sue if most of the inquiries for support that come in or about a particular EN like your state vocational rehabilitation program, obviously you’ve worked considerably with the state voc rehab program, correct?

Sue: Everyday of my life. Um, Indiana Vocational Rehabilitation Services has a, I, I would say um currently has, has a director that’s very client centered, very choice centered, um and we are fortunate in that um because we’ve had directors that weren’t even trained in employment, didn’t understand what vocational rehabilitation was suppose to um do as their mission in life but we do work with um twenty six, twenty seven field offices and we try to do some systems work as well in the hopes that the same problems don’t keep popping up but ah they keep us busy. They keep us very busy. 1 Thomas: Let’s take a step back, Sue, um and talk you use the term employment network. Can you give us just a little bit of context about the ticket to work and self sufficiency program because obviously employment networks are involved with that program so could you help us to understand or, or provide us just a real basic primer on what the ticket to work program is.

Sue: Certainly. The ticket to work program was part of a large piece of legislation passed and I believe 1999 ah, ah TWEA act right Ticket to Work….

Thomas: right

Sue: Work Incentives Act of 1999. Social security wanted to return more folks who were beneficiaries of benefits back to work. Their hope was a ticket to work program would encourage entities um even non traditional entities to become employment networks and therefore complete the activities that folks needed to get into careers and get back to work. Unfortunately um the recruitment of employment networks wasn’t as affective as they had hoped and in most states and certainly in Indiana, Indiana Vocational Rehabilitation remained the largest employment network and the majority of tickets that are assigned are assigned to Indiana Vocational Rehabilitation Services but the intent was to increase the universe of providers.

Thomas: And so what, what we’ve found is that not many providers are interested in the program. It is an outcome based payment system so you are fronting a lot of money and a lot of resources to get a person to work and then only getting paid at certain points thereafter and so I think that probably posed a huge challenge like you’re saying to recruitment and trying to get more folks interested in the program but from a PAPS perspective purely now what do you think were the most important elements in the ticket to work program? What were the things that they tried to accomplish with that program that you think were essential?

Sue: In the past most individuals on social security had to make a choice either of maintaining income and their health insurance or returning to work. Social security realized that they had put a lot of barriers in place for people who wanted to return to work. If you went back to work and if you made too much money you lost your health insurance. Um if the job didn’t hold you had to or, or you were laid off from your job then it would be possibly years before you could get back on benefits and get your insurance back and for people with disabilities health insurance is such a necessity. Social security tried under the ticket to work program to remove those barriers. They included things in that piece of legislation such as um exemption from continuing disability reviews during the time that you’re assigned the ticket….

Thomas: right

Sue: so that up to 60 months while you attempted to get back into work and into a career you were exempt from social security looking at your disability medically and determining that you were improved or that your disability did not continue and that was a huge, um huge safe guard for people and their insurance coverage. They also included expedited reinstatement which um was a clause that included if you went back to work if you were laid off from the job for some reason or your health um decreased to the point where you couldn’t work that within thirty days you were back on your benefits and your insurance was reinstated.

2 Thomas: Something that you had said earlier Sue was you really emphasized choice as being an important element of the ticket to work program. Now you know as well as I do that in September of 2002 the SSA had a significant policy shift, um in the program that impacted some of the important elements that you that you kind of talked about and that was known as the infamous transmittal seventeen. Um, could you just highlight real quickly what did transmittal seventeen attempt to do? What was its purpose?

Sue: I want to take you back a little bit before…

Thomas: ok

Sue: even got rolled into Indiana in November of 2001 I believe, we had ah PAPS had met with Indiana VR on many, many occasions to try to coordinate the efforts of the ticket program to try to get more employment networks interested and during that time we talked about transmittal seventeen and Indiana Vocational Rehabilitation Services indicated that they would never ever, ever on their mother’s grave use transmittal seventeen. So silly me I felt somewhat assured that we would never have to deal with this choice issue ah however it became clear when you would look at these statistics from region 5 of which Indiana is one of the state VR agencies, we were so far behind in terms of numbers of tickets assigned that the program was failing dismally.

Thomas: So Sue what were some of the specific steps and interventions that you took to kind of minimize the negative impact of transmittal seventeen?

