2007 Comprehensive, Cross-Governmental Strategic Plan to Assure

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2007 Comprehensive, Cross-Governmental Strategic Plan to Assure







    2009 Progress Report

    Adopted June 23, 2009 Pursuant to Executive Directive 6 (2007)

    By the Community Integration Implementation Team


    Submitted to The Honorable Timothy Kaine, Governor of Virginia

    August 10, 2009

    Table of Contents






    Critical Success Factor #1: Plan, Understand, Choose and Self-Direct

    Services and Supports 5

    Critical Success Factor #2: Choose Among Quality Community

    Providers and Direct Support Professionals 10

    Critical Success Factor #3: Obtain Housing 13

    Critical Success Factor #4: Locate and Obtain a Job 20

    Critical Success Factor #5: Access Transportation 22

    Critical Success Factor #6: Surrogate Decision-Making 25

    Critical Success Factor #7: Access Ongoing Supports: Community 25

    Critical Success Factor #7: Access Ongoing Supports: Facilities 29


    Appendix I A Guide to Acronyms Used in This Progress Report Appendix II Executive Directive 6 (2007)

2009 Progress Report: Community Integration for Virginians with Disabilities 1




    2009 Progress Report


    On August 2, 2007 the four Secretariats, two Councils, 21 Executive Branch entities, and six local government and agency representatives comprising the Community Integration Implementation Team (Team), and the 21-member stakeholder Community Integration 1Advisory Commission (Commission) jointly adopted Virginia’s first Comprehensive, Cross-

    Governmental Strategic Plan to Assure Continued Community Integration of Virginians with Disabilities (the Plan) pursuant to Executive Directive 6 (2007). The original Plan was submitted to the Honorable Timothy Kaine, Governor, on August 31, 2007.

    Executive Directive 6 charges the Team to annually update the Plan and report on implementation progress by August 31 of each year. The original 2007 Plan was updated and submitted to Governor Kaine in August 2008. The Team respectfully submits this 2009 2Progress Report, which measures progress in implementing the 2008 updated plan.

How the 2009 Progress Report Was Prepared

    Each of the 21 state entities having a role in implementing various components of the Plan was asked to provide an update on progress covering the July 2008 to May 2009 period. This Report represents a compilation of the agencies’ reports, additional publicly available

    information, and progress reports made by four Team Task Groups that developed recommendations on portability of the auxiliary grant, family members as providers, housing barriers, and proposed amendments to the nurse and medical practices and drug control acts. This Report was presented to the Commission and approved by the Team on June 23, 2009. Acronyms used in this Progress Report appear at Appendix I. Executive Directive 6 (2007) appears at Appendix II.


    This section highlights major initiatives of the past year that move Virginia closer to attaining the Plan’s two goals:

    1) Virginians with disabilities who currently reside in a mental health, mental retardation (now intellectual disability), nursing or assisted living facility will have the opportunity to choose to move from these facilities to an appropriate, more integrated setting and stay there; and 2) Virginians with disabilities who are at risk of unwanted admission to a mental health, mental retardation (now intellectual disability), nursing or assisted living facility, will have the opportunity to receive services and supports that prevent admission.

     1 SB 1062 (2009) extended the Commission’s original July 1, 2009 sunset provision to July 1, 2010. 2 At the request of the Commission, this 2009 Progress Report was developed as a stand-alone document. It should be read in conjunction

    with the 2008 Updated Plan, which is available at

    2009 Progress Report: Community Integration for Virginians with Disabilities 2

Money Follows the Person (MFP) Demonstration:

    As of July 27, 2009, 74 individuals had enrolled in this project, and 46 had successfully transitioned to the community from nursing facilities, long-stay hospitals and Intermediate Care Facilities for Individuals with Mental Retardation /Intellectual Disability (ICFs/MR). Of these, 36 were enrolling in the Elderly or Disabled with Consumer Direction (EDCD) waiver; 37 the Mental Retardation/Intellectual Disability (MR/ID) Waiver, and one the Developmental Disabilities (DD) Waiver. To assure appropriate Medicaid-reimbursed community services and supports for these individuals, the following services were added to the indicated Medicaid Home and Community Based waivers:

    ; Transition services (up-front household expenses) were added to EDCD, MR/ID, DD,

    HIV/AIDs and Technology Assisted (Tech) Waivers.

