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Mayor's Office on Disability
Americans with Disabilities Act Self Evaluation for the City of San Francisco
Results & Recommendations
June 2004
Gavin Newsom, Mayor
Susan Mizner, Director, Mayor's Office on Disability
[Note: All of the photos of people in this document are either headshots or from the waist up, to emphasize that many people have non-visible disabilities]
Table of Contents
ADA Coordinator
ADA Rights Notice
Reasonable Modifications
Effective Communication
Accessible Telephone Communication
ADA Grievance Procedure
Contracting
Purchasing
Spotlight 1: Intensive ProgramsSpotlight 2: 5 Common Barriers
Appendices
Public Forums Outreach Flyer
Survey Introduction & FAQs
Survey Results (All Programs)
Compliance Overview Table
ADA - Title II Regulations
From the Mayor's Office
It is with great pleasure that I introduce, "Toward Unobstructed Access," San Francisco's ADA Self-Evaluation Report. With this report, San Francisco is continuing its historic role in the disability rights movement.
We want, and expect, San Francisco to be a model City-a place in which people with disabilities are not only included, but also embraced; a place where we follow not only the letter of the law, but also the spirit. This Self-Evaluation is a major step toward that goal. Based on what we believe is the most detailed and exhaustive self-evaluation survey in the country, it shows us as we are, with flaws and problems to overcome, but also with hundreds of employees who are eager and willing to do the work that is necessary in order for us to improve.
And this is necessary work. More than 150,000 people living in San Francisco have a disability. Our government needs to be as open and useable to them as to everyone else. In addition, people with disabilities are over-represented among those individuals who most depend on crucial City services and benefits.
For these reasons, I hope that you will take the time to read the report's findings and recommendations, and that you will be part of our efforts to be fully welcoming and inclusive of everyone who lives, works, and visits San Francisco. Together, we can make San Francisco one of the most accessible cities in the world.
If you have questions or want more detail, please feel free to contact the Mayor's Office on Disability for assistance.
Sincerely,
Mayor Gavin Newsom
[Photo of Mayor Gavin Newsom in suit and tie in front of City Hall]
[PHOTO OF BOB PLANTHOLD IN SUIT AND TIE AT CITY HALL]
THE ISSUE
Public services exist to benefit every qualified individual who requires or desires them. However, their ability to achieve this purpose is wholly dependent on their accessibility. For example, regardless of the talent or expertise of its staff, a public health clinic that never unlocks its doors is of benefit to no one. Similarly, a public art museum that refuses to release information about its location can be enjoyed only by those fortunate few who happen to discover it. Though at first glance these situations seem implausible, the Americans with Disabilities Act exists because people with disabilities face this sort of inaccessibility all the time. Indeed, the law states that "individuals with disabilities continually encounter various forms of discrimination," including failure to make modifications to policies and practices, communication barriers, segregation, and relegation to lesser services.
According to the U.S. Census 2000, twenty percent of the population in San Francisco is comprised of people with disabilities. This includes over 8,000 children and youth, 95,000 adults between the ages of 21 and 64, and just over 46,000 adults 65 and older-some 150,000 people who have disabilities that are both conspicuous (e.g., mobility impairments that require the use of wheelchairs) and inconspicuous (e.g., mental disabilities, cognitive impairments and immune system disorders).
The issue explored in this report is whether the programs and services provided by the City and County of San Francisco are as accessible to these 150,000 as to others.
Access Defined
Unlike other civil rights laws, which dispute notions of difference, the Americans with Disabilities Act acknowledges that people are different, and argues that despite these differences, every qualified individual with a disability should be allowed to participate in public programs just like any other qualified individual. Thus, rather than requiring that all people be treated the same, the ADA requires that people be treated according to their individual needs; and rather than requiring that the individual conform to rigid policies, procedures and practices, the ADA requires that programs conform their policies, procedures and practices to the individual, so long as doing so does not fundamentally alter the program.
This report is concerned with the ADA regulations having to do with "programmatic" and "communication" access. Distinct from "architectural" and "employment" access (which are covered in separate reports), programmatic and communication access are defined as follows:
PROGRAMMATIC ACCESS
"Programmatic Access" is a term that refers to the extent to which people with disabilities can participate in and benefit from public programs. Unlike architectural access, which considers tangible barriers to access, programmatic access considers intangible barriers to access such as discriminatory policies, procedures and practices. Examples of these barriers include a policy that rigidly requires something to be done in person, a long and confusing application, and an employee who lacks awareness or holds stereotypical views about people with disabilities.
Most often, programmatic access can be ensured by making simple, temporary modifications to a particular policy, procedure or practice that acts as a barrier in a given situation. For example, in the case of a policy that requires something to be done in person-which can be a barrier to people with speech impairments, mobility impairments, immune system disorders and other disabilities-a program might allow a person to do whatever needs to be done by some other means, such as mail, phone or email. In the case of a long and confusing application-which can be a barrier to people with mental and cognitive disabilities, as well as others-a program might consider simplifying the application, or, at a minimum, providing a staff member to assist with its completion. Finally, in the case of an unaware employee, who can create access barriers in all sorts of ways without even knowing it, ensuring programmatic access might mean providing the employee with thorough and relevant disability training.
Also distinguishing programmatic from architectural access, which usually involves making one-time modifications to facilities, programmatic access involves making modifications that vary from situation to situation. Therefore, the ADA programmatic access requirements are intentionally general, placing the burden on public programs to be flexible, rather than on people with disabilities to conform to unnecessarily rigid and discriminatory rules.
The people most affected by programmatic access barriers are people who have hidden disabilities, such as mental disabilities, cognitive impairments and immune system disorders. However, all people with disabilities are affected by programmatic access barriers in one way or another.
COMMUNICATION ACCESS
"Communication Access" is a term that refers to the extent to which people with disabilities can effectively communicate with public programs and vice versa. Day in, day out, public programs provide and receive information that is essential to the delivery of services; but not all forms of communication are equally accessible to everyone. Indeed, because of the limits of various methods of communication, a form communication that is perfectly accessible to one person may be totally inaccessible to another. Some communication barriers are obvious. For example, a written brochure is not accessible to a person who is blind. However, other barriers are less obvious. For example, because of the number of steps involved, an automated phone menu may be inaccessible to a person with a memory impairment.
Most often, the people who face communication access barriers are people how have visual and hearing impairments (also known as "sensory impairments"). However, communication barriers are also faced by people with learning disabilities, memory disabilities, brain injuries, mental illnesses, speech impairments and other disabilities.
[In one instance, providing access may mean reminding someone with a memory disorder to call in at a specified time so that their service is not terminated. In another, it may mean allowing someone with a speech impairment to do something by mail that is usually required to be done in person.]
The ADA Self-Evaluation
In order to establish a foundation upon which improvements can be made, the ADA requires each public entity to evaluate its policies, procedures and practices with an eye toward which, if any, are not in compliance with the law. San Francisco met this requirement with a two-phased Self-Evaluation, designed to draw as complete a picture of accessibility as possible.
The first phase of the Self-Evaluation, conducted in 2000, was a series of public hearings designed to allow "consumers" to give feedback on the accessibility of San Francisco's programs and services. In all, six forums were held, one for each of six categories of service that the City provides: public transportation, public protection, public health, culture and recreation, human welfare and neighborhood development, and housing.