Sue: They are, to their credit, did talk with us before they initiated the involuntary assignment. We were not happy um but it was allowed, there wasn’t anything to fight so we needed to look at how to make the best of a bad scenario and we understood that there were a lot of folks in the pipeline with VR who had tickets, they simply weren’t assigned. They chosen VR services but they hadn’t assigned their tickets and we blamed, we blamed VR very much for that and that’s a pretty strong word. We felt their staff had not been trained adequately. That their staff did not prioritize the ticket, did not share the information about the good things about that program that would help beneficiaries as they went through the VR process. So when we met with VR we said fine go ahead and assign those tickets involuntarily but we’re going to make some requests here. We’re going to request that you retrain all 166 of counselors and further we’d like to approve the training curriculum and we would like to participate. Number two we would like you to notify individuals before you assign their tickets involuntarily and we would like to have our name, address, phone number in the letters that you utilize to assign those tickets already in the pipeline and being the good VR agency they are they did agree to that, to all those conditions.

Thomas: That’s great. Sue, as we both know in September of 2002 the Social Security Administration um had a significant policy shift in the ticket to work program that impacted some of those important elements such as choice that you were talking about um earlier. Could you tell us what transmittal seventeen was when it came out in September of 2002?

Sue: Transmittal seventeen was a document um approved by both Social Security Administration and CSAVR the Consortium for State VR agencies and basically transmittal seventeen allowed VR agencies without any notice ah without any permission to simply assign tickets on individuals that were seeking VR services. It took um away the um requirement for 3 notification. It took away the requirement for appraising the, the VR customer, if you will or the beneficiary of the advantages of assigning a ticket and it took away that customers right or that consumers right, I’m using several terms here, to really understand what ticket assignment meant to him or her.

Thomas: Sue I’ve known you for awhile and, and I know that your PAPS program specifically engages in some real pro active types of interventions. Now when transmittal seventeen came out you obviously identified early on what some issues might be stemming from that. I’m wondering if you could share what some of those issues were.

Sue: One of the first things that we got wind of, if you will, and, and some of the information actually came from the folks at social security, was that once transmittal seventeen was out and about that we had some VR offices asking the consumer up front when they would come to apply for VR services whether or not they would assign their ticket. Again without explanation of what the ticket is, what the benefits would be, what any draw backs would be, if the customer refused VR was refusing to take an application which is in violation of the federal rehabilitation act. Um when wrote to the state director actually met with him in person and he sent out a memo to all the field offices stating that under no circumstances were individuals to be denied application to voc rehab if they refused to assign their ticket up front.

Thomas: Sue you had mentioned that you you’ve worked extensively with Mike Head and your director of your state vocational rehabilitation agency in the past. I’m wondering um through you collaborative relationship with him um over the last year let’s say specifically ah what, what would you define has been like your greatest impact of your work together so far?

Sue: I believe that counselors now are better trained in terms of the ticket to work program and they understand what the benefits of that program are and can now communicate those much more effectively with individuals coming to them to return to work. Everybody wins I believe. The numbers of tickets assigned have gone up. We’re now within um the normal range, if you will, for most of the region five agencies but I think all in all the beneficiaries the one who really wins in this scenario because counselors now can talk about things such as um being exempt from continuing disability reviews, having expedited reinstatement. I think the counselors understand more how they can work with someone to provide choice throughout the course of their plan of employment and to allow them to actually settle into a career not just a job where you’re asking if you’d like fries with that burger.

Thomas: Sue obviously a successful PAPS program has to have a lot of different skills in their tool belt to affectively work and represent the beneficiaries that they’re working with and it sounds to me like probably one of your strongest suits there at the Indiana PAPS program is the art of negotiation. Could you ah maybe talk to our audience a little bit about what are those skills that you actually engaged when you were working with VR and, and how important were they to your success?

Sue: Um, you’re absolutely correct, negotiation is, is a huge issue in any type of advocacy. We were fortunate we had dealt with the same vocational rehabilitation issue under our client assistance program so we had a relationship, if you will, before we ended up with the PAPS grant. One of the tenants that we live by is that we try to be hard on the issues and not hard on the people involved.

