Centers for Independent Living

The NYS Centers for Independent Living End of Year Report is due to VESID on or before November 15 of each contract year.

Format

Name of Center:
Contract No.:
Report Period:
Contact Person:
Board President Certification:

Part 1: Narrative Report

All Attachments should be referenced in the body of the report but included at the end under Part 4: Attachments.

I. Community and Systems Advocacy Activities and Outcomes

List the contract goals, activities and outcomes under each of the six systems advocacy categories A. through F. below. Include the activity and outcome for a goal that was not stated in the contract but added during the contract year. Count all systems change activity from all funding sources. Be clear to delineate activities from outcomes and milestones of systems change. Placement of activities, outcomes and milestones in an advocacy category depends upon the issues being addressed and the system being changed. For example, efforts to change public transportation systems will go under Commerce, while work toward improving transportation specifically for seniors to attend a social event would go under Social. Distinguish between outcome achievements for the reporting period and updates on outcomes accomplished in a prior reporting period, as systems change credit cannot be granted again for refinements to a previously credited outcome. Reference Appendix B "Examples of Community and Systems Change" for further clarification on measuring outcomes.

Documentation will be required by VESID on a case by case basis. The type and scope of documentation requested could vary depending upon the advocacy area or type of outcome. Well described steps taken to achieve an outcome should be noted under the reporting of “activities”. Improving access in the business community, educational facilities and elsewhere should be described in detail. Outcomes should be supported with documentation such as: if a curriculum developed by the CIL was added into a training model then it should be attached, if a new committee or task force gained representation of a CIL staff member or consumer then an appointment letter or minutes of a meeting should be attached, and if legislation was passed through a bill or proclamation then the detailed extent of CIL involvement should be attached along with a summary of the bill or proclamation.

A Center for Independent Living (CIL) must achieve one systems change outcome in at least three of the six systems advocacy categories A. through F. in the contract year. If systems change is not achieved in three required systems advocacy categories, an acceptable program improvement plan must be submitted to VESID for continued funding within 30 days following the unacceptable performance finding outlining efforts to contact and receive community and systems change training from other high performing NYS CILs.

Category G. Other Community and Systems Change Issues has been added for your convenience and is optional. No outcomes achieved under G. can be counted as part of the three outcomes required by the contract between the center and VESID.

Goals: In this section of the report "goals" refers to those items listed in the CIL's contract under I. Community and Systems Advocacy Plan, Categories A. through F.

Education

Goal:

Activities:

Outcomes:
Employment

Goal:

Activities:

Outcomes:
Health Care

Goal:

Activities:

Outcomes:
Commerce

Goal:

Activities:

Outcomes:
Social

Goal:

Activities:

Outcomes:
Citizenship

Goal:

Activities:

Outcomes:
Other Community and Systems Change Issues

Include other activities which had an impact on the community but which may not be covered by one of the preceding categories.

Goal:

Activities:

Outcomes:

II. Technical Assistance to the Community (Education/Awareness)

This section should contain information on trainings, in-services, workshops, awareness activities, presentations provided by the center to groups of consumers, businesses, agencies, etc. in the community. Provide bulleted lists including topics, date, targeted audience and number of participants. This section could also include Architectural Barrier Consultations, American with Disabilities Act (ADA) workshops, Individuals with Disabilities Education Act (IDEA) trainings, Fair Housing Act in-services, etc. given to groups.

III. Public Relations

Use bullets to describe any activities which promoted center services and disability-related issues including appearances on radio, television, and in print media as well as center publications (newsletters, brochures, annual reports), web pages, volunteer recognition events, etc. Attach press releases, public service announcements, articles, web site address, etc.

IV. Resource Development

Report on annual goals and objectives related to diversifying funding and developing resources other than New York State Independent Living Aid to Localities funding. Include grants applied for and/or received, special events, fees-for-service, development campaigns, etc.

V. Staff and Board of Directors

Describe activities related to staff and governing board training.
Describe the affirmative hiring steps taken by the CIL to fill openings in the past year.

VI. Outreach

Provide the Racial/Ethnic demographic data collected on consumers with a Consumer Service Record (CSR) served in the report year along with data from the most recent US-local/county Racial/Ethnic census. If the CSR Racial/Ethnic data is disproportionate to the most recent Racial/Ethnic census data, a program improvement plan must be submitted within 30 days following the unacceptable performance finding to remedy the discrepancy. If additional funds are required, a good faith effort must be made to obtain them and should be reported in the resource development section.

The comparison of the CSR Racial/Ethnic demographics to the census Racial/Ethnic demographics is to be done using both numbers and percentages. The data comparison is to be presented in a table along with a narrative. A table makes it easier to compare the CSR data with the most recent census data and readily identify any discrepancy. The narrative is used to discuss the data given in the table and describe the steps the center will take to remedy an identified discrepancy.
If it is deemed necessary to outreach to unserved or underserved groups including age, gender, race, disability or any other unique subpopulation, identify the groups and describe steps taken. If additional funds are required, a good faith effort must be made to obtain them and should be reported in the resource development section.

VII. Determination of Community Need/Consumer Involvement in Center's Mission and Philosophy

Describe activities that promoted consumer involvement in the development of center's policies, services, etc. This could include focus groups, advisory boards, ad hoc committees, etc.

VIII. Training and Technical Assistance Needs

If the center has identified training and technical assistance needs for the next fiscal year, list these needs in priority order (from most important to least important). Please be specific.

IX. Deinstitutionalization Cost Savings

All Centers for Independent Living are required to report results of assistance provided to consumers to prevent or transition from an institutional setting to integrated community settings using the VESID approved statewide cost benefit reporting model. The CIL Deinstitutionalization Cost Savings Report Summary must be submitted as an attachment to the End of Year Report. VESID updates its cost benefit analysis of assistance provided to consumers to avoid or leave an institutional placement once a year at the end of each contract period.

When submitting the CIL Deinstitutionalization Cost Savings Report Summary it is not necessary to provide Individual Consumer Worksheets. VESID is only interested in receiving the Summary Report. However, centers are required to maintain for verification purposes the Individual Consumer Worksheets. If there has been no activity in this area during the report period, submit a statement of “No Activity” in order to confirm the completion of this section of the report.

Part 2: Direct Services and Statistical Report

Name of Center:

Report Period:

Count all statistical data from all funding sources.

I. Demographic Data for People with CSRs

Report unduplicated demographic data for all consumers with disabilities with a Consumer Service Record (CSR) served during the report year. Include data for new consumers with a CSR started since October 1 of the report year and returning consumers with a CSR served during prior report years that have returned in the reporting year. Every item of demographic data must be recorded for every consumer with a CSR unless a consumer is unwilling to provide it (in which case "unknown" should be recorded for the missing data). Age, Education Status and Employment Status must be updated annually for each consumer with a CSR. The six demographic categories A. through F. must agree. These demographic categories do not need to agree with the disability data.

A.	Age
	1.	Under 6	________________
	2.	6 - 17	________________
	3.	18 - 22	________________
	4.	23 - 54	________________
	5.	55 & over	________________
	6.	Unknown	________________
		TOTAL	________________

B.	Gender
	1.	Female	________________
	2.	Male	________________
	3.	Unknown	________________
		TOTAL	________________

C.	Race/Ethnicity
	1.	White	________________
	2	Black (non-Hispanic)	________________
	3.	American Indian or Alaskan Native (includes Native Hawaiian)	________________
	4.	Asian or Pacific Islander	________________
	5.	Hispanic	________________
	6.	Unknown	________________
		TOTAL	________________

D.	Employment Status
	1.	Full Time	________________
	2.	Part Time	________________
	3.	Looking for a Job	________________
	4.	Unemployed (not looking)	________________
	5.	Student or in a Program	________________
	6.	Retired	________________
	7.	Participating in segregated work or day program setting	________________
	8.	Other employment category not specified above	________________
	9.	Unknown	________________
		TOTAL	________________

E.	Education Status
	1.	Pre-K Program	________________
	2.	K-8	________________
	3.	Some High School	________________
	4.	Completed High School	________________
	5.	Some College	________________
	6.	Business Trade, Vocational School	________________
	7.	Completed two year undergraduate degree program	________________
	8.	Completed four year undergraduate degree program	________________
	9.	Completed post graduate degree program	________________
	10.	Unknown or Not Yet Enrolled in School	________________
		TOTAL	________________

F.	County(s) Served
		Reporting "unknowns" is not an option under County(s) Served. Each consumer with a CSR should have a mailing address to identify the county of residence. If a consumer lives in another state/country, give the name of that state/country.
		Name
	1.	________________	________________
	2.	________________	________________
	3.	________________	________________
	4.	________________	________________
	5.	________________	________________
	6.	________________	________________
	7.	________________	________________
	8.	________________	________________
	9.	________________	________________
	10.	________________	________________
		TOTAL	________________

II. Disability Data

Report all people with disabilities who received services (people with and without a CSR) during the report year. While an unduplicated count is provided for each of the five disability categories, the disability data can reflect more than one disability category selection of A. through D. by a consumer, which would also be reported under category E. For example, a consumer who selects both epilepsy and blindness would be reported under B. Physical, D. Sensory, and E. Multiple Disabilities. The Disability category must be recorded in order to document the establishment of a CSR. People without a CSR may be individuals receiving the service of Information and Referral (I&R) only. These individuals have also been referred to as “casual” consumers. In order to document the impact of CILs on people with disabilities, CILs are encouraged to request name, address, and disability information from “casual” consumers.

A.	Cognitive
	1.	Mental Retardation	________________
	2.	Traumatic and other brain injuries	________________
	3.	Learning Disability	________________
	4.	Autism	________________
	5.	Other cognitive disabilities	________________
		TOTAL	________________

B.	Physical
	1.	Spinal cord injury	________________
	2.	Neuromuscular	________________
	3.	Orthopedic	________________
	4.	Cerebral palsy	________________
	5.	Spina Bifida	________________
	6.	Other congenital birth anomaly	________________
	7.	Epilepsy	________________
	8.	Muscular dystrophy	________________
	9.	Amputation	________________
	10.	Back Injury	________________
	11.	HIV/AIDS	________________
	12.	Environmental and other related illnesses	________________
	13.	Other physical disabilities	________________
		TOTAL	________________

C.	Mental
	1.	Mental Illness	________________
	2	Emotional/behavioral disabilities	________________
	3.	Substance Abuse	________________
	4.	Other mental illnesses	________________
		TOTAL	________________

D.	Sensory
	1.	Blindness	________________
	2.	Low Vision	________________
	3.	Deafness	________________
	4.	Hard of hearing	________________
	5.	Deaf/Blind	________________
	6.	Other sensory disabilities	________________
		TOTAL	________________

E.	Multiple Disabilities		________________
	Report consumers with combinations of the categories above. Not to be checked independent of the selection of two or more disability categories.

F.	Total of Disability Categories (A+B+C+D+E)		________________
	When adding up the five disability categories, the total may be equal to or greater than the total reported for III.A. People With Disabilities (PWD) but not less than.

III. Total People Served During the Year

A.	People With Disabilities (PWD) (new CSRs + Returning CSRs + I&R PWD only)	________________
B.	Family Members/Significant Others	________________
C.	Other Non-Disabled including personnel from Businesses/Agencies	________________
D.	Total consumers projected in contract to be served	________________
E.	Total consumers receiving direct services (A + B + C)	________________
F.	Total Community Education and Awareness Recipients	________________
G.	CSRs returning that were served during prior reporting years.	________________
H.	CSRs started (new) since Oct. 1 of report year	________________
I.	Total CSRs served during report year (G+H)	________________
J.	Businesses/Agencies served	________________

IV. Individual Services - Number of Persons Served

For each service offered, report the unduplicated number of consumers receiving that service during the reporting year. The same consumer can be counted in more than one service area.

A.	Advocacy/Legal services	________________
B.	Architectural barrier services	________________
C.	Assistive devices/equipment	________________
D.	Children's services	________________
E.	Communication services	________________
F.	Counseling services	________________
G.	Family services	________________
H.	Housing and shelter services	________________
I.	Information and referral	________________
J.	Independent living skills development and life skills services	________________
K.	Mobility training	________________
L.	Peer counseling	________________
M.	Personal assistance services	________________
N.	Recreational services	________________
O.	Transportation services	________________
P.	Youth services	________________
Q.	Vocational Services	________________
R.	Plan for the Achievement of Self Support	________________
S.	Business/Industry/Agency services	________________
T.	Benefits Advisement	________________
U.	Voter Registration	________________
V.	Other	________________
TOTAL		________________

Part 3: self-Evaluation with NYS Standards

Name of Center:
Report Period:

Standard 1 - Consumer

A.	Governing Board:
	1.	Verification of consumer control:
	a.	No. of persons on governing board.	________________
	b.	No. of governing board members with disabilities.	________________
	c.	The CIL has a process for nominating and electing board members.	____ Yes ____ No

	2.	The board is the principal policy making body:
	a.	Bylaws or other documents or practices of the CIL ensure that policy decisions are vested with the governing board?	____ Yes ____ No
		if decision or veto authority rests in a body other than the governing board, please describe.
		________________________________________________
		________________________________________________
	b.	Do the CIL bylaws specify board member roles and responsibilities?	____ Yes ____ No
	c.	The governing board is the principal governing body of the CIL.	____ Yes ____ No
	3.	Attach a current board membership list including names, addresses, phone numbers and asterisk (*) members with disabilities.

Standard 2 - Equal Access

A.	CIL advocates for and conducts activities that promote equal access to all services, programs, activities, resources, and facilities in society whether public or private, and regardless of funding source, for individuals with disabilities. Equal access, for purposes of this paragraph means that the same access provided to individuals without disabilities is provided in the CIL's service area to individuals with disabilities.	________________
B.	CIL makes available in alternative format, including Braille, large print, cassette tape, electronic disk, etc. upon request, all of its written policies and materials and IL services.	____ Yes ____ No
C.	The CIL is totally physically accessible for persons with mobility disabilities.	____ Yes ____ No
D.	There are TDD/TTY's and/or other available means, either by the CIL itself or through contract, of communication to ensure access at the CIL for persons with hearing disabilities.	____ Yes ____ No
E.	The CIL is accessible to persons with disabilities requiring alternative means of ensuring ways of access to CIL services.	____ Yes ____ No
F.	Interpreters are available at the CIL upon request.	____ Yes ____ No
G.	Reader assistance is made available at the CIL upon request.	____ Yes ____ No
H.	A sampling of public relations materials reviewed emphasizes attention to equal access to society for all individuals with disabilities.	____ Yes ____ No

Stan dard 2 - Equal Access

The CIL maintains the following information in each Consumer Service Record:
A.	Annually updated educational and employment status data from intake/consumer profile forms.	____ Yes ____ No
B.	Consumer signed and dated notification of rights and responsibilities as a consumer of the CIL.	____ Yes ____ No
C.	Rights and responsibilities document includes acknowledgement of consumer right to confidentiality.	____ Yes ____ No
D.	Rights and responsibility document acknowledges and describes an internal CIL grievance process.	____ Yes ____ No
E.	Rights and responsibility document acknowledges the availability of VESID with a contact address and phone number for addressing consumer complaints about CIL services.	____ Yes ____ No
F.	There is a record of specific services provided including:
	Specific services received	____ Yes ____ No
	Dates of service contract	____ Yes ____ No
	Referrals made on behalf of consumers (either written or other formal referrals).	____ Yes ____ No

Standard 4 - Community Options and Community Capacity

In the reporting year, the CIL promoted the increased availability and improved quality of community based programs that serve individuals with disabilities and promoted the removal of any existing architectural, attitudinal, communication, environmental or other type of barrier that prevents the full integration of people with disabilities into society. During the reporting year, the CIL performed at least one activity in each of the following categories:
A.	Community Advocacy.	____ Yes ____ No
B.	Technical Assistance to the Community on making services, programs, activities, resources, and facilities in society accessible to individuals with disabilities.	____ Yes ____ No
C.	Public Information and Education.	____ Yes ____ No
D.	Outreach to populations of individuals with disabilities that are unserved or underserved in the CIL's outreach plan.	____ Yes ____ No

Standard 5 - Resource Development

The CIL during the reporting year conducted resource development activities to obtain funding from sources other than New York State Independent Living Aid to Localities funding.
A.	Resource development is reflected in End of Year CIL Annual Performance Report.	____ Yes ____ No
B.	Resource development is reflected in Annual Certified Financial Statement.	____ Yes ____ No

Part 4: Attachments

All attachments referenced in Part I. Narrative Report should be placed in this section. This can include items that will help to illustrate or document activities mentioned in one or more sections of the narrative. For Part 1: III. Public Relations, it is required to attach all pertinent items such as press releases, public service announcements, publications, articles, web site address, etc. For Part 1. IX. Deinstitutionalization Cost Savings, attach a completed CIL Deinstitutionalization Cost Savings Report Summary. If a Program Improvement Plan(s) is indicated in Part 1: I. Community and Systems Change Activities and Outcomes, VI. Outreach; Part 2. III. D. Total consumers projected in contract to receive direct services; and/or Part 3: Self-Evaluation with NYS Standards, the completed plan(s) should be placed in this section.

End of Year Report

Updated Oct. 2007