In 2001, San Francisco conducted the second phase of the Self-Evaluation, which consisted of an extensive, web-based survey of all "program managers" working for the City. (A term used loosely, for the purposes of the Self-Evaluation only, "program managers" was meant to describe managers who work close enough to the day-to-day operations of their program to be as familiar with the practices of customer-service staff as they are with their program's official policies and procedures.) Like the public forums, the survey was divided into sections; however these divisions were based not on the types of services provided by the City to the public, but on the types of contact City employees have with the public, including "general contact," "intensive/ongoing contact," "purchasing" and "contracting." The survey also included a section on staff training, which was intended to gather information on the disability-related training that City employees receive.
The Findings
The Self-Evaluation revealed that San Francisco benefits from dedicated leadership in the Mayor's Office on Disability and significant goodwill among its employees (84% of program managers completed a survey and over 50% expressed desire for ADA training). Additionally, narrative responses to survey questions about recent modifications of policies, procedures and practices indicated that City employees frequently make efforts to create access. Consider these quotations, taken from individual surveys:
"We'll do things by phone that policy says must be done in person."
"Flexible hours have been arranged for people with immune disorders. Requirements to come to the office with personal identification have been waived for known individuals who have mobility impairments."
"Our program uses a numbering system. If there is a wait for service, a person can take a number and have a seat until their number is called. If mobility is an issue a staff member can come from behind the counter and personally assist anyone. Or, if appropriate, a staff member can take a person's paperwork or payment to the necessary window."
"Home school student called seeking job shadowing opportunity with marine biologist. He was offered an opportunity to join a sample collecting trip at Hetch Hetchy reservoir. When he mentioned access issues, we jointly determined that HH Reservoir was not feasible but that a similar trip to Cherry Reservoir would work for him."
On the other hand, the City has a relatively weak infrastructure of ADA policies and procedures, and almost no disability training program to speak of. Indeed, there are no City-wide programmatic or communication access policies or procedures, and communication equipment is inconsistently used and irregularly maintained. Though some individual departments have adopted ADA policies and/or procedures, they are the exception rather than the rule. Consequently, accessibility is highly variable and often depends on factors as unreliable as the mood and disability awareness of the employee providing service.
Overall, the Self-Evaluation clearly revealed that San Francisco is only partially in compliance with the ADA's programmatic and communication access requirements. Noteworthy statistical results include:
* Less than 50% of program managers reported that they allow modifications of their program policies, procedures or practices-a basic programmatic access requirement.
* 49% of programs have no known means of communicating by telephone with people who have hearing or speech impairments (i.e., neither have a TTY, nor use the California Relay Service).
* Only 21% of respondents reported that they notify members of the public of their right to request modifications of policies and procedures, and only 35% notify the public of their right to request alternative formats and auxiliary aids-also basic requirements.
* Over 50% of the programs in the City do not have an ADA Grievance Procedure-another basic requirement.
* Over 50% of the people investigating and resolving ADA grievances receive no training in the requirements that have allegedly been violated.
* Only 19% of programs that contract programs and services to third-party agencies train their program officers and contract monitors how to recognize programmatic and communication access barriers.
The Recommendations
In general, the most significant thing that San Francisco can do to achieve barrier-free access is to renew its commitment to providing programs and services that benefit all qualified individuals, including people with disabilities. Though this may sound simple, in practice it will mean making a relatively major shift, from thinking about the participation of people with disabilities in City programs and services as exceptional (or, as is often the case, not thinking about their participation at all), to assuming their participation and designing programs, policies and practices accordingly. As a result, in a truly accessible San Francisco, service delivery would be characterized by flexibility and individual attention rather than rigid adherence to official policies and procedures; access efforts would emphasize the barrier-free design of services, spaces, forms, policies, procedures and practices rather than barrier-removal; and disability training for City employees would be considered fundamental and necessary (and thus a standing item in the City budget), as opposed to ideal but not always possible. With the amount of goodwill demonstrated in the Self-Evaluation Survey responses, as well as the dedicated leadership of the Mayor's Office on Disability, San Francisco is in a good position to make this shift.
More specifically, Toward Unobstructed Access contains two sets of recommendations. The first is comprised of steps that the City must take in order to be able to comply with the law. Examples of these include:
* Designate capable ADA Coordinators in all departments with 50 or more employees.
* Develop and disseminate a standard ADA Rights Notice.
* Develop a Reasonable Modifications Policy, Effective Communication Policy, and ADA Grievance Procedure.
* Develop contracts with providers of Auxiliary Aids and Services.
* Establish a rule for when TTYs are required and purchase TTY machines for all programs that need them.
* Incorporate disability access criteria into contracting and purchasing processes.
* Develop and provide disability rights and awareness training to City employees.
* Involve department directors in overseeing their department's compliance with the ADA.
The second set of recommendations is comprised of steps that, though not specified in the law, would move the City beyond mere compliance and toward truly barrier-free access. Examples of these include:
* Provide all ADA Coordinators with adequate training and support.
* Clarify the relationship between Mayors Office on Disability and ADA Coordinators.
* Involve people with disabilities in reviewing new policies, procedures, communications, etc.
* Develop an "accessible communications" guide and ADA Reference Manual for City employees.
* Adopt a policy of awarding additional points to potential contractors who go beyond minimum access requirements in their proposals, and terminate contracts with contractors found to be in violation of the ADA.
* Make the City's ADA Training available to employees of contracting agencies.
* Develop pre-purchase accessibility review process akin to existing architectural plan review process.
* Consider conducting a more in-depth evaluation of "intensive" programs.
Finally, San Francisco must develop a process for monitoring the effectiveness of its efforts to comply with the ADA, as well as its accessibility generally, and for making improvements whenever necessary. Ideally, this process would somehow involve representatives of key stakeholders, including the Mayor's Office on Disability, heads of Departments, ADA Coordinators, employees who have direct contact with the public and members of the public with disabilities.
[PHOTO OF TODD HIGGINS SITTING AT HIS DESK]
Toward Unobstructed Access
BACKGROUND
The Americans with Disabilities Act is a comprehensive and complex set of legal requirements, and as such can be an overwhelming document. Very often therefore, to make it manageable for the purposes of a self-evaluation, cities create a checklist of the required policies and procedures, then tick through the list to determine what they do and do not have. Then, taking the list of what they do not have, they officially adopt policies and procedures that are near verbatim transcriptions of the language of the law. Such a process meets the minimum requirements of the law, but its effectiveness is questionable, as very often it barely scratches the surface-policies and procedures are adopted, but then what? How are they institutionalized? What about the employees who are supposed to implement them-do they receive any training?
From the start, San Francisco wanted to do more with its self-evaluation. It wanted to evaluate its accessibility as completely as possible, and to honor the spirit of the law as well as the letter. To do this, it sought comments from members of the public and administered a comprehensive survey to over 400 program managers. This process generated an unprecedented picture of the City's accessibility, a compilation of the two perspectives that matter most: that of the people trying to gain access and that of the people charged with ensuring it.
In presenting this picture, Toward Unobstructed Access aims to be similarly complete and practical.