    ; Transition coordination services (transition assistance both before and after transition)

    were added to the EDCD Waiver.

    ; Personal Emergency Response Systems were added to the Tech Waiver.

    ; Assistive Technology and Environmental Modifications were added to the EDCD and 3 HIV/AIDs Waivers (but now are available only for individuals participating in MFP).Additionally, the Department of Housing and Community Development (DHCD) is providing supplemental funding for home modifications that exceed $5,000 and temporary rental payments while home modifications are being completed for individuals participating in MFP. Planning is underway for Consumer-Directed Supported Employment, which provides a consumer-directed option for individual supported employment services, to be added to the MR/ID, DD, and Day Support Waivers in the future.

Systems Transformation Grant:

    This grant supports the disability and aging services systems in Virginia in working together to improve services and supports for all individuals and includes:

    ; Expansion of Virginia’s No Wrong Door system to add sites and all disability populations;

    ; Launch in 2008 of Virginia Easy Access, a public-private partnership involving the

    Commonwealth of Virginia, SeniorNavigator, and 2-1-1 Virginia, which provides

    comprehensive information on a variety of topics of interest to seniors and people with

    disabilities. Under this project, disability services and supports information is being added

    to the SeniorNavigator database to create VirginiaNavigator;

    ; Streamlining of Medicaid eligibility determinations through creation in July 2009 of an on-

    line Medicaid application on Virginia Easy Access;

    ; Infusion of person-centered practices throughout all services systems with development of

    an Individual Support Plan; training; technical assistance; revision of Code, regulatory and

    policy terminology; and examination of practices within many of the Medicaid waivers; ; Creation by individuals who use Medicaid waiver services of guides to various topics of

    interest to individuals who direct their own services;

    ; Planning for individual budgeting to be added to certain Medicaid waivers; ; Creation of a statewide critical incident database; and

    ; Modernizing the application and preauthorization processes for some Medicaid waivers.

     3 These services were also added on July 1, 2008 to these waivers for individuals currently residing in the community; however, according to DMAS, “the extension of these services to all EDCD and AIDS waiver participants has led to costs in excess of the cost-savings generated through the MFP Demonstration program.” Thus, these services were no longer available as of July 1, 2009.

    2009 Progress Report: Community Integration for Virginians with Disabilities 3

Nursing Home Diversion Grant:

    The Virginia Department for the Aging (VDA) is working in conjunction with three Area Agencies on Aging (AAAs) to implement this grant, which provides funding to divert seniors with disabilities from nursing facility admission and creates individual budgets for them to purchase services they need in the community.

    Plan for elimination of MR/ID and DD Waiver waiting lists; 400 new MR/ID Waiver slots: The 2009 General Assembly (GA) funded 400 MR/ID Waiver slots and passed legislation expressing its intent to eliminate the waiting lists for the MR/ID and DD Medicaid Waivers. Beginning July 1, 2010, and each year thereafter, the Department of Medical Assistance Services (DMAS) is required to add at least 400 funded slots for MR/ID Waivers, and at least 67 funded slots for DD Waivers, until the waiting lists for both have been eliminated. A plan for elimination of both lists by the 2018-2020 biennium is due to the chairman of the Joint Commission on Health Care, and the chairmen of the House Appropriations and Senate Finance Committees by October 1, 2009.

Training center downsizing and development of community housing:

    The 2009 GA directed the Department of Mental Health, Mental Retardation and Substance Abuse Services (DBHDS, now the Department of Behavioral Health and Developmental 4Services or DBHDS) to work with the Department of General Services, the Virginia

    Department of Health (VDH), DMAS and others on a state and community planning team to plan for rebuilding of a 75-bed Southeastern Virginia Training Center (SEVTC) and the construction of community housing for individuals who would be transitioned to the community from SEVTC and also for individuals residing at Central Virginia Training Center. The plan must be based on certain information such as completed needs assessments of individuals residing in the facility and completed care plans, the availability of appropriate community facilities and services, and plans for construction or renovation of community facilities in the region and the construction of a new 75-bed facility. A preliminary plan and a progress report are due by October 1, 2009, and quarterly reports are required until construction is complete and individuals are transitioned into community housing. State agencies are required to fast track licensing and certification of community facilities.

Rate increase for personal care providers:

    In spite of an ailing economy, the Governor and the 2009 GA made a commitment to community supports by providing a 3% increase for both agency and consumer-directed Medicaid personal care providers.

