Transportation: Unlike the Weather, People Are Doing Something About It

1
Transportation Unlike the Weather, People Are
Doing Something About It

• Alan Marzilli
• Advocates for Human Potential, Inc.
• Karen Wolf-Branigin
• Easter Seals Project ACTION

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Background

• Early work on the Olmstead/NFI technical
  assistance initiative identified transportation
  as a barrier not being addressed.
• In the Community Integration Now curriculum,
  some solutions are discussed.
• CMHS/SAMHSA commissioned a report on
  transportation issues and approaches.

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The Final Report

• Getting There Helping People With Mental
  Illnesses Access Transportation. DHHS Pub. No.
  (SMA) 3948. Rockville, MD. Center for Mental
  Health Services, Substance Abuse and Mental
  Health Services Administration, 2004.

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The Need for Transportation

• Access to treatment is important . . .
• But transportation is also needed
• To visit friends
• To shop for groceries
• To do fun activities
• To worship
• To attend school
• To volunteer and get involved
• To get to work each day

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Whats Out There

• Public transit
• Paratransit
• Other forms of public transportation
• Private organizations
• Mental health transportation

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(Having) mobility is the only way you can
fulfill your recovery.

• --A person with a disability who trains clubhouse
  members to use public transit and who advocates
  for greater understanding the needs of people
  with hidden disabilities

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BarriersThe Five As

• Affordability
• Accessibility
• Applicability
• Availability
• Awareness
• Cf. Beverly Foundation. (2004). Supplemental
  Transportation Programs for Seniors A Report on
  STPs in America. Washington, DC AAA Foundation
  for Traffic Safety.

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Affordability

• As with housing, lack of transportation is often
  not a matter of disability, but one of poverty.
• In 2002 about one-third of the nearly 5 million
  adults under 65 receiving SSI had mental
  disorders other than mental retardation.
• SSI income levels and resource limits make owning
  a car all but impossible.
• Even paying for transit can be burdensome In
  some major cities, the cost of a monthly bus pass
  can be 7-13 percent of SSI income.

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Accessibility

• Transit systems continue to struggle to
  understand and accommodate the needs of people
  with hidden disabilities such as mental
  illnesses.
• People with psychiatric disabilities might have
  trouble navigating or might fear crowded
  situations.
• Transit employees might not have training in
  responding to problematic behavior or have the
  capacity to provide training to riders with
  disabilities.

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Applicability

• Eligibility for many programs offering assistance
  with transportation is based on a persons
  ability to use transit independently.
• Though millions of people with psychiatric
  disabilities live in poverty, people with
  psychiatric disabilities alone are excluded from
• Paratransit
• Half-fare (unless he or she has a Medicare card)
• Medicaid transportation is generally available
  only for billable services.

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I dont see the reason why only
transportationally disabled people qualify for
a Federal program. Every other definition of
person with a disability is inclusive, and we
dont tolerate discrimination among disabilities

• --Rehabilitation service provider

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Availability

• According to the Association of Programs for
  Rural Independent Living (APRIL)
• 40 percent of people living in rural areas have
  no access to public transportation
• Another 25 percent have extremely limited access,
  meaning that households without cars receive less
  than two transit trips per month on average.
• In many areas, hours of operation or routes limit
  access to social events, shopping, medical care,
  and other important activities.

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Awareness

• Even in places where transportation may be
  accessible, affordable, and available to people
  with psychiatric disabilities, they might not
  know about their options.
• During the course of preparing the report,
  several comments were made that family members or
  service providers sometimes try to limit the
  access of people with psychiatric disabilities to
  public transit.

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Addressing These Barriers

• Improving access to transit
• Providing on-demand transportation
• Coordinating resources

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Improving Access to TransitBenefits

• Many rides are off-peak and fill empty seats.
• Transit offers greater flexibility for a wide
  range of activities.
• People with disabilities ride alongside other
  members of the public rather than being
  segregated in special transportation.

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Improving Access to TransitExamples

• Expanded half-fare programs
• Medicaid transit passes
• Travel training

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Expanded Half-Fare Programs

• Federal minimum transit systems receiving
  Federal funding must offer half-fare on off-peak
  trains and buses to people with transportation
  disabilities and people with Medicare cards.
• States/transit systems are permitted to go
  further.
• New York State grassroots campaign resulted in
  expansion to cover people with SSI/Medicaid.
• Another issue With new emphasis on work, should
  peak times and express buses be included?