THE STRUCTURE
Where the public forums were structured according to the way members of the public experience public service, and the survey was organized according to the way City employees experience public contact, Toward Unobstructed Access is organized according to the way the City might approach the work of ensuring that its programs are as accessible as possible. Primarily, it divides the concept of access into two parts-"infrastructure" and "practice"-where infrastructure refers to the systems, policies, procedures, equipment and resources that make access possible, and practice refers to the attitudes, behaviors, knowledge and sensitivity of the people providing service. Both of these parts are essential, because the best infrastructure in the world will not ensure equal access if, in their practices, employees are creating barriers. Likewise, the absence of an infrastructure will leave even the best-intentioned employees hampered in their efforts to ensure access.
Therefore, the bulk of the report's recommendations are contained in the sections entitled "Infrastructure" and "Practice." Between these two sections are two "spotlight" sections, which look closely at specific aspects of access. The first, "Spotlight 1: Intensive Programs," looks at the Self-Evaluation results having to do with a particular set of City programs-programs that provide critical services such as health care, shelter, employment and mental health treatment. Called "intensive" both because of the intensive contact they have with members of the public and because of the critical nature of the services they provide, these programs received special attention because they tend to have a higher than average number of access barriers and serve a higher than average number of people with disabilities. "Spotlight 2: 5 Common Barriers," describes the results and recommendations relevant to five barriers that are common to all public programs. For convenience, each section and subsection of the report closes with a "To-Do List" that highlights the steps that the City must take in order to comply with the ADA and move toward truly unobstructed access.
[Photo of Mayor's Disability Council Member Elizabeth Grigsby]
The Elements of Infrastructure
A City cannot have truly accessible programs and communications without an integrated, thoughtfully-designed infrastructure that includes policies and procedures, well-functioning equipment, proper financial support and accountability systems. Generally speaking, policies and procedures bring necessary consistency and clarity to the delivery of services; well-functioning, well-maintained, well-integrated communication technology and equipment ensures minimum delays in removing access barriers; financial support ensures that employees have what they need to provide the individual service that is critical to programmatic and communication access; and accountability systems encourage continuous improvement. More specifically, a complete infrastructure includes:
* ADA Coordinators.
* A standard ADA Rights Notice.
* A Reasonable Modifications Policy.
* An Effective Communication Policy and a capacity to provide Auxiliary Aids and Services upon request.
* Telecommunication Equipment for communicating with people who have hearing and speech impairments.
* An ADA Grievance Procedure.
* Access criteria for contracted services and programs.
* Access criteria for purchases.
Element 1: ADA Coordinator
THE LAW
The ADA requires that all public entities with fifty or more employees designate at least one employee as an ADA Coordinator, whose job it is to ensure that the entity comply with all aspects of the law. [28 CFR Part 35 §35.107] In some cities, it might be sufficient to designate one person to coordinate compliance for the entire city. In others, it may be useful to also appoint departmental ADA Coordinators to coordinate compliance within individual departments.
Though the law does not specify the qualifications an individual must have in order to be an ADA Coordinator, experience reveals that in order to effectively ensure compliance with the ADA, the designee must be knowledgeable about all aspects of the law, be familiar with a wide range of disabilities and access barriers, and be comfortable with taking steps to remove access barriers. Moreover, because the ADA Coordinator is responsible for investigating and resolving grievances, the designee must be adept at keeping good records, conducting investigations, and maintaining neutrality in order to reach prompt and fair judgments. In all departments, but especially in those that have significant contact with the public, the ADA Coordinator is a sort of arbiter between customers and department staff, and so must be a person who can keep his or her attention focused on his or her purpose: ensuring access.
Ideally, even in small departments, there would be a person who receives thorough training in programmatic and communications access, as well as information about various disabilities, since the goal of the ADA is to have people with disabilities enjoying the same opportunities as people without disabilities in all public services. Also, many small departments impact a large number of people (e.g., the Elections Department).
THE RESULTS
The Self-Evaluation revealed that San Francisco is largely in compliance with the ADA Coordinator requirement. As it is now, the City of San Francisco has a City-wide ADA Coordinator, who is responsible for programmatic, communication and architectural access issues and is based in the Mayor's Office on Disability. (The ADA Coordinator for employee-related issues is based in the Department of Human Resources.) The City-wide ADA Coordinator is responsible for overseeing and coordinating City-wide ADA Compliance, implementing the Transition Plan and the Self-Evaluation recommendations, providing technical assistance and guidance to Departments and their ADA Coordinators, assisting with ADA Coordinator trainings, and overseeing the development of and compliance with the City's ADA Grievance Procedure.
Also positive, in addition to appointing a ADA Coordinator for the entire City, the City has taken steps to ensure that all departments with fifty or more employees, as well as several smaller departments, have their own ADA Coordinator.
Less positively, the Survey also revealed that many program managers either do not know the name of their ADA Coordinator, do not know what he/she is responsible for, or both. Also, the survey demonstrated that not all ADA Coordinators are responsible for ensuring programmatic or communication access (as opposed to employment and/or architectural access). Indeed, only 62% were said to be responsible for programmatic access issues and 66% for communication access.
With regard to the training that ADA Coordinators receive, the survey revealed that many are not receiving even the minimum necessary to handle grievances. When asked, "Do staff members who make decisions on grievances receive training in the requirements of federal and state disability rights laws?" only 46% of respondents said yes. Additionally, the Self-Evaluation revealed that the majority of ADA Coordinators have full-time jobs in addition to their ADA duties, which suggests that they must somehow squeeze what are significant responsibilities into an already heavy workload.
THE RECOMMENDATIONS
San Francisco has in place nearly everything it needs to meet the ADA Coordinator requirements of the law. At present, only eleven departments have not appointed an ADA Coordinator, and of these, four are very small commissions, which, with relative ease, could appoint someone who would then receive assistance from the Mayor's Office on Disability.
Given this strong foundation, San Francisco need take only a few steps to achieve true accessibility. First, the Department of Human Resources should be charged with developing a job description and list of minimum qualifications required for ADA Coordinators, as well as criteria to be integrated into regular performance evaluations. Second, San Francisco should ensure that every program with more than fifty employees has, in fact, appointed an ADA Coordinator. Third, San Francisco must adopt a rule for small departments: will they be expected to designate an ADA Coordinator, regardless of their size, or will their be some other arrangement? Fourth, and perhaps most important, San Francisco must improve the training that ADA Coordinators receive, and provide them with adequate support. Any employee who is designated an ADA Coordinator must receive thorough training in federal and state disability laws, as well as education about disabilities and the barriers that prevent full participation in public programs by people with disabilities. Along with this training, ADA Coordinators must receive support. Being an ADA Coordinator, especially in programs that have significant contact with the public, is no small duty to be tacked onto an already overworked employee. The ADA Coordinator must be free enough to be proactive about ensuring accessibility, to provide training, assistance and advice to employees within their department, and to investigate and resolve grievances fairly and promptly. Also, since it is likely that the majority of people serving as ADA Coordinators will not be experts, and the range of issues that they will be expected to address will be very broad, the ADA Coordinator must have access to people who have expert knowledge of the law and of methods of ensuring access.
Additionally, there must be clarification and subsequent education within departments and programs about the role of the ADA Coordinator. This may be resolved with a clear job description, but beyond this, because survey responses demonstrated so clearly how many employees are uncertain both about whether their department has an ADA Coordinator and about the specifics of their ADA Coordinator's responsibilities, San Francisco must establish some way of informing employees of the duties of the ADA Coordinator and the resources that he or she can provide.