4 Thomas: right

Sue: A lot of those vocational rehabilitation counselors are in their offices until the day they die. They’ve been there for thirty years or more and they feel they know their job and they’re doing their job well and when a protection advocacy agency is called by someone, my goodness that’s, that’s um, um some sort of black mark against them or some sort of criticism and we always try when we’re going in to look at a situation to tell them that the first step is fact finding. We realize there are two sides to every, every situation and we really try to keep the hard feelings away from the person, stay on the issue, try to, you know, we understand that sometimes individuals with disabilities much like you and I come in every shape, size, and personality. Ah we like to tease VR that the difficulties they have with a person doesn’t necessarily go away when they come to the PAPS program for assistance. They’re still the same person um but certainly trying to stay on the topic of the issue and not ah belittle the person or, or trying to keep it keep the emotion out of the negotiations um and everything that we can do and building relationships and trying to keep those relationships. However transmittal seventeen I will tell you I, you know there were a couple approaches we could have used. We could have stormed into voc rehab and said this is horrible, you’re horrible people, this takes away all choice…

Thomas: right

Sue: um I don’t think we would have gotten very far. Um we wouldn’t have certainly gotten VR counselors retrained or VR staff retrained. We probably wouldn’t have done anything that would have benefited um the individuals with the tickets trying to go through voc rehab. So begrudgingly we said this is allowed but how can we make the most of it? How can we make sure people are appraised of their rights? How can we not show our distaste with the VR agency that’s going to implement this um those sorts of issues.

Thomas: Well Indiana is not the only state to face the transmittal seventeen dilemma and, and I know probably many of your sister PAPS programs are listening today and wondering what advice you might have for them as they think about engaging in some relationship building with their state vocational rehabilitation program. What were um some of your early successes in relationship building with state VR?

Sue: We’ve attempted to partner with them when we could, um conducting trainings we are part of their orientation of their new staff. We do a presentation on the client assistance program and the PAPS program now as well and that’s a nice open forum for brand new counselors who don’t really have a mind set about who the CAP advocate is or who the PAPS advocate is that allows them to see us as people rather than um some sort of Darth Vader that comes in to investigate issues against them um and we find that’s very affective. We’ve also um we also comment on their policies as well as their procedures and they feel free to share those with us. We provide written feedback. Um I try to meet on a regular basis with the VR director. Um my staff talk with counselors on a weekly basis sometimes almost daily um and I think we we’ve looked at ways that we could agree with them because we disagree with them enough…

Thomas: right

Sue: ah as it is.

5 Thomas: So finding some commonality…

Sue: absolutely

Thomas: ah between, between the two of you. What advice would you have Sue for a PAPS program that’s thinking about replicating the intervention that you engaged in with state vocation rehabilitation? What might the first three steps that you would encourage them to take be?

Sue: Number one: sit down and talk with them. Explain why transmittal seventeen how you view that as a violation of individuals rights but also acknowledge that it’s allowed to voluntarily sign tickets. Number two: look for ways within that process that your VR agency is going to um the process that they’re going to undertake to see where you might fit in. Having your information in the letter that acknowledges and voluntary assignment allows consumers to be pick up the phone and call you if they don’t understand something and then I, I guess the third step would be agree to help train them if training is the issue um and I truly believe usually training is the first issue. Yes you might have some attitudes um some reluctance to change, change is a tough thing for many of us but try to, again, find ways to partner and, and offer, you know, offer to ah speak with customers that don’t want their tickets assigned. Um truly Thomas there have been very few people folks applying for VR services with a ticket after having explained to them that then agree or disagree to have that ticket assign. I mean we’re talking a very small number here of individuals that given the information, make unwise decisions or are fearful of having their ticket assigned. It’s a matter of communication.

Thomas: Sue the reality is that um transmittal seventeen um is lawful in the social security administration’s eyes and the eyes of the rehabilitation services administration regardless of how we feel as individual advocates for people’s rights um within that context though and in the intervention that you undertook with the state vocational rehabilitation agency, tell us a little bit more about the fine details. For example when a counselor is engaging in a dialogue with a beneficiary what were some of those things that you as a PAPS program really advocated for it to be a part of that interaction when it came to making an informed choice?

Sue: We, we tried to identify barriers as to why the VR counselor wouldn’t be comfortable or wouldn’t share the information with a beneficiary and there were several touch points, if you will. Number one at the point of intake VR is suppose to ask if someone is on SSDI or SSI um so we know that they’ve identified them because that’s done on all the applications so really the barrier appeared to be talking about the ticket to the individual and talking knowledge, knowledge, yep I can’t say that word.

