Updated 12/04

_____CIL Name______

END OF MONTH REPORT

(DATE)

I.ADMINISTRATIVE

Activity that has program wide implications:

1.Hiring of staff

2.State or federal committee or activity and explanation (include date)

3.Contracts with the Department of Mental Health ____ County, ___state___ Office of Mental Retardation and Developmental Disabilities, and __state___ Education Department.

4.Negotiations or plans

5.Significant donations

6.Significant legislative or governmental activities that affect programs, funding or activity

7.Any major public relation effort or receipt of publicity

8.Reports of agency audits, results and/or issues

9.Intra agency issues: i.e. Recipient of Monthly Quality Service Award, special staff recognition from outside agencies, internal committee work (Standards Committee)

II.DIRECT SERVICES

This is a report of all training programs received by staff. Areas include: In-services, policy training, workshops, conferences, report of peer and self help groups.

Enter the date, length, location, and number of participants of the following activities when conducted. Enter under other the name of the activities that were not planned with the same information.

Conduct Consumer Workshops monthly that will include the following topics:

1. Benefits advisement

2. Housing

3. Transportation

4.Other

Trainings Received by Staff

Date, name of training, presenter, location, very brief explanation of training and duration of training (hours).

1.Cultural Competency

2.Independent Living Philosophy

3.Appropriate Office Conduct

4.Drug and Alcohol Awareness

5.ADA Training

6..Safety Training

7.TB Awareness Training

8.In-service training a minimum of four times per year

9.Other trainings

Board of Directors Training

1.Conduct Board Orientation

2.Conduct Independent Living Philosophy

Agency Sponsored or Hosted Peer or Recreational Support Groups

Enter Group name, number of times met during the month and number of people attending.

1.____name of elder blind group______(6 times per year)

2.Other Groups

Self-Help Groups Sponsored or Hosted

Enter Dates met, group name (if applicable), location and number of people

Technical Assistance

Workshops, Conference presentations, Trainings, Presentations to consumers that provides individual information on anything that is NOT an explanation of departments’ programs and services.

Include in this order:

Date, name of presentation, locations and number of participants. This may be done either at the Center or out in the community.

Examples: Presenting to consumers, professionals or others on work incentives, vocational options, training programs

Training to consumers and professionals on methods of advocacy

Conducting a workshop on housing

Providing cultural competency training

Presentation of managed care issues and answers

Providing workshop or conference on ADA

Workshops to train self-help facilitators.

1.The __name of CIL_____ will conduct a workshop on Americans with Disabilities Act (ADA) for Employment Issues.

2.The __name of CIL_____ will conduct a workshop on implementation of ADA for consumers.

3.The __name of CIL_____ will conduct one workshop for consumers on effective self-advocacy.

  1. The __name of CIL_____ will conduct 2 workshops.

5.Other

Education Campaigns

  1. Conduct workshops for mental health recipients at risk on civil rights under the AOT program.
  2. Conduct community education on implementation of the Medicaid Buy-In program.
  3. Conduct meetings with peers working on AOT teams.
  4. __name of CIL_____ will continue to provide an anti stigma campaign to schools in the community through its “______” program.
  5. The __name of CIL_____ will conduct workshops on consumer choice in services provided under the ______program.
  6. Disabled but able to vote

III.SYSTEMS ADVOCACY

Activities that relate to accomplishment of a systemic or community goal.

** Note: Not all staff are involved in Systems Advocacy. If in doubt, check with your supervisor.

Include in this order:

Date of activity; Name of Goal; Meetings or activity (write letters, demonstrations, possible 1 on 1 meeting or committee meeting, mailings, negotiations/arbitration, public hearings, public forums on issues; Potential outcomes: law, policy and/or regulation changed, money found, entrance given. Put in brief paragraphs. Use appropriate committee name and/or title of organization where applicable. (i.e. Horizon Human Services, not Horizon).