Auxiliary Grant portability pilot:

    The Governor and the 2009 GA approved a pilot project that would allow individuals with mental health challenges to use their auxiliary grants to live in residences other than in an assisted living facility or adult foster care.

Developmental disability services coordination:

    DBHDS will begin coordination of services to individuals with developmental disabilities.

     4 This name change was effective July 1, 2009. This report uses the new name and acronym, DBHDS.

    2009 Progress Report: Community Integration for Virginians with Disabilities 4


    Critical Success Factor 1--Plan, Understand, Choose and Self-Direct Services and Supports

    Strategy 1.1: Inclusion of individuals with disabilities or their families in state and local initiatives

    (1) (Best Practices)

    In Fall 2008, the Office of Community Integration (OCI) requested DMAS, VDA, DBHDS, the Virginia Department of Education (VDOE), the Virginia Department of

    Social Services (VDSS), the Department of Rehabilitative Services (DRS), and the State Council of Higher Education for Virginia (SCHEV) to identify best or promising practice models from other states and Virginia that demonstrate intent to promote best practices and support self direction. The following were received: ; A Life for Me Cyber Community:

    ; Consumer-Directed Respite CareAn Agency’s Perspective (Area Agency on Aging of Southwestern Illinois)

    ; Consumer Direction: Programs & Practices in the Aging Network (Virginia Dize, Associate Director for Home and Community-Based Services, National

    Association of State Units on Aging)

    ; Going to College: (Virginia Commonwealth University (VCU))

    ; ―I’m Determined‖ Program: (VDOE)

    ; Long-Term Services and Supports: Consumers in ChargeConsumer Direction and Money Follows the Person (National Health Policy Forum) ; Mission and Purpose Statements, Adult Services and Protective Services (VDSS)

    ; More Can Be Done: Involvement of Older Consumers in the Design, Implementation. and Oversight of Home and Community Based Services: (National Association of the State Units on Aging)

    ; National Secondary Transition Technical Assistance Center:

    ; Notes about Consumer Direction (National Association of Area Agencies on Aging Annual Conference, July 20-23, 2008)

    ; Person Centred Thinking with Older People: (Helen Sanderson Associates, UK) ; RENEW: Individualized, School-to-Career Supports for Youth with Emotional and Behavioral Disorders (JoAnne Malloy, MSW, UNH Institute on Disability) ; Summary of Person-Centered Practices (DRS)

    ; Self Direction--Money Follows the Person (Suzanne Crisp, Boston University)

    ; Shared Decision-Making (Patricia Deegan, Wyandot Center for Community Behavioral Health Care)

    ; Student-Directed Transition Planning:!!.html (Zarrow Center for Learning Enrichment)

    These materials have been transmitted to the Systems Transformation Grant (STG) Goal 2 Resource Team, which is working on implementation of person-centered practices (PCP) across service systems. This Team has developed PCP materials, including an instruction manual, a principles booklet, a glossary, an individual support plan (ISP), and tools for self-direction.

    Person-centered plans are required for individuals transitioning under the MFP Demonstration; case managers and transition coordinators were trained in the use of PCP in Spring 2009.

    2009 Progress Report: Community Integration for Virginians with Disabilities 5

    The DBHDS Office of Developmental Services (ODS) (formerly Office of Mental Retardation) has made significant strides during the last year toward implementation within the MR/ID system of PCP planning materials, including an instruction manual, principles booklet, glossary, ISP, and tools for self-direction.

    Orientation to the new PCP process began in October 2008 with Community Services Board (CSB) case managers/support coordinators, private providers, and non-

    state-operated ICFs/MR and training center staff. The new process represents a major change in the proposed MR/ID Waiver application, currently being considered

    by CMS for approval and implementation on July 1, 2009 for a five year period.

    In addition, ODS has conducted training sessions around the state to prepare Master Trainers in the administration of the Supports Intensity Scale (SIS). The SIS

    is the proposed single assessment tool for the MR/ID Waiver that will be phased in as a triennial assessment. On February 19, the DBHDS Commissioner and

    DMAS Director rolled out the PCP/SIS Training Package to the MR/ID community, and 14 training sessions of waiver providers and training centers were conducted

    in April. Session I provided an overview of the SIS and a brief introduction to the PCP process. Session II provided a more in-depth overview for direct support staff and providers on the plan PCP, including the roles and responsibilities of the various professionals involved. The SIS has been instrumental to DBHDS in preparing

    for the recently approved downsizing of Southeastern Virginia Training Center (SEVTC) to determine community support and living needs for SEVTC residents to transition to the community.