Finally, the City should also clarify the relationship between ADA Coordinators and the Mayor's Office on Disability, with the distribution of responsibilities of each receiving particularly close attention. At a minimum, it should be decided:
* Which party is responsible for training City employees.
* How MOD and ADA Coordinators will cooperate on investigating and resolving grievances.
* How MOD can assist ADA Coordinators in fulfilling the requirements of their positions.
Ideally, a formal system of regular meetings or other means of communication would be established to keep these two parties working in concert. While it is likely that MOD will continue to play a leadership role, San Francisco is strongly urged to use departmental ADA Coordinators as "local experts" to whom employees with questions or concerns can go for advice or support.
* Develop a job description and minimum qualifications required for ADA Coordinators, as well as performance evaluation criteria.
* Appoint ADA Coordinators in departments with >50 employees; determine and implement rule for departments with =50 employees.
*Provide adequate training and support to ADA Coordinators.
Also recommended:
Clarify roles and establish communication systems between MOD and ADA Coordinators.
THE LAW
The ADA requires local entities to notify members of the public about the provisions of the law, as well as the ways that those provisions apply to the services and programs offered. [28 CFR Part 35 §35.106] Providing notice is critical, because when people are informed, they are more likely to advocate for themselves, as well as to understand what is and is not guaranteed by the law. More specifically, when people are aware that they can request accommodations or modifications of policies and procedures, they are more likely to request them, which means that they are more likely to receive the services intended, less likely to encounter barriers, and less likely to file grievances. Providing notice is also important for CCSF employees, since proper notification clarifies from the outset the expectations of all parties.
It is important to note that providing notice means developing and publicizing a standard notice of rights. It does not mean adopting a passive policy of "if someone needs something, he/she can just ask." This approach is insufficient because it:
* Places a burden of inquiry on members of the public instead of a burden of informing on public programs.
* Practically ensures that requests will be made after barriers are encountered.
* Leaves far too much open to interpretation by individual employees.
Indeed, to be effective, a notice should be clear, concise yet complete, and conspicuously posted/readily available anywhere that City services are provided. The notice may be expanded upon with information specific to individual departments, but the wording of the basic statement of rights should be standard.
THE RESULTS
Self-Evaluation results indicate that many programs are not in compliance with this regulation. Notice of the "right to file grievances" was the notice that most people reported providing, but even this is done by only 59% of all programs. Only 21% of respondents reported that they provide notice to members of the public of their right to request modifications, and only 35% reported that they provide notice of their right to request alternative formats and auxiliary aids. Of those programs that are providing notice, the overwhelming majority reported that members of the public were notified of their rights through a "Verbal explanation at service window," and this, combined with descriptions of the "procedure," suggested that in most cases, notification is happening informally, i.e., after a member of the public has come up against a barrier.
Generally, program managers seemed to be working with the assumption that "anyone who needs help will ask for it," and therefore, that providing notice is not necessary. Yet, as shown in Chart 1, this is simply not true. Consider requests for modifications: Program managers were asked how often they receive requests for modifications each year, and "never" was one of the options. Of those programs that notify members of the public of their rights, only 17% said they never receive requests. In contrast, 38% of program managers working in programs that do not notify said they never receive requests.
Chart 1: Effects of (Not) Providing Notice
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A similar response came when program managers were asked how often they receive grievances in a year. Again, "never" was one of the choices. Of those programs that notify the public of their right to file grievances, 26% said they never receive grievances. In contrast, 50% of program managers that do not notify the public said they never receive grievances. Moreover, program managers working in programs that don't notify the public were far more likely to skip the question about frequency altogether, which suggests that the number of them that are not receiving any grievances is higher than it appears. These results illustrate a common sense, but important point: If you do not let people know they can ask for an accommodation, they are less likely to ask, and thus, less likely to get what they need. Similarly, if you do not let people know that they can file a grievance, they won't, and the problem either won't be corrected, or will only be corrected after the person resorts to an external resolution via a lawsuit.
THE RECOMMENDATIONS
San Francisco must develop a standard ADA Rights Notice that is adaptable for use by individual departments and programs. The notice should include:
* San Francisco's/department's commitment to complying with federal and state disability laws.
* A statement of an individual's right to reasonable modifications of policies and procedures.
* A statement of an individual's right to alternative formats and auxiliary aids and services.
* A statement of an individual's right to file a grievance alleging violations of federal/state disability rights laws.
* Information about how an individual might exercise his/her rights (i.e., name of person to contact about modifications, alternative formats and auxiliary aids; information about how they should be contacted; information about the process for filing grievances; etc.).
Ideally, the notice would also include a statement indicating San Francisco's commitment to providing a prompt and courteous response to any request or grievance.
Once the standard ADA Rights Notice is developed, San Francisco must distribute it to all departments along with guidelines for informing employees about the Notice's purpose, its application to City programs and their obligations as City employees. Departments should also be provided with guidelines for posting the Notice in program offices and incorporating it into program materials. As with all communications, the ADA Rights Notice must be presented in clear, straightforward language, and legal and bureaucratic idioms should be avoided. Also, the Notice must be available in a variety of formats, so as to be accessible to persons with visual, hearing, cognitive and other disabilities. It would also be good to have the Notice reviewed by a panel of people with disabilities before it is distributed to departments.
Finally, San Francisco should develop a process for monitoring the effectiveness of its efforts to comply with this regulation and for making improvements whenever necessary.
To Do List - ADA Rights Notice
* Develop clear and complete ADA Rights Notice.
* Distribute the Notice to all departments along with guidelines for posting/incorporating notice into program materials in such a way that ensures communication access.
* Inform all employees who have contact with the public about the purpose of the notice, its applications and their obligations.
* Establish a process for monitoring the effectiveness of the Notice and make improvements as needed.
Also recommended:
* Have Notice reviewed by people with disabilities before finalized.
* Include a statement of intent to provide prompt and courteous response to all requests and grievances.
Element 3: Reasonable Modifications
THE LAW
Under the ADA, public entities are required to "make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability." They are required to do so in every situation, unless they can demonstrate "that making the modifications would fundamentally alter the nature of the service, program, or activity." [28 CFR Part 35 §35.130(7)] Beyond this, the law says no more. Indeed, the ADA reasonable modification requirement is intentionally general, placing the burden on public programs to be flexible, rather than on people with disabilities to conform to unnecessarily rigid and discriminatory rules.
The reasonable modification requirement is perhaps the most important element of a programmatic access infrastructure. This is so because the Reasonable Modification Policy is the policy that says every policy, every procedure, and every practice is modifiable. It is the policy that says if you are qualified to participate in this program or receive this service, we will do whatever is reasonable to ensure that you receive as effective a service as any other qualified individual. It is the requirement of the ADA that demands a combination of flexibility, patience and creativity, without which a program cannot be fully accessible.
THE RESULTS
Because of the variable and often informal actions (or inactions) that constitute "reasonable modifications," it is extremely difficult to achieve a hard and fast conclusion about compliance with the reasonable modification requirement. Not only do many modifications go unrecorded, but also, it is impossible to determine the number of reasonable modifications that are never requested, and almost equally difficult to determine the number that are refused. Still, judging from the data that was generated by the Self-Evaluation, it can safely be said that San Francisco is unevenly compliant. On the one hand, as stated earlier in the report, there is significant goodwill among employees, and indeed there are some departments that appear to have integrated a sort of reasonable modification "attitude" into their general approach to service-delivery. On the other hand, there is a very little in the way of a consistent City-wide policy or approach.