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Medicaid Transit Passes

• States must ensure transportation to
  Medicaid-billable services.
• Taxis and vans are expensive.
• Some places found that a monthly bus pass was
  cheaper than just a few rides.
• All involved benefit
• Medicaid recipients can use their passes for
  whatever they want.
• Medicaid agency saves money.
• Transit system receives revenue from pass sales.

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Travel Training

• Specifically addresses issues of accessibility
  and awareness.
• Transit is more flexible and can be easier to use
  than call-ahead vans.
• Peers can have an impact as trainers.
• Training sessions can help identify people who
  need assistance and are therefore eligible for
  additional programs.

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Providing On-demand Transportation

• Not quite as flexible as transitusually requires
  advance scheduling.
• Presents a viable solution in areas without
  transit.

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Providing On-demand Transportation Examples

• Peer-run programs
• Volunteer-augmented programs
• Travel vouchers

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Peer-run Programs

• Because peer-run services such as drop-in centers
  are typically not Medicaid-billable,
  transportation is an obstacle.
• Some peer-run services have started auxiliary
  transportation programs to improve access and to
  help people do other activities.
• Rely on block grants, donations, and volunteers,
  but also have paid staff.
• Organized social outings are possible with access
  to transportation.

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Volunteer-augmented Programs

• Generally take an inclusive approach to providing
  transportation to people with financial need.
• Volunteers can use their own vehicles and receive
  excess liability protection from the program.
• Volunteers are able to deduct their mileage on
  their tax returns.

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Travel Vouchers

• Recipients receive vouchers from sponsoring
  agency.
• Anyone (within sponsoring agencys guidelines)
  providing rides is reimbursed at a flat rate per
  mile. Examples
• Taxi
• Friends and family
• Another service provider with vans
• Can qualify for Federal fundingto be discussed.

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Coordinating Resources

• In a community running separate vehicles with
  different funding streams, seats go unfilled.
• Federal government has called for maximizing the
  use of transportation funds.
• Some States have begun using agencies as a single
  point of entry for all subsidized transportation
  in a region.

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Transportation providers in a lot of places go
right by the house of someone who needs a ride,
and (then) Medicaid sends a taxi 20 miles (to
pick up that same person).

• --Transportation advocate

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Federal Funding

• Capital Assistance Program for Elderly Persons
  and Persons with Disabilities (Section 5310)
• Nonurbanized Area Formula Program (Section 5311)

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Opportunities for Advocacy

• Local transit authorities
• States must designate agencies to administer 5310
  and 5311 programs.
• Metropolitan areas must designate a Metropolitan
  Planning Organization (MPO).
• Other regions also have planning processes.

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Regardless of the size of a county, it will be
getting Federal and State dollars for
transportation for elderly people and people with
disabilities. (The planning process is) a great
avenue for getting consumers involved.

• --Rehabilitation service provider

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The Reports Recommendations

• States, inspired by the Olmstead decision and the
  New Freedom Initiative, should make
  transportation a central part of any plan to help
  people with disabilities live in the community.
• Information gathered about the accessibility
  barriers faced by people with psychiatric
  disabilities should be shared with transit
  providers so that they can better understand
  consumer needs and ensure appropriate
  transportation access.
• Projects receiving Section 5310 funding should
  include people with psychiatric disabilities when
  they provide services to older adults and people
  with disabilities.

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• An assessment tool appropriate for psychiatric
  disabilities should be developed to aid in
  determining eligibility for Paratransit.
• The half-fare statute or regulations should
  incorporate a more inclusive definition of
  disability so that all people with disabilities
  who also experience financial hardship qualify.
• The half-fare statute or regulations should
  extend reduced fares to rush hour and commuter
  vehicles, recognizing that many people with
  disabilities want to work but cannot, due to
  transportation costs.
• Materials should be developed for training travel
  trainers who want to help people with psychiatric
  disabilities use public transit independently.

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• State Medicaid agencies should receive technical
  assistance on implementing Medicaid transit
  passes, and should be encouraged to provide them
  whenever feasible.
• States should receive technical assistance on
  using Community Mental Health Services Block
  Grant funds to provide transportation through
  innovative programs such as consumer-run,
  volunteer-augmented, and voucher programs.
• States should follow the Federal lead in
  coordinating transportation resources to
  eliminate waste.
• Mental health consumers, family members, and
  advocates should receive technical assistance on
  becoming involved in transportation planning
  within Metropolitan Planning Organizations and
  other planning bodies.