    There is increasing interest in Person Centered Thinking (PCT) from providers across Virginia, as a part of the PCP Implementation Grant in partnership with Support Development Associates (SDA), the National Association of State Directors of Developmental Disabilities Services (NASDDDS), the Virginia Partnership for

    People with Disabilities (PPD) and ODS. There are now 11 endorsed PCT trainers and coaches in Virginia, representing CSBs, private providers, training centers,

    ODS and private individuals. Training of CSB case managers/support coordinators in every region by certified trainers has been underway since October 2008.

    In the most recent update to the DBHDS Performance Contract with CSBs, the Recovery Oriented Systems Indicators (ROSI) was listed as a requirement for all CSBs to administer at least annually. The ROSI is a naturally recognized instrument for measuring movement in the areas of recovery-oriented services for individuals with mental health challenges. The instrument has a strong emphasis on inclusion of individuals receiving services measuring their level of participation in service planning and directing their own supports.

    PCP principles are also a part of the Rehabilitation Act, which governs both the vocational rehabilitation (VR) and independent living (IL) programs.

    VDOE held a second Youth Self Determination Summit in March 2009 in conjunction with its I’m Determined program. Education efforts are also conducted through statewide conferences such as the Transition Forum and Collaborations Conference each held yearly. VDOE hosted regional trainings on PCP (focus:

    Good Day Plans and Goal Setting) in Rockingham, Chesterfield, Franklin County, Appomattox, and Montgomery. Attendance in programs included special education teachers, general education teachers, school psychologists, agency representatives, parents, and administrators. Good Day Plans are used in some Local Education Agencies (LEA) as an alternative to formalized Functional Behavior Assessments. One local agency incorporates the Good Day Plans in their work with individuals.

    The Department of Veterans Services (DVS), in cooperation with DMHRMSAS, DRS and other partners, launched the Virginia Wounded Warrior Program (VWWP) this year. While not focused specifically on self-direction, the VWWP provides additional resources for veterans, Guardsmen, Reservists and their families who need assistance in recovering from the effects of stressrelated injuries (such as post traumatic stress disorder) or traumatic brain injuries. In April 2009, DVS awarded $1.7 million in grant funding to five regional partnerships, so that the partnerships could assist these individuals. The VWWP expands treatment options for Virginia’s Wounded Warriors and their family members, bringing this care closer to where they live.

    DVS operates two veterans care centers which provide nursing care, assisted living, Alzheimer’s care, and rehabilitative services. Treatment plans are developed for all individuals upon admission and with the individual or the responsible party. DVS follows federal regulations which provide individuals or their responsible parties the right to participate in all phases of care and treatment, including any changes to that care or treatment. The Sitter & Barfoot Veterans Care Center in

    Richmond reached full occupancy (160 beds) in FY09. An additional 40 beds are planned. Individuals or their responsible parties participate in all phases of care

    planning, which includes treatment alternatives and discharge planning.

2009 Progress Report: Community Integration for Virginians with Disabilities 6

OCI and the Virginia Board for People with Disabilities (VBPD) are working together to provide opportunities for graduates of the VBPD Partners in Policy-Making

    and Youth Leadership Forum to participate on state-level work groups.

    VDA’s Nursing Home Diversion Grant seeks to divert individuals from the Medicaid program and prevent or delay premature institutionalization. One pilot involves

    DVS and will focus on preventing the premature institutionalization of veterans as well as allowing institutionalized veterans to return to their community. This Grant

    has also trained the caseworkers in the three pilot projects around self-direction. Additional training in self-direction took place in June and will be expanded to all Area Agencies on Aging (AAAs).

    The Commonwealth Council on Aging sponsors an annual Best Practices Awards program. At its third program in 2009, eight community service providers were recognized.

    (2) (Person-Centered Terminology)

    The STG Goal 2 Resource Team’s glossary is being used in all PCP training.