Consider, for example, that only 49% of program managers reported that they allow modifications of their program policies, procedures or practices. This is less than half of all programs surveyed-a number that would be unimaginable if San Francisco had an official reasonable modifications policy that was well distributed and explained to employees. Furthermore, other responses indicated that program managers were not at all familiar with the term "reasonable modifications," and when asked about how staff members are informed about how to handle modification requests, program managers overwhelmingly said "by word of mouth/experience," as opposed to "employee handbook," "training," and "other documented procedure." All of these data suggest that employees are not receiving adequate training and information about their obligations.
The fact that programs are not notifying the public of their right to reasonable modification is also a problem. As discussed above, the lack of a standard ADA Rights Notice has real consequences. As illustrated in Chart 1, programs that notify members of the public of their right to reasonable modifications receive far more requests for modifications than programs that do not. Yet only 21% of all program managers reported that their program notifies the public about their right to reasonable modifications.
On the other hand, anecdotal responses to survey questions suggest that modifications of all sorts are being made on a regular basis. They range from the very straightforward to the somewhat more involved, for example:
"We'll do things by phone that policy says must be done in person. (Police, Central Station)"
"Flexible hours have been arranged for people with immune disorders. Requirements to come to the office with personal identification have been waived for known individuals who have mobility impairments. (Ethics Commission)"
"Home school student called seeking job shadowing opportunity with marine biologist. He was offered an opportunity to join a sample collecting trip at Hetch Hetchy reservoir. When he mentioned access issues, we jointly determined that HH Reservoir was not feasible but that a similar trip to Cherry Reservoir would work for him. (Hetch Hetchy)"
With regard to comments made at the public forums, the overriding message echoed the conclusions drawn from the survey data: some people and some departments are making good efforts to create access, but on the whole, many barriers remain.
THE RECOMMENDATIONS
San Francisco must develop a Reasonable Modifications Policy that is adaptable for use by individual departments and programs. Without such a policy, the City will not be doing even the minimum to communicate its commitment to creating unobstructed access. Also, the City will practically guarantee continued inconsistency and the existence of access barriers.
At the same time, the City should take steps to encourage a shift in the attitudes of employees who have contact with the public, from one that is oriented toward removing barriers that come up, to one oriented toward avoiding the creation of barriers in the first place. Though the difference between the two may appear subtle, their long-term effects especially are quite different. Where the former forces people with disabilities to identify themselves as different and in need of accommodations, the latter forces the City to work on becoming barrier-free. Based on an assumption that people with disabilities will participate in all City programs and services, the latter attitude would prioritize the achievement of standard goals over adherence to standard operating procedures. It would the render the needs of people with disabilities as no more or less unusual than other factors that are considered when designing methods of service-delivery. For example, consider the way that, over the past decade, programs have integrated internet technology into their normal ways of doing service. Today, members of the public can access program information, apply for programs and submit queries using the internet where before they had to call or come personally to the program. This was done because programs recognized consumers' needs for convenience, and saw that they could meet these needs without altering a program's goals. So would it be in programs that assumed participation by people with disabilities-their needs and preferences would be factored into decisions just like the needs and preferences of other members of the public.
With regard to the need for a reasonable modifications request procedure, it is recommended that there not be a formal procedure for receiving and responding to requests. However, if it is decided that a procedure is needed for handling certain requests-for example, it may be necessary to have a procedure for handling requests for communication aids and services that are not provided in house-the procedure should be as simple and straightforward as possible, allowing for flexibility and involving as few steps and individuals as possible.
Once a policy is developed, it should be incorporated into the standard ADA Rights Notice, so that members of the public may be informed not only of the rights guaranteed to them by law, but of the nature of the City's commitment to upholding those rights.
Finally, it is important that, regardless of the policy it adopts, San Francisco adopt methods for continuously monitoring its accessibility and for improving access when necessary.
To Do List - Reasonable Modifications
Develop a Reasonable Modifications Policy adaptable for use by individual departments and programs.
(If needed) Develop a simple and straightforward procedure for handling any requests that require follow-through.
Incorporate information about the policy and procedure into the standard ADA Rights Notice.
Establish a process for monitoring the provision of reasonable modifications and making improvements as needed.
Also recommended:
Consider developing a "barrier-free access" policy or some other goal-focused policy.
Element 4: Effective Communication
THE LAW
[Day in, day out, public programs provide and receive information that is essential to the delivery of services. But not all methods of communication are equally accessible to everyone.]
The effective communication requirement of the ADA is targeted largely at barriers faced by people with sensory impairments. Essentially a requirement to reasonably modify the way information is communicated, what distinguishes the effective communication requirement from the general reasonable modification requirement is the specificity of the modifications it mandates:
For people with vision impairments: written materials must be provided/accepted in large print, auditory or tactile (Brailled) form.
For people with hearing impairments: oral communication must be provided/accepted in visual or amplified aural form.
For people with speech impairments: oral communication must either be provided/accepted in written form, or the person must be allowed sufficient time to communicate whatever must be communicated.
That said, it is important to note that the effective communication requirement applies to all communications, and it requires programs to do whatever is necessary to ensure that their communications are accessible to all people with disabilities, including people with cognitive disabilities, developmental disabilities, memory disabilities, brain injuries that result in confusion, various psychiatric disabilities, and others. [28 CFR Part 35 §35.160(a)]
When it comes to basic communications, accessibility often can be created on the spot. For example, to explain written instructions to individuals who have vision impairments, employees can simply read the instructions out loud. Indeed, in many basic transactions, such as paying bills or filing applications, communications provided through such simple methods will be as effective as the communications provided to other individuals in similar transactions. However, in situations that involve extensive, complex, or very significant communication, such as in a hospital emergency room or in court proceedings, creating access may require the use of a communication device or a person with expertise in a certain form of communication, such as an American Sign Language interpreter. These devices and experts are referred to as "auxiliary aids and services," and under the ADA, programs are required to furnish them whenever their use will create equal access. [28 CFR Part 35 §35.160(b)(1)] Table 1 contains a list of commonly used auxiliary aids and services.
Table 1: Impairments, Barriers and Auxiliary Aids and Services
Vision Impairment --
Barrier: Visual communications, e.g., print materials, presentations, displays and exhibits, RV broadcast, Signage
Auxiliary Aid or Service: Qualified readers, taped texts, audio recordings, Brailled materials, large print materials, materials on floppy disc/CD, and assistance in locating items
Hearing Impairment --
Barrier: Aural communications, e.g., explanations provided at service windows, oral presentations, sound broadcasts, tours
Auxiliary Aid or Service: Qualified interpreters, real-time captioning, note takers, computer-aided transcription services, written materials, telephone handset amplifiers, Assistive listening systems, telephones, compatible with hearing aids, closed caption decoders, open and closed captioning, use of state relay service or TTY's for telephone communication, videotext displays, and exchange of written notes
Speech Impairment --
Barrier: Oral communications (from members of the public to program), e.g., spoken testimony, interviews, requests for information/modifications/grievances
Auxiliary Aid or Service: TTYs, telephone relay service, computer terminals, speech synthesizers, communication boards, and additional time (e.g., to provide oral testimony or convey other information)
With regard to the use of particular auxiliary aids or services, the law is specific. Programs are required to give primary consideration to whichever aid or service is preferred by the person with a disability (rather than providing them with an aid or service of the program's choosing). [28 CFR Part 35 §35.160(b)(2)] Other steps programs should take include:
* Ensure that all communications are accessible, including communication in the context of their regular services and communication in public meetings and special events.