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Public Transportation Providers Focus on

• Increasing maintaining funding
• Increasing political support
• Providing efficient and effective service
• Meeting regulatory compliance
• Delivering superb customer service
• Increasing safety security

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Serving Specific Customer Groups is Not a Major
Focus for Public Transportation

• Providers view customers with disabilities
  separately from other customers
• Those using mobility aides receive attention due
  to vehicle capacity
• Older adults are the largest segment of the
  special population
• Specialized services are often contracted out
• Separate is not equal

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Transportation Providers Are Eager to Solve the
Special Population Challenge

• We cost more money to serve
• We have unique problems
• We require personal one-on-one service
• We require expertise
• Transportation providers focus on macro, not
  micro issues

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Mental Health Advocates Focus on

• Recovery
• Transformation
• Housing, education employment
• Living full community lives

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While Public Transportation is a Lifeline and
Major Focus for Those Who Rely on it

• We have competing issues that often get our
  attention
• Were unfamiliar with transit operations
• Were unsure who to talk to, what to ask for

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While Public Transportation is a Lifeline and
Major Focus for Those Who Rely on it

• Were often dissatisfied with responses
• We dont realize that we can help solve
  transportation provider challenges

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Establishing a Partnership to Create a Win-Win
Closing the Gap
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Increasing and Maintaining Funding

• Mental health advocates can communicate our
  interest in
• Using limited transit dollars effectively
• Recommending cost efficient ways for transit to
  serve our customers
• Identifying successful programs used in other
  states

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Increasing Political Support

• Mental health advocates can communicate our
  interest in
• Developing a legislative education partnership
  with transit
• Preparing customers to provide testimony on
  behalf of transit
• Working our own networks to advise them of
  transportation needs

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Providing Efficient and Effective Service

• Mental health advocates can communicate our
  interest in
• Serving on transportation boards
• committees
• Inviting transportation professionals
• to serve on our boards
• committees

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Providing Efficient and Effective Service

• Mental health advocates can communicate our
  interest in
• Creating ways to provide positive
• constructive feedback in
• appropriate transportation
• forums
• Recommending solutions that
• benefit everyone

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Meeting Regulatory Compliance

• Mental health advocates can communicate our
  interest in
• Understanding paratransit eligibility
• Training transit personnel on mental health
  issues and how they related to the paratransit
  application process
• Recommending strategies for supporting customers
  to use fixed route service

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Delivering Superb Customer Service

• Mental health advocates can communicate our
  interest in
• Providing training to transit personnel
• Providing training to the people we serve on
  customer rights and responsibilities
• Providing feedback on draft marketing materials,
  route maps, applications, etc.

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Increasing Safety and Security

• Mental health advocates can communicate our
  interest in
• Providing feedback on draft policies and
  procedures
• Recommending policies and procedures with regards
  to people who are homeless
• Providing training to the people we serve on
  safety and security issues
• Serving as a resource in emergency situations

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Establishing a Partnership Becoming Part of the
Solution

• Director of Transportation
• Director of Operations
• Director of Bus Service
• Director of Marketing
• Director of Customer Service

Message Serving our customers can be a challenge
we want to offer our support to you our
mental health expertise to find workable
solutions for everyone
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Establishing a Partnership Becoming Part of the
Solution

• Director of Paratransit
• Director of Elderly and Disabled Services
• Anyone with an interest in our issues

Message Serving our customers can be a challenge
we want to offer our support to you our
mental health expertise to find workable
solutions for everyone
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Establishing a Partnership Becoming Part of the
Solution

• Offer to attend or host a meeting
• Identify challenges recognized by transit in
  serving our customers
• Identify challenges recognized by human services
  in using public transportation
• Discuss a plan for determining what it will take,
  given the current resources, to find workable
  solutions for everyone

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U.S. Department of TransportationFederal
Transit AdministrationUnited We Ride
www.unitedweride.gov
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Easter Seals Project ACTION

• Call us toll free 800-659-6428
• Order free resources
• Enroll in our training events
• Visit our website www.projectaction.org