Thomas: That’s ok, they can cut that.

Sue: And talking knowledgably about the ticket.

Thomas: Say that line again.

Sue: Um, where did I start? So we, we believe the barrier was having the VR counselor talk with the client and talk knowledgably about the ticket and the benefits of its use with the client that’s coming to them for services. The retraining was, was extremely important. The other thing that happened that was helpful was that VR identified two point people in downtown Indianapolis at the main VR office that could answer counselors questions um would, would be 6 able to help them through scenarios. VR also began to send out a newsletter, if you will, to counselors to talk about um specific issues in, in depth continuing disability reviews, expedited reinstatement, um Medicaid coverage, um so that the counselor had the information and they felt comfortable that they could go to an expert if they didn’t know. Um further we offer just the PAPS program that if a client said no I don’t want my ticket assigned we offered to talk with that person to make certain that they understood the benefits that they had made an informed decision about not assigning that ticket. The other thing that we were able to negotiate with voc rehab is that if someone said no they didn’t assign the ticket.

Thomas: Oh interesting.

Sue: Now they went ahead and they wrote up an IPE and there’s language on the IPE that states um almost a check off list if you will in the IP I don’t wish to assign my ticket now ah but understand that the VR counselor will be speaking regarding this to me at, you know, talking to me in the future regarding this issue. So that VR wasn’t simply overriding the persons initial choice.

Thomas: right, right. So Sue tell us what’s the promise in your practice?

Sue: Well transmittal seventeen while it certainly it bridges the rights of individuals with disabilities it doesn’t take away all of the rights and I think that you have to look at ways to make certain people’s rights are left intact in that process. Um having touch points, if you will, such as having information about the PAPS program in the letter that assigns the tickets involuntarily. Having counselors understand that they can speak with the PAPS advocates to talk with clients who might refuse the ticket. Offering to help VR retrain their staff so that they’ve got a better understanding of not only the ticket but the clients rights under that ticket process. Um and, and just monitoring that program and, and talking with your state VR agency on that consistent basis to see how it working, if there are issues or problems that you can assist them with um because if you make your VR agency better at what they do it certainly benefits any individual with a disability that wants to use services through that VR agency.

Thomas: It’s obvious to me that as a PAPS program you’ve promised to protect the beneficiaries that you serve. Tell me one thing in closing that you would encourage other PAPS programs to think about as they think about the transmittal seventeen issue.

Sue: I, I believe that the one thing that, that we looked at again is that transmittal seventeen allows VR to assign a piece of paper. Again it doesn’t take away all that individuals rights that’s applying for services and if you can help VR to understand that and then assist them in putting that in to practice so that things, you know, silly things don’t occur such as um denial or refusal to assign a ticket leads to a case being closed um that refusal to assign a ticket doesn’t lead to a delay in um developing an individual plan of employment. Um the counselor can keep asking at any time in the process if the person would reconsider the assignment of the ticket and again we’re only talking I believe a small percentage of individuals. Um, ticket assignment has so many good, good things um for the beneficiary that, that really I believe most individuals given the information will make informed choice to have that ticket assigned.

Thomas: What’s one thing that you would caution them against?

7 Sue: Well don’t trust your VR program to do this well on their own. Ok, you need to monitor this. You need to enter into dialogue with them to understand what they’re doing um and, and just try to partner on this. Try not to make it so adversarial that, that you aren’t that you don’t have an open dialogue. Um with our state VR when they become frustrated they will do things in the quickest way possible they aren’t looking at rights they’re looking at keeping within their budget and, and getting folks rehabilitated. So if you can partner with them they may stop and think to give you a call first before they do anything too dramatic or too drastic.

Thomas: That’s great. That’s a good one. Non adversarial relationship um is an interesting term of art to say the least. How, how do you and the other advocates that work with your program um the PAPS program and even the CAP program, what are some of the basic principles that you hold too when trying to forge non adversarial relationships?