* Be prepared to fulfill any request they might receive with minimum delay.
* Caption all television and video broadcasts intended for public consumption.
With regard to procedure, because the provision of auxiliary aids and services typically involves the use of a service or equipment that is not standard, it is not unreasonable to have a procedure through which an individual requests an aid or service. Indeed a procedure can be useful even in situations where a program has the aid or service on hand, because it affords people with disabilities the opportunity to express their preferences. However, if a procedure is adopted, it must be as simple and straightforward as possible, involve as few steps and individuals as possible, and, of course, be modifiable.
THE RESULTS
Survey responses and commentary at public forums indicate that San Francisco lacks an effective communications policy. Thus, though some barriers are removed as a result of good will and knowledge on the part of some employees, many remain.
Positively, several survey responses illustrated the simple steps employees often take to remove barriers, such as, "Form was typed for customer, read before witness and then a ruler was placed below signature field for customer to sign." Also, a presenter at one of the public forums had multiple praises for deaf service in the new Main Library:
"Deaf services used to be in a corner of the old library with limited resources at its disposal. The new site is quite a bit bigger, has computers and internet access for deaf people to use and is a much nicer place to visit".
Less positively, the Self-Evaluation revealed that many employees are unaware of the primary consideration requirement. For example, a speaker at one of the public forums noted that:
"San Francisco General and some of the smaller clinics have a system in place where a person can get a sign language interpreter fairly easily. Trouble occurs however when a person needs an accommodation other than an interpreter, such as a real time captioner or an oral interpreter...Requests for accommodations other than a sign language interpreter are often ignored."
Moreover, survey responses revealed that, in general, program managers are unaware of the range of auxiliary aids and services available. For example, in one question program managers were given a list of fourteen aids and services and were asked to identify the ones that they use. Of these fourteen choices, the one that was selected by the largest percentage of respondents (65%) was "website," which is a good, but inadequate, medium, because though people with the necessary computer technology can translate a website into an aural form, many people with disabilities do not have access to computers, let alone such advanced technology. In contrast, "sign language interpreters" was chosen by 45% of program managers, "enlarged print"-which is relatively easy to produce-was selected by only 41%, "assistive listening devices" was chosen by 35%, "audiotape" by 31%, "call-in/speakerphone capability" by 20%, and only 19% chose "Braille."
Responses also indicated that auxiliary aids and services are being utilized for public meetings far more often than for every day service delivery. This is a positive sign, in that it underscores the fact that San Francisco has a basic infrastructure for providing aids and services. However, it also suggests a limited view of communication access, as well as the possibility that there remain many barriers in day-to-day communications.
With regard to broadcasts, improvement is also needed: of all of the programs that provide information through broadcasts, videos or movies, only 34% offer captioning. (However, all broadcasts on SFGTV-the channel on which the City does the majority of its broadcasting-are captioned.)
THE RECOMMENDATIONS
In order to clearly express its expectations to employees and its intentions to people with disabilities, San Francisco must develop an Effective Communication Policy that clearly states its commitment to ensuring communication access in all program communications, including both those that take place in the course of regular service delivery and those that take place during meetings and special events. This policy need be nothing more than a simple statement, but it should, at a minimum, clarify San Francisco's commitment to:
* Providing auxiliary aids and services upon request.
* Giving primary consideration to the requested aid or service.
* Guaranteeing that customer-service employees are informed about available auxiliary aids and services, and knowledgeable about how they work, who they help, and how they can be accessed.
* Responding to requests with a minimum delay.
Once developed, the policy should be incorporated into the standard ADA Rights Notice and distributed for conspicuous posting throughout the City.
To give the policy teeth, San Francisco should develop contracts with providers of any aids and services that the City cannot provide in house. These may include firms that produce materials in Braille, ASL interpreters, captioners, providers of assistive listening devices, or other firms. It is also advised that San Francisco develop a policy and a procedure for maintaining its communication equipment.
The City may also decide to develop a procedure for requesting auxiliary aids and services. If this is the case, the procedure should be as simple and straightforward as possible, and in only the rarest of cases should point-of-contact staff be required to seek approval of a request. Also, if a procedure is developed, a concise description of it should be incorporated into the standard ADA Rights Notice, as well as contact information for the person to whom requests should be directed.
San Francisco should also develop standard language to be included on all City-sponsored materials, such as "To request this document/video/etc in another format contact..." Additionally, the City should consider developing "effective communications guidelines" similar to those described in Table 2, for City employees to use when developing and producing City-sponsored communications.
Table 2: Guide to Communication Types and Barrier - Removing Steps
Communication Type: General Communications
Barrier - Removing Step: Information must be presented in clear, straight-forward language, avoiding legal and bureaucratic idioms, and published in a variety of formats.
Communication Type: Static/long term written materials (i.e., not often changed)
Barrier - Removing Step: Keep a supply of large-print and Brailled copies of materials that are not frequently updated.
Communication Type: Temporary written materials
Barrier - Removing Step: Establish a process for producing "temporary", or frequently updated written materials in alternative formats as quickly as possible (maximum acceptable delay 72 hours).
Communication Type: Orally delivered materials
Barrier - Removing Step: Establish a process for transcribing oral materials into appropriate written formats as quickly as possible (maximum acceptable delay 72 hours).
Communication Type: Broadcasts, videos, movies for public consumption
Barrier - Removing Step: All television and video broadcasts should be captioned.
Communication Type: Public meetings and hearings
Barrier - Removing Step: Provide large-format written materials and Assistive listening devices. Depending on size of audience and significance of content, consider also providing ASL interpreters and / or real-time captioning.
Additionally, San Francisco may wish to develop a review process, whereby the Mayor's Office on Disability or some other knowledgeable body reviews major communications intended for public consumption before they are produced. If not, communications should be reviewed at the program level. Regardless of the model chosen, the following types of communications should be reviewed for accessibility:
* Basic information about programs, services offered and ways to access services.
* All notices about policies and procedures.
* All flyers and signs about locations of meetings, public toilets, emergency exits, etc.
* All television and video broadcasts.
* All presentations, meetings and hearings that involve the public.
* Exhibits and displays.
* Methods of notifying people in waiting rooms when it is their turn.
* Methods of notifying people of changes in services or impending service terminations.
* All website and electronically-conveyed material.
Finally, San Francisco should develop a process for monitoring the effectiveness of its communications, and for making improvements whenever necessary.
TO DO LIST - EFFECTIVE COMMUNICATION
* Develop an Effective Communication Policy and procedure for requesting auxiliary aids and services; incorporate into the standard ADA Rights Notice.
* Develop standard language about availability of materials in alternative formats for inclusion in all City-sponsored communications.
* Develop contracts for maintaining communication equipment and accessing expert providers of auxiliary aids and services on an as-needed basis; provide City employees with descriptions and contact information.
* Train employees in effective communication.
* Establish a process for monitoring effectiveness of communications and making improvements when needed.
Also recommended:
Develop "accessible communications" guide for all City-sponsored communications.
Establish communications review process.
Element 5: Accessible Telephone Communication
THE LAW
Under the ADA, programs that communicate with the public by telephone are required to also use an equally effective system for communicating with people who have hearing or speech impairments. [28 CFR Part 35 §35.161] This applies to incoming as well as outgoing calls, which means that if a program has a practice of allowing members of the public to use its phones to make outgoing calls-for example, to track down required documentation-it must provide an equally effective alternative to members of the public with hearing or speech disabilities.
The most common device used to create telecommunications access is a teletype machine (TTY), which is a device that allows a user to send typed messages over standard telephone lines. Additionally, the state of California operates a free public service, called the California Relay Service (CRS), which connects a person using a TTY to a person using a standard telephone via a third party that also uses a TTY. There is also a new service through which a caller can connect to a third party via a video screen and thus communicate in sign language. However, because of the involvement of a third party, the CRS and the newer video relay services are only "equally effective" in circumstances in which privacy is not a concern. Therefore, people with hearing and speech disabilities often prefer direct TTY communication over communication by other means.
[Often, TTYs are preferred over relay services, because of the privacy they afford.]
* Obviously, the California Relay Service and other relay services are only useful if staff are familiar with how they work. Similarly, a TTY is accessible if:It has a dedicated phone line.
* The TTY number is advertised as broadly as the number for the standard phone.
* It has an answering machine.
* It is answered by a person who is both proficient in using a TTY and knowledgeable about the program called.
Another barrier to effective telephone communication has arisen with the proliferation of automated phone and voicemail systems. Very often, when there is silence on the line, these systems are programmed to disconnect. This is a problem, especially for people using relay services and people with speech disabilities, because moments of silence sometimes occur either while information is being transmitted to the relay service, or while people with speech impairments are trying to speak.
THE RESULTS
The Self-Evaluation revealed that, as far as telecommunications are concerned, the majority of programs are inaccessible to people with hearing or speech impairments. In the first place, the survey revealed that 22 departments-not programs but entire departments-do not have a single TTY. Though some program managers working in these departments reported that they use the California Relay Service, 49% did not, which means that 49% of all programs have no known means of communicating by telephone with people who have hearing or speech impairments.
With regard to staff training, only half of the programs that have a TTY said that their staff is trained how to use them. Also, only 40% of these programs have answering machines connected to their TTY. Another potential problem is that at least a third of the programs that have TTYs are sharing the machine with another program. While there is nothing in the law that says each program must have its own TTY, a machine that is not answered by someone who is knowledgeable about the program being called does not qualify as an equally effective system for communicating with people who have hearing or speech impairments.
With regard to providing phones for members of the public to use to make outgoing calls, only 37% of programs that provide this service have a TTY available for use by members of the public with hearing or speech impairments.
Comments at the public forums were consistent with the survey findings. For example, one speaker stated that there was a general lack of TTYs in City departments, then added:
"Many times, a City department will have a TTY, but it is set as an answering machine only and never answers directly. This often results in a person having to wait hours and possibly days before his call is returned."
On a positive note, the majority of programs that have a TTY were advertising the number in at least two forms. The forms used most frequently were "brochure" and "website," but programs were also shown to be making good use of letterheads and business cards.
THE RECOMMENDATIONS
To ensure access in telecommunications, San Francisco must establish a rule for when a program must have a TTY versus when it is acceptable to use CRS or other relay service. [Note that by law, Emergency Communications programs cannot substitute a relay service for a TTY. The San Francisco Department of Emergency communications is in compliance with this law.] At a minimum, it is recommended that TTYs be required for:
* Programs that serve high numbers of people with disabilities.
* Programs that typically receive confidential information over the telephone.
* Programs that provide telephones to members of the public for making outgoing calls.
Once the rule is established, San Francisco must conduct an inventory of those programs that are required to have a TTY, purchase TTYs for those programs that do not have them, and equip the TTYs with dedicated phone lines, as well as answering machines if necessary. (If the TTY is only for outgoing calls for the public, the TTY does not need to have an answering machine or dedicated phone line.)
San Francisco must also train its employees to use whichever system is required for their program. That is, staff who work in programs that use a TTY must be trained in their use, and staff that will use CRS or other relay service must be trained in its use. To ensure that the training is sufficient, San Francisco could monitor the numbers, periodically calling programs to check their ability to handle calls from people with hearing and speech impairments.
San Francisco must also develop guidelines for advertising TTY numbers, since these numbers are only useful when people know they exist. Finally, San Francisco should develop a process for monitoring the effectiveness of its efforts to comply with this regulation and for making improvements whenever necessary.
To ensure that people using relay services and people with speech disabilities can communicate with programs that use automated telephone and voicemail systems as effectively as others, the City must ensure that these systems are programmed to allow for extended silences.
To Do List - Telephone Communication
* Establish a rule for circumstances in which a TTY is required vs. those in which CRS or other relay service is sufficient (taking into consideration outgoing calls as well as incoming).
* Conduct inventory, purchase needed TTYs and furnish them with dedicated telephone lines and (where needed) answering machines.
* Train employees to use system they are expected to use.
* Develop standards for advertising TTY numbers.
* Set automated phone and voicemail systems not to disconnect immediately when there is silence on the line.
* Establish a process for monitoring and improving quality of equipment and staff ability to handle calls.
Element 6: ADA Grievance Procedure
THE LAW
No matter how effective an access infrastructure or practices may be, there will always be a chance that problems will occur. Therefore, the ADA requires public entities to adopt "procedures providing for prompt and equitable resolution of complaints alleging" violations of the ADA, or, in other words, an ADA Grievance Procedure. [28 CFR Part 35 §35.107(b)]
Beyond the fact that having a grievance procedure is required by law, there are at least two reasons why having one is important. First, a fair and easy-to-use grievance procedure ensures that disability barriers are addressed and removed. Second, a fair and easy-to-use grievance procedure can significantly reduce the likelihood that members of the public will become frustrated to the point of filing a formal, costly lawsuit.
In order for a grievance procedure to work, programs must not only adopt a procedure; they must also inform members of the public about how they can access it; educate their employees about its purpose and benefits; and designate (and train) at least one employee to investigate grievances and ensure that they are fairly resolved.
THE RESULTS
The public forums and survey data indicate that, when it comes to the existence of grievance procedures, notification about grievance procedures, and the training received by the people who are responsible for investigating and resolving grievances, San Francisco is inconsistent.
Existence of grievance procedures: Half of the programs (52%) in the City do not have a grievance procedure. Furthermore, the way that many program managers described the procedures they have in place suggested that the term "procedure" was fairly loosely used. For example, at least half of the program managers described a first step but said nothing about what happens after a complaint is filed, as in: "Anyone can file a written complaint to the division manager and they can also file a complaint through our public service division."
On the other hand, about half of the program managers who reported having a grievance procedure (about 20% of all program managers surveyed) described fairly complete procedures, as with this one: "Any grievance is directed to the Access Coordinator who reviews said grievance, has the authority to resolve or make a recommendation and finally, responds to the grievant."
Notification: Results for notification also indicate a need for improvement: forty-one percent (41%) of programs that have a grievance procedure do not notify the public about it. Also, the most frequently chosen response for how the public is notified about the grievance procedure was "Verbal explanation at service window," a method which is less than adequate because it places a burden of inquiry on members of the public and leaves the explanation open to the interpretation of the staff member doing the explaining.
Training for People Who Investigate and Resolve Grievances: Only 46% of program managers that reported having a grievance procedure reported that staff members who make decisions on grievances receive training in the requirements of federal and state disability rights laws. This means that more than half of the people investigating and resolving grievances receive no training in the requirements that have allegedly been violated.
THE RECOMMENDATIONS
San Francisco must develop an ADA Grievance Procedure that is suitable for large and small departments alike. In San Francisco, every department with fifty or more employees has an ADA Coordinator. Thus, while larger departments have an employee designated to investigate and resolve grievances, smaller departments might not. The procedure for smaller departments therefore, will depend somewhat on the City's decision with regard to ADA Coordinators and procedures established to deal with ADA issues for these departments.
The current lack of a City-wide procedure presents an opportunity to create a process that best utilizes customer service staff, ADA Coordinators and the Mayor's Office on Disability. It is strongly recommended that representatives of all three groups, as well as people with disabilities, be involved in the procedure's design. It is also strongly recommended that the procedure include a mechanism for keeping Department Heads informed about all grievances filed against their department, as well as all actions taken by the department in response.
[More than half of the people investigating and resolving grievances receive no training in the requirements that have allegedly been violated.
At a minimum, the ADA Grievance Procedure should:
* Be "consumer" friendly (i.e., guided by an interest in providing access).
* Have the minimum number of steps possible.
* Clearly identify the specific individual(s) responsible for receiving, investigating and resolving the grievance.
* Allow several different means (i.e., by TTY, mail, in person, etc.) of filing a complaint.
* Have prompt and reasonable timelines.
* Require good record keeping.
* Ensure fairness.
* Be manageable for City employees.
* Have an appeals process.
Once the procedure is developed, a clear and concise description of how a person can access it must be incorporated into the standard ADA Rights Notice. Also, a clear and concise description of the actual procedure should be available in a variety of formats. Information about the procedure should be included in the City's basic disability training, and ADA Coordinators and customer-service staff must be trained in how to handle grievances when they are filed. Training for ADA Coordinators should also include training in the requirements of the law and in methods for investigating and resolving grievances fairly and promptly.
Finally, San Francisco should develop a process for monitoring the effectiveness and fairness of the ADA Grievance Procedure in practice, and for making improvements when they are needed.
To Do List - Grievance Procedure
* Develop an ADA Grievance Procedure that is suitable for large and small departments.
* Incorporate a clear and concise description of how a person can access the Grievance Procedure into the standard ADA Rights Notice.
* Produce a clear and concise description of the Grievance Procedure in a variety of formats.
* Educate customer-service staff and ADA Coordinators about their roles and responsibilities in the Grievance Procedure.
* Establish a process for monitoring the effectiveness of the Grievance Procedure and making improvements as needed.
...also recommended
Involve representatives of the Mayor's Office on Disability, ADA Coordinators, customer-service staff and people with disabilities in the development of Grievance Procedure.
[Photo of woman dressed in a red jacket]
Element 7: Contracting
THE LAW
A significant percentage of San Francisco's programs and services are provided through contractual arrangements with third-party organizations (in fiscal 2002-2003 alone the City awarded upwards of $600 million in contracts). This is particularly true of programs and services that fall under the purview of the Department of Public Health and the Department of Human Services. For example, many mental health services, substance abuse treatment programs, supportive housing and employment readiness programs are operated by third-party agencies. Because they receive City funds to provide City programs and services, these organizations are bound by the regulations contained in the ADA. As the contracting entity, San Francisco is required to ensure that these organizations comply with these regulations. [28 CFR Part 35 §35.130(b)(1)]
The Self-Evaluation Survey therefore included a section on contracting, which was comprised of three series of questions: one about criteria used to evaluate proposals, one about criteria used by contract monitors to evaluate existing contracts, and one about the disability training provided to CCSF program officers and contract monitors.
[Organizations that receive City funds to provide service to the public on the City's behalf are bound by the regulations contained in Title II of the ADA.]
THE RESULTS
The Self-Evaluation revealed clearly that San Francisco has not integrated accessibility criteria into either proposal review or contract monitoring. Of all the criteria asked about-ranging from "training of contractor's staff in serving people with disabilities" to "whether contractor has a grievance procedure"-none was chosen by a majority of program managers, and most "yes" answers hovered around 15-25%. Interestingly, the criteria chosen by the largest number of program managers (42%) was "potential contractor's history of providing service to people with disabilities"; yet, only 19% of program managers reported that their contract monitors and program officers are trained how to recognize programmatic and communication access barriers.
THE RECOMMENDATIONS
To ensure compliance with ADA regulations by all organizations that provide services to the public on its behalf, San Francisco must integrate programmatic, communications and architectural access criteria into proposal review criteria, standard contracts and criteria used in monitoring existing contracts. At a minimum, San Francisco should hold both potential and existing contractors responsible for:
* Adopting and publicizing a standard ADA Rights Notice that includes information about an individual's right to request reasonable modifications, request alternative formats and auxiliary aids, and file grievances.
* Adopting San Francisco's ADA Grievance Procedure or its equivalent.
* Responding promptly and fairly to requests for reasonable modifications, requests for auxiliary aids and services, and grievances.
* Ensuring that their employees receive basic disability rights and disability awareness training.
However, to better ensure access, San Francisco could integrate more specific criteria into its standard review processes, including, for evaluating proposals:
* Contractor's history of providing service to people with disabilities.
* Training of contractor's staff in serving people with disabilities.
* Contractor's ability to modify services to accommodate people with disabilities.
* Contractor's ability to provide written materials in alternative formats.
* Contractor's experience using auxiliary aids or services.
* Contractor's ability to provide transportation to people with disabilities (if applicable).
* Whether a contractor has a written grievance procedure.
and, for evaluating existing contracts:
* Whether contractor notifies the public about how to request modifications or accommodations.
* Training of contractor's staff in serving people with disabilities.
* Contractor's record of accommodating people with disabilities.
* Contractor's record of using auxiliary aids and services.
* Contractor's record of providing transportation to people with disabilities (if applicable).
* Whether the contractor has designated staff who are trained in resolving grievances.
* Contractor's record of receiving and resolving grievances.
* Whether an individual can get on a waiting list (or participate in a lottery type selection process) through means other than standing in line (if appropriate).
To clearly communicate a commitment to creating truly unobstructed access, San Francisco could also adopt a policy of awarding more points to potential contractors whose proposals go beyond the minimum criteria in demonstrating the accessibility of their services. It is also strongly recommended that San Francisco consider establishing consequences, such as contract termination, for noncompliance with the ADA by existing contractors.
San Francisco must also educate the people who develop, review and monitor contracts, so that these employees understand the requirements of the ADA and their application to services provided through contractual arrangements. Moreover, these employees should be trained how to identify access barriers and help organizations remove them.
San Francisco should also make funds available to contractors for providing accommodations. This is important because many accommodations can be costly and overly-burdensome for social service organizations working with tight budgets. Also, because of the significant impact that contractors have on members of the public, and because many of the policies and procedures will be unique to the City, San Francisco should consider making its standard ADA training available to the employees of its contractors. Only in this way can the City ensure that these employees, too, are well-informed about ADA regulations, San Francisco's ADA policies and procedures, the ways that the regulations, policies and procedures apply to their program activities, the wide range