    The STG Goal 2 Resource Team Regulations and Policies Work Group has continued to review the regulations and policies of DMAS, DBHDS, DSS and VDH to

    make suggestions for incorporation of PCP terminology. The group met in March with DSS staff responsible for the General Relief and Permanency regulations, and

    is planning meetings with VDH (Home Care and Hospice regulations) and DMAS. On July 14, 2009 the group met with the Division of Legislative Services and Office of the Attorney General to provide an overview of the project. The group has also revised its plan for review of regulations and policies as they come up for periodic review through 2011 to include additional items, and is setting outcome measures for its work. VDSS incorporated PCP terminology in its proposed Auxiliary Grant (AG) regulation and is considering revisions in various policy manuals.

    OCI is working with the Mental Health Geriatric Partnership to incorporate PCP terminology into a glossary currently under development.

    HB 2300 and SB 1117 (2009) changed the name of DBHDS to the Department of Behavioral Health and Developmental Services (DBHDS) and several terms

    within the statutes to person-centered terms, effective July 1, 2009. The former DBHDS Office of Mental Retardation Services is now named the Office of

    Developmental Services (ODS).

    The General Assembly (GA) was not able to change the term ―Mental Retardation (MR)‖ to ―Intellectual Disability (ID)‖ in the Code of Virginia, as proposed in 2008, due to concerns regarding potential loss of funding.

    (3) (Strategies to Address System Disparities)

    The Office of the Secretary of Health and Human Resources (OSHHR), OCI, DBHDS (ODS), DRS, DSS, DMAS, VDA, VDH, the Virginia Association of Centers for Independent Living (VACIL), AAAs, self advocates, and several Community Integration Advisory Commission (CIAC) members have been actively participating in the implementation of the STG.

    As described in Strategy 1.1(1) above, the STG Goal 2 Resource Team has continued training on PCP awareness, PCP planning processes and tools, and PCT to

    a variety of audiences. A resource bank has been established on the PPD website, and tools developed and/or reviewed by the Resource Team, including ―Person-

    Centered Principles and Practices,‖ ‖I Want a Good Life Workbook,‖ a Glossary, and individual and organizational assessment tools are now available. These

    documents are also available on a newly-created STG web page on the OSHHR website. Additional documents available on the STG web page include seven

    cross-services guides to self-directionall authored primarily by individuals who use services--as described in 1.2.1(3) below.

    Although the ISP was adopted by DBHDS and DMAS for use with individuals with MR/ID, expansion of the ISP to other populations has been challenging, and the group is currently reviewing processes and documents required in other waivers to ascertain changes that may be needed to increase person-centeredness. In

    connection with VDA’s Nursing Home Diversion Grant, PCP training was made available to AAAs, and the Resource Team is planning to follow up with the aging

    community. VACIL is also planning training for individuals who use the EDCD and DD Waivers in appropriate use of the ISP.

2009 Progress Report: Community Integration for Virginians with Disabilities 7

    Virginia Easy Access, a statewide web portal launched in August 2008 under Goal 1 of the STG and administered by VDA, continues to improve to better enable seniors and adults with all types of disabilities to find services and supports. A self-advocate now chairs the portal Work Group.

    VDA’s No Wrong Door initiative (working through SeniorNavigator) has identified best practices that will expand the initiative to include more focus on adults with disabilities. For example, SeniorNavigator is creating VirginiaNavigator. VBPD recently approved a competitive grant award for SeniorNavigator to create a Community-Based Network of VirginiaNavigator Centers. The goal is to develop a person- and family-centered network of VirginiaNavigator Centers which will foster interagency cooperation, expand service capacity, encourage inclusion in the community and enable adults with disabilities to achieve greater independence. The

    project will have a special focus on transportation.

    VDOE staff working with the school systems’ I’m Determined program has been invited to present to the STG Goal 2 Resource Team on August 11, 2009.

    See also Strategy 1.1(1) above.

    (4) (Training):

    See Strategy 1.1(1) above.

    (5) (Post-Secondary Curriculum Development)

    SCHEV and OCI met in September 2008 to discuss the PCP initiative. SCHEV later attended an STG State Work Group meeting to learn more about the project.

    Strategy 1.2.1: Expansion of self-direction options

    (1) (Best Practices)

    OCI received several responses to last Falls request for best practices information. See listing in Strategy 1.1(1) above.

    VDA worked with other southern states in 2004 to prepare a review of best practices for the Southern Governor’s Association; some of the best practices focus on self-direction.

    Virginia is one of six states participating in the PCP Implementation Grant in partnership with SDA, NASDDDS, the PPD and ODS. Virginia is obtaining technical assistance and support from SDA in expanding PCT and self-direction in Virginia and is benefiting from the cross-collaboration with the other grant states.

    VDH has increased family and parent advisory participation in Care Connection for Children (CCC), care management for children with special health care needs.

    VDH also serves on committees researching models of self-direction in other states to form Virginia’s policy.

    VDOE held a second Youth Self Determination Summit in March 2009 in conjunction with its I’m Determined program. Youth met via social networks and in

    person to plan the Summit. Approximately 50 youth met and developed responses to adult, service provider questions that youth posed several months prior to the stForum. They also met in Washington, D.C. where they were involved in seminars developed by the American Civics Foundation regarding the 1 Amendment and citizen advocates. The I’m Determined website is up and contains a variety of materials. Video 2 is posted on the website. A third video was made by youth participants during the Summit and is called a Youth Credo. Another video will be online by winter 2009. The parents of the youth attending the Youth Self Determination Summit met to learn more about self determination and the transition process.

    Under the Tri State Grant, VDOE is developing a Transition Slide Guide that will be a consumable product for parents and services providers to use as they move

    with students through the transition process.

    Youth are meeting in June to help develop and assemble materials and resources to be sent to each LEA. The LEA may use this information to support disability awareness activities during Disability Awareness Month.

    VDOE will continue to assist youth with attending the Youth Leadership Forum, 2009.

2009 Progress Report: Community Integration for Virginians with Disabilities 8

(2) (Increased Self Direction Options)

    Self-direction of Medicaid waiver personal assistance, companion and respite services continues to increase rapidly, with the following numbers of individuals self directing one or more of these three services in the four indicated waivers:

     From January-December 2007 As of March 2008 As of July 1, 2009

    EDCD 2,294 3,144 4,313 of 15,421 who use EDCD Waiver services

    HIV/AIDS 2 4 6 of 48 who use HIV/AIDs Waiver services

    DD 64 352 388 of 594 who use DD Waiver services

    MR/ID 288 1,156 1,104 of 7,810 who use MR/ID Waiver services

    DMAS is continuing to explore the addition of consumer-directed supported employment to the MR/ID, DD and Day Support Waivers. Workers’ compensation issues

    must be worked out first.

    VDSS, DBHDS, and selected local departments of social services and CSBs have been planning for a portable auxiliary grant (AG) pilot that would allow

    individuals with mental health challenges to make decisions about where they live. See details in Section III. 7.2-F below.

    A proposal for DRS and DMAS to permit family members to be paid caregivers if it is in the best interests of the individual receiving services would likely increase self-direction options, while also addressing workforce shortages. See Additional Implementation Activities for Critical Success Factor 2 below.

    VDA’s Nursing Home Diversion Grant includes training for AAA staff around best practices for modifying their business practices to enhance the ability of adults to

    access an assessment, receive service referrals, and obtain information about a wide variety of services and programs in their community.

    Proposed amendments to the Nurse and Medical Practices Acts and the Drug Control Act should also result in expanded options for individuals who direct their

    own services by enabling them to direct their personal assistants, respite workers and companion aides to perform health care tasks that, but for their disability, they

    could perform themselves. See Strategy 2.1.3 below.

    Effective July 1, 2009, Virginia law will allow persons and entities other than law officers to transport individuals who are subject to the emergency custody, temporary detention and involuntary civil commitment processes. New amendments also clarify notification options so that individuals and providers can have more opportunity to communicate with loved ones and representatives about their involvement in the involuntary process. These two sets of changes will enhance individual choice and self-direction, and at the same time decrease the stigmatizing and criminalizing aspects of the transportation process and the overall

    disruptiveness of the involuntary treatment process.

    See also Strategies 1.1(1)-(5) and 1.2.1(1) above.

    (3) (Education and Awareness)

    The STG Goal 2 Resource Team Self-Direction Work Group (chaired by a self-advocate and comprised chiefly of individuals who direct their own services) has

    completed seven ―Easy Speak” documents that are available on the STG website at

    ; What is a PCA and Who Can Be One?

    ; Hiring a PCA

    ; How to Train your PCA

    ; Supervising Your PCA

    2009 Progress Report: Community Integration for Virginians with Disabilities 9

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