Sue: Well I think first we do our fact finding. We don’t automatically assume that anyone is right or wrong in the scenario. We have a client that has asked us to look at something. They’re complaining against another entity, the VR agency, so we do pretty careful fact finding. Sometimes voc rehab has not violated the rights of an individual and I think that we try to let vocational rehabilitation know in those situations um although those occur much um less frequently than, than we would like. On the other hand um the issue becomes your focal point not the person. VR counselors are just like advocates. Some of them have different styles, different ways of dealing with individuals and so you keep it off the person you reassure in some manner shape or form you maintain a professionality about yourself when you’re going through this. I know that I’ve actually been cursed at in a formal mediation by a counselor that to this day has a lot of trouble even looking at me. On the other hand that doesn’t stop me from going about my business with this woman.

Thomas: sure

Sue: Um, that kind of stuff doesn’t prevent you from doing your job as a professional. Um, sure that tells me something about her as a VR counselor and if a client complains that she’s not been treated very well by her um I can relate to that um but truly being treating poorly is not a rights violation necessarily. It’s the person needing the services and getting what they need through that person.

Thomas: Um Sue since ah the implementation of this plan with your state vocational rehabilitation agency, have you actually seen a decrease in the number of issues that you’re seeing coming from the state voc rehab agency?

Sue: Absolutely. We’re not receiving the calls from individuals, beneficiaries going to voc rehab and then having to pick up the phone to call PAPS to say what is the ticket to work program. Evidently voc rehab is not doing a much better job explaining that and in fact we have had um a couple of referrals from vocational rehabilitation back to us on um issues such as overpayment or continuing disability reviews um which is a nice partnership. We’ve been able to assist them because again some counselors or many of them really want to assist the person. They are not in it to do any harm to the person um and I’ll give you an example. There was a fellow being served on the east side of the state um became ticket eligible during the course of his individual plan of employment, didn’t tell the counselor, didn’t know to tell the counselor, counselor didn’t know to ask, he had a continuing disability review and he was going to be forced off of benefits and he had less than a year left on his VR plan to have his career in check. 8 We were able to assist him and I believe similarly assist VR by ah talking with social security and getting him under a status that’s allowed under um for clients that are under taking a VR program at the time that they’re found ineligible for benefits and he was able to maintain his benefits through spring of this year when he’ll complete his program.

Thomas: Oh that’s a win-win. That’s mutual gains for not only…

Sue: absolutely

Thomas: the beneficiary but the state voc rehab program and, and the PAPS program as well. That’s great.

Sue: absolutely

Thomas: Sue, any systems issue is complex. There’s a mirror of rules and regulations that you have to go through and understand and in your state you very proactively engaged in dialogue around transmittal seventeen. Um, for other PAPS though that could be scary, it could be frightening, um especially if you’re not wanting to engage in an adversarial relationship but I think lots of folks are hands off, I, I don’t even want to begin to tackle that. Talk to our audience a little bit about the plus is for engaging in dialogue around this.

Sue: Well I think we could do individual cases until we’re 90 years old and without some kind of systems change it will always be the same violations occurring. So systems change is very important to try to, you know, to try to really get the most bang for your buck if you will. I mean I love doing individual representation but systems change effects, you know, a multitude of people for generations to come. So I do think it’s worth the effort and I realize that some PAPS programs don’t have the advantage of having worked with their state VR agency under a client assistance program as well but I would encourage them to get a monthly meeting with the state director or the, the point person for the ticket program and just sit down and, and talk about non adversarial types of things. Just find out what, what their state VR is doing in terms of this as with any employment network because I know some states have other employment networks that are healthy and alive but, but start to do some positive dialogue with folks because it, it really helps when you have to go into a more negative dialogue with, with those individuals and, and, um pick up the phone, talk with those folks, meet face to face, um look for ways that you can support them.

Thomas: Sue we so appreciate you taking the time to come out and share with us. I know that as you were engaged in a lot of these dialogues we were kind of poking and prodding along side of you to see what it was that the Indiana PAPS program was going to be dealing with state VR and we are so pleased with the progress that you’ve made and are so happy that you’ve taken the time to come and share with our broader audience of PAPS programs across the country how they can engage in some meaningful dialogue that really does result in successful systems change. Thank you.

Sue: Well thank you and we are grateful in Indiana for the support of Cornell University and all of the training and support that you folks have provided us as well.

Thomas: Isn’t she good?

9 Sue: I studied last night.

Thomas: Oh my heavens.

Sue: There wasn’t any good t.v. on.