Protection and Advocacy for Developmental Disabilities (PADD)
 Annual Program Performance Report (PPR)

Section I.	Identification

Reporting Period:  October l, ____ Through Se ptember 30, ____

State: 

P&A Agency Name:

Name and Phone Number of Contact Person (regarding questions):

Section II.	Individual Clients Served

This section is for reporting of persons with developmental disabilities who received individual advocacy addressing at least one disability-related problem.  Do not report the same individual more than once even if they received multiple services, and do not include individuals who were only represented as part of a group or class action.

A.	Number of Individual Clients (Persons with Developmental Disabilities Receiving Individual Advocacy)

	1.	Number of clients receiving advocacy at start of fiscal year:	_____

	2.	Number of new/renewed clients represented during fiscal year:	_____
			Total	_____

B.	Number of Case Problems* of Individual Clients	_____

*This number may be more than the total number of clients served since each client may have more than one presenting problem to be addressed.

C.	Age of Individual Clients

	 0-2 	_____
	 3-4	_____
	 5-22	_____
	23-59	_____
	60 and over	_____
		Total 	_____

D.	Sex of Individual Clients

	Male	_____
	Female	_____
		Total 	_____

E.	Racial/ Ethnic Background of Individual Clients
Data is self-reported.  Select only one category for each client.

Asian	_____
Black, not of Hispanic/Latino origin	_____
Hispanic/Latino	_____
North American Indian or Alaskan Native	_____
Pacific Islander	_____
White, not of Hispanic/Latino origin	_____
Multi cultural (identified with more than one of above)	_____
Other than above	_____
Information Not Provided 	_____
		Total Clients	_____

F.	Individual Clients' Geographic Location			

Number of clients living out of state	_____
	List states include number of clients living in each state:

Data by County (see instructions; use additional space as needed).  Please provide the following:

									    	Number of
County Name		Total Population		Is County Mostly Rural 	Individual Clients
						(fewer than 100 persons
						  per square mile on average)

Total number of clients living in and out of state	_____

G.	Clients' Living Arrangements

	Independent	_____
	Parental or other Family Home	_____
Community Residential Home (e.g.,supervised apartment,	_____
	  Semi-independent, halfway house, board & care, small group home 3 or less)
	Foster Care	_____
	*Nursing Home(includes ICF, SNF, etc.)	_____
	*Public (State Operated) Institutional Living Arrangement
 (e.g., hospital treatment center/school or large ICF/MR  group home more than 3 beds)	 _____
*Private Institutional Living Arrangement	_____
(e.g.., hospital or treatment center, school or large group home more than 3 beds)
*Legal Detention/Jail/Prison/Detention Center	_____
	Homeless	_____
*Federal Facility (List) 	_____
	Other	_____
		Total Client Cases by Living Arrangement	_____

	(*Is considered an institution for the purposes of completing Section III A-1)

H.	Individual Clients' Disability 
Identify the client’s primary disability.  This is the disability which directly impacts or allows the individual to be considered developmental disabled and results in the need for advocacy.

	Autism	 _____
	Cerebral Palsy	 _____
	AIDS/HIV	 _____
	Epilepsy	 _____
	Mental Illness	 _____
	Mental Retardation	 _____
	Muscular Dystrophy	 _____
	Spina Bifida	_____
Learning Disabilities	_____
	Traumatic Brain Injuries (TBI) and other head injuries	 _____
	Tourette Syndrome	 _____
	Visual Impairment/ Blind	_____
	Hard of Hearing/Deaf	 _____
	Other Physical/Orthopedic*	 _____
	Other Emotional/Behavioral*	 _____
	Other Intellectual* 	_____

		Total Disabilities	_____

Breakout of Other Disability* 

Section III.	Case Problem Areas (Complaints) of Individual Clients Served
This is the total number of problems addressed by the PADD program and collected at case closure.  This will allow the PADD program to better determine the outcome of its work.  This can be more than the number of problems presented upon intake that is the total number reported in Section II B.