Enter after each goal enter the Date of the activity; a summary of the Meeting or event. Put in brief paragraphs. Under other put in the new goal and enter the same information that you did for the pre-planned goals.

A.Educational Advocacy

Goal - Adoption of institution-wide policy on insertion of Independent Living Philosophy within school curriculum.

Problem - Persons working in professional fields with a high percentage of persons with disabilities are not presented with clear understanding of the role that persons with disabilities have in today's society.

Standard - Equal Access

Results Desired - At least one college or university will incorporate __name of CIL_____ 's Independent Living Philosophy presentation into its curriculum for professional preparation programs that work with persons with disabilities.

Milestones

  1. Identify appropriate colleges and officials that have social work, physical therapy, nursing, or other professional programs.
  2. Identify appropriate deans and instructors in appropriate department.
  3. Write letters to local professional associations and set up meeting.
  4. Present Independent Living presentation to instructors. Present program to classes.

Goal- Local colleges and universities to set aside time within their professional curricula to learn the recovery model philosophy.

Problem: The current training for the mental health Care Providers involves the Medical Model of recovery, which does not recognize the consumer’s ability to recover and participate in their own recovery.

Standard: Consumer Choice, Peer Relationships

Results Desired: One Institution of Higher Learning will incorporate a Peer Recovery Model presentation, created with the consultation of the __name of CIL_____ , into its curriculum for mental health care providers

Milestones:

  1. Identify the Educational Institutions that have departments in the healing arts.
  2. Attend the Partnership subcommittee on Education.
  3. Prepare presentation to instructors on the Peer Recovery Model.
  4. Create linkage to the identified Institutions to present program to classes.
  5. Advocate for permanent adoption of the curricula.

B.Employment Advocacy

Goal - The __name of CIL_____ will improve opportunities for employment within the business sector by adoption of a consumer defined sensitivity program by the member agencies of the local Employment Consortium.

Problem - Consumers need improved skill preparation to prepare for work. The traditional agency “place-first, train later” model of traditional agencies quite often leads to employment failure.

Standard - Consumer Control Consumer Choice

Results Desired - As a result of __name of CIL_____ 's participation on the local Employment Consortium, one employment placement agency will change its policies and procedures to provide disability sensitivity training for newly hired job coaches and developers.

Milestones

1.Identify Agencies that perform job placement, training, or job coaching.

2.Have a Town Meeting on Employment, to identify issues related to employment failure.

3.Participate in local Employment Consortium.

4.Identify training needs changes, as developed from town meeting.

5.Meet with effective agencies on proposed changes.

6.Develop a training program on sensitivity for job coaches.

  1. Adoption of program as policy for new hires for the agencies in the employment consortium.

C.Health Care Advocacy

Goal - The __name of CIL_____ will improve the local implementation of the Supreme Court Olmstead Decision through the establishment of a County sanctioned committee to implement the local process.

Problem - Persons with disabilities have difficulty with the transition from hospitals, nursing homes, or other restrictive placements to community environments without proper community supports.

Standard - Consumer Choice, Equal Access, Peer Relationships

Results Desired – Creation of a county-wide process to increase successful transition for persons with disabilities leaving facilities in __name of CIL_____ by linking them with appropriate community services at appropriate levels.

Milestones

  1. Identify the hospitals and facilities that provide restrictive placements for persons with disabilities.
  2. Identify program managers.
  3. Identify community supports needed for community success, and barriers to use of those services.
  4. Meet with providers of community supports on those barriers.
  5. Meet with program managers about the __name of CIL_____ and other community Support Services.
  6. Get program managers to set up meetings with __name of CIL_____ and discharge planners about support services.
  7. Establish working agreement or memorandum of understanding for referrals of consumers discharge to IL options and arrangements, with community base organizations.
  8. Get county to appoint an agency to oversee Olmstead activity

Goal: The __name of CIL_____ will increase consumer choice within the ______service system by promoting the creation of a peer consumer information program.

Problem: Under the proposed ______initiative consumers are not being given information on the full range of choices available. Information given stresses non-consumer directed medical model.

Standard: Consumer Choice, Equal Access

Results Desired: State Department of Mental Health shall issue regulations mandating the consistent application of notification of rights of consumer choice.

Milestones:

  1. Identify the Metal Health agencies providing service under ______to consumers.
  2. Identify partnering consumer agencies
  3. Hold a Town Meeting on ______.
  4. Meet with OMH officials to promote change in program.
  5. Meet with legislators to promote change in program.

D.Social Advocacy

Goal – The __name of CIL_____ will increase access for persons with disabilities in places of worship

Problem – Persons with disabilities have difficulty accessing both the religious and social functions available at local places of worship in ______County. While religious service areas are not covered by the ADA, access needs to be improved in the public areas of such facilities.

Standard – Equal Access

Results Desired – One place of worship will become more accessible to persons with disabilities.

Milestones

  1. Hold a Town Meeting on Social Activities
  2. Meet with consumers regarding locations they wish to make more accessible
  3. Meet with Church leaders and Boards, offering IL services for accessibility audits
  4. Assess access at willing facilities
  5. Work with facility to remove barriers to public areas

Goal - The _____NAME OF CIL____ will increase physical access and use of assistive listening devices in area theaters.

Problem - Consumers have complained about the lack of physical access, as well of lack of assistive listening devices in area theaters.

Standard - Consumer Access and Choice

Results Desired – Theaters will increase physical access through ramps and seating and increase the use of assistive listening devices.

Milestones

  1. Facilitate two meetings for consumers, one for people in wheelchairs and one for people who use assistive listening devices, to identify what theaters are not fully accessible.
  2. Offer to perform and/or perform accessibility study of the theaters.
  3. Meet with the theater management to discuss the results of these studies.
  4. Conduct a letter writing campaign by consumers to the targeted theaters.
  5. Identify the consumer that wishes to file a DOJ complaint and assist in filing complaint.
  6. The theater will put in either seating for persons who use wheelchairs and/or an assistive listening device.

E.Commerce Advocacy

Goal - The __name of CIL_____ will increase housing opportunities for persons with disabilities.

Problem - Currently few opportunities for housing exist. Disabled persons are forced to stay either in institutions or in substandard housing due to the lack of appropriate public housing.

Standard - Equal Access, Consumer Choice

Results Desired - More accessible and integrated housing will be available for persons with disabilities.

Milestones

  1. Hold Town Meeting on Housing.
  2. Develop position paper on Housing.
  3. Present position paper to ______county______Commission on Homelessness, HUD, RAC, Belmont Shelter, ______County Health Committee, Housing Needs Assessment, Community Services Board (CSB), in hopes to allocate more housing slots for persons with disabilities.
  4. Get CSB to recommend re-investment funds be used for housing.
  5. Work with Housing Options for more slots for supported housing.
  6. Send paper to federal legislators.

7. Passage of a resolution by the ______County Commission on Homelessness encouraging the construction of integrated accessible housing for persons with disabilities

Goal - The ____ County Department of Social Services will increase their sensitivity toward people with disabilities and will increase their physical access to Social Services programs

Problem - Currently, numerous accessibility problems exist with programs coordinated by the _____County Social Services Department. Staff is unaware of the rights of persons with disabilities, and program access is affected by inappropriate planning and policy decisions.

Standard - Equal access

Results Desired – ______County will increase physical access to social service programs in ____ County. In addition, the ______County Department of Social Services will create a employee-training program to deal with program access issues for people with disabilities.

Milestones

  1. Identify consumer willing to file complaint on program access complaints with ______County.
  2. Identify appropriate official, and register complaint with ______County Department of Social Services.
  3. Inform ECOD as to problem, as well as ______County Advisory Council on the Disabled.
  4. Passage of a municipal law by the ______County Legislature insuring access to county services for persons with disabilities.
  5. File complaint with DOJ, if needed.

F.Citizenship Advocacy

Goal - The __name of CIL_____ will expand opportunities for the deaf to equally participate at the City of ______Common Council meetings and hearings

Problem – Persons needing interpreting services have no defined process to request interpreters since the change in the provision of 504/ADA services.

Standard – Equal Access

Results desired – The City of ______will modify its policy to allow for easy access to interpreters for common council and other public meetings sponsored by the City of ______.

Milestones

  • Have a meeting to identify 504/ADA Coordinator for the City of ______
  • Meet with City Residents who are deaf about problems in interpreting services
  • Propose resolution to Common Council (and Control Board, if applicable)

Goal - The __name of CIL_____ will increase physical access to local polling places.

Problem - Consumers have identified that some polling places are inaccessible requiring them to use absentee ballots.

Standard - Equal access and consumer choice

Results Desired - More local polling places will be accessible.

Milestones

  1. Have a meeting with consumers to identify what polling places are inaccessible.
  2. Contact ______County Board of Elections.
  3. Conduct accessibility studies of identified polling places.
  4. Communicate results to the ______County Board of Elections, ECOD, and _____County Advisory Council on the Disabled.
  5. Identify consumer affected by inaccessible polling place.
  6. Assist consumer in filing complaint if needed.
  7. Barrier to accessing the polling place is removed.

IV.SUPPORT TO THE COMMUNITY

Collaboration, including communication, coordination, and cooperation with other agencies and groups. Put after the pre-planned activity the date and a summary of the event or work done. For other collaborative activity, enter the name of the collaboration (purpose of the meetings, activities, events and/or activities), after the name, enter the date and a summary of what was done and why.

Include committees, boards and meetings attended, of where you are in attendance, participating, but you are only in a supportive role, where outcomes of these meetings don't reflect systems change, goals or activities.

Include in this order:

Date, name of meeting, committee or organization, and a very brief explanation of what occurred.

  1. The __name of CIL_____ will work with the ______County Community Services Board to improve hospital rehabilitation services in ______County.
  2. The __name of CIL_____ will work with the ______County Mental Health Housing Planning Committee on increasing housing services for the most severely mentally ill in _____County.
  3. The __name of CIL_____ will work with the City of ______to reestablish the Advisory Council for Persons with Disabilities.
  4. The __name of CIL_____ will continue to work with the Lifelong Services Network in its effort to increase communications between the Center and other State Education funded programs to assist in referrals and services for people with disabilities.
  5. The following are activities that we conduct within the _____ Psychiatric Center in assisting persons to leave the institution:
  6. Other

Community Presentations Agency Programs and Services

Any presentation that you talk about programs and services offered by __name of CIL_____

Include in this order:

Date, Name of organization or group, Location, Number of people attending

1.The __name of CIL_____ will make at least one presentation a month to a community organization, class or service group and/or business

2.__name of CIL_____ will provide at least 3 education presentations to area colleges or universities.

V.COMMUNITY RELATIONS

Provide date and title of publication for each reporting month. Only enter the date of when the action was accomplished. For radio television, or websites, enter the title of show, channel and call letters, or addresses.

Provide date and title of publication for each reporting month

1.Agency News Letter

2. Consumer Information phone Line

3.Job bank line.

4. Public service announcements

5.Press releases.

6. Annual Report for the fiscal year 2003-2004

7. Weekly radio show "______"

8. "______" television shows

9.Other (brochures, flyers, any other agency publications, TV appearances, newspaper articles, Alert Line topics and give original to Executive Secretary for the Archives)

VI.FUNDRAISING MONTHLY REPORT.

Report on the progress of the following planned activity. Enter date and summarize the activity. When possible enter the amount of funds received for the event.

1.Conduct two membership drives held in the winter and spring

2.Participate and/or conduct two fund raising events

3.Get corporate sponsors to underwrite a fundraising event

VII.OUTREACH

VIII.OUTREACH FOR DEINSTITUTIONALIZATION

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