A.	The outcome of problems addressed for Individual Clients

1.	Number of persons with developmental disabilities living in institutions* served by the P&A whose complaint of  abuse, neglect, discrimination of their rights was remedied by the P&A.		    ____

	(*See living arrangements to determine definition of institution)

	(GPRA Outcome)
2.	Number of persons with developmental disabilities living in the community who were served by the P&A and whose complaint of abuse, neglect, discrimination of their rights was remedied by the P&A during the course of the plan year

										________

This GPRA Outcome will be included in a national total reported to Congress, in compliance with the Government Performance and Results Act of 1993 (GPRA).  This Outcome will be compared with the Target/Objective in the SGP previously submitted in the Plan Year.

B.	Types of problems addressed by areas of emphasis 

	1. Quality Assurance including abuse, neglect & other violations of rights	____
	2. Education and early intervention	____
	3. Child care 	____
	4. Health care	____
	5. Employment	____
	6. Housing	____
	7. Transportation	____
	8. Recreation	____
	
Total Case Problem Areas of Individual Clients Addressed upon closure	____

C.	Reasons for Closing Individual's Case Files:

1.Issues resolved partially or completely in the individual's favor	_____
2.Other representation found	_____
3.Individual withdrew complaint	_____
4.Appeals were unsuccessful	_____
5.PADD services not needed due to individual's death, relocation, etc.	_____
6.PADD withdrew because individual would not cooperate	_____
7.PADD unable to take case because of lack of resources	_____
8.Individual's case lacks legal merit	_____
9.Other  	_____

D.	Intervention Strategies Used in Serving Individuals:
(List the highest level of Intervention used by PADD prior to closing each case file.)

	1.	Technical assistance in self-advocacy	_____
	2.	Short-term assistance	_____
	3.	Investigation/monitoring	_____
	4.	Negotiation	_____
	5.	Mediation/alternative dispute resolution	_____
	6.	Administrative hearings	_____
	7.	Litigation 	_____

E.	Satisfaction of Individuals Served:

1.  Number of satisfaction surveys distributed	_____
2.  Number of satisfaction surveys returned during the year	_____
(may not be the same number sent out)
3.  Of the total number of surveys returned, indicate how many individuals rated their overall satisfaction with PADD in the following ways:
	a	.satisfied		_____
	b.	not satisfied	_____

4.	Number of client grievances filed under the client grievance procedure 				    _____

Section IV.	Interventions on Behalf of Groups of Clients

A.	Summary Information

Type of Intervention	Number of 	Potential #	Concluded	Concluded	Pending
			Groups	 	Individuals	Successfully	Unsuccessfully
					Impacted

Group Advocacy

Investigations

Monitoring

Court-Ordered
Monitoring

Systemic or Class-
Action Litigation

Total

B.	Systems Change & Capacity Building (of service delivery system for persons with developmental disabilities) Activities

In general, for all systems change and/or capacity building (of service delivery system for persons with developmental disabilities) activities, respond to the following:

1)	What are the major areas of systems change and/or capacity building activities?
2)	Which groups are likely to be affected?
3)	What have been the major outcomes during the fiscal year?

Section V.	Non_Case Directed Services

A.	Information and Referral Services (See glossary for definition)

	(Individual Non_Case I&R) Total I&R	_____

B.	Public Education and Training Activities (see glossary for definition)

Number of persons with disabilities (or their family members) who received education or training about their rights, enabling them to be more effective self advocates.	_____

C.	Information Dissemination Activities	Number of Items

     1. radio/TV appearances 	 _____
     2. newspaper articles (attach select articles)	 _____
     3. PSAs/videos/films/etc. aired	 _____
     4. reports disseminated	 _____
     5. publications disseminated	_____
     6. Information about P&A disseminated	_____
 (include general training /outreach or presentations not included in training activities)	 
     7. Number of hits on Website	 _____
     8. Describe other media activities:	_____

D.	Consumer Involvement in P&A Organization
Please provide the following information on the number of individuals who self identify.

Primary	Secondary	Other 		Out of
Number of consumers (DD)		Consumers	Consumers 	Disabilities 	Total 
	
•	on governing board

•	on advisory board

E.	Racial/Ethnic Involvement in P&A Organization
Number of persons in a minority group in the P&A system:

		African		Hispanic	Asian		Native				Out of
American	American	American	American	Other		Total 

•	staff
•	governing-
board
•	advisory councils

Does the PADD program utilize volunteers?  If so how?

Section VI.	Outcomes of Priorities and Objectives
List reporting year priorities from the Statement of Objectives and Priorities in order by priority.

Copy this page for each priority in the SGP, and provide the following information:

1.	Identify and describe the priority. 	Priority # P/ ___ /  (provide # from the SGP)

2.	Identify the need, issue or barrier addressed by this priority.

3.	Identify and describe indicators PADD used to determine successful outcome of activities pursued under this priority.

Indicator # (___) (from the SOP)   Indicator is:	/  /Met   /  /Partially Met/Continuing  /  /Not Met 
	If "Not Met" was checked, explain:

4.	Explain whether pursuing this priority involved collaborative efforts by other entities.  If so, describe this collaboration.

5.	If this was this addressed through individual advocacy, provide the number of cases handled under the priority.  

6.	If this priority addresses systemic advocacy or capacity building of the service delivery system for persons with developmental disabilities, please describe how including indicating if any were class actions.

7.	Was this priority targeted to under/unserved and minority populations?  If so please describe whether or not services to the targeted population resulted in an increase in clients served.

8.	Provide at least one case summary that demonstrates the impact of the priority.

9.	Rounding off to the nearest hundred dollars how much of this year’s grant or award or its program income was spent on this priority?

10.	Will this priority be continued in the next fiscal year?

Section VII.  Developmental Disabilities Network Collaboration

A.	Provide information related to only those issues/barriers affecting individuals with developmental disabilities and their families in your State that the DDC, P&A, and UAP(s) (the DD network) have jointly identified as critical State issues/barriers.

Using short titles, list 5-10 areas that the DDC, P&A, and UAP(s) have identified as critical State issues/barriers.  Then, by checking the circle(s) to the left of the short title(s), identify any issues/barriers selected by your State DD Network for joint collaboration.

(1)	O
(2)	O
(3)	O
(4)	O
(5)	O
(6)	O
(7)	O
(8)	O
(9)	O
(10)	O

B.  	Provide the following information for at least one of the issues/barriers selected for DD Network collaboration.  Repeat this section for reporting each issue/barrier selected for DD Network collaboration.

1.	Issue/Barrier # (from above):

2.	Provide a brief description of  the collaborative issue/barrier and expected outcome(s).

3.	Reference applicable SGP Goals(s):

4.	Describe the P&A's specific roles and responsibilities in this collaborative effort.

5.	Briefly identify problems, if any, encountered as a result of this collaboration.

6.	Describe unexpected benefits, if any, of this collaborative effort.   

7.	If your P&A can provide technical assistance expertise in this area to other States, please describe.

8.	If any, describe the technical assistance needs the P&A/DD Network have in this area.

Section VIII.	Coordination

Check if the following programs are housed in the same organization as the P&A program:

/  / Client Assistance Program (CAP)

/  / Long Term Care Ombudsman (Older Americans Act)

/  / Other:  Please list:

If the Client Assistance Program (CAP) and  the Long Term Care Ombudsman (Older Americans Act) are not part of the P&A System (PADD, PAIMI, PAIR and PAAT programs) describe coordination between the PADD program and the CAP and the Long Term Care Ombudsman (Older Americans Act.)

Describe your system's relations with agencies other than above and any inter-agency agreements or joint projects you may have, other than mentioned above.

Section IX.	Services Provided Using Non-Part C Funding
Are services and activities benefiting persons with developmental disabilities and their families supported by funding other than that provided by Part C of the DD Act or its program income.

Yes /  /  No /  /

Please describe the projects funded with non-part C funding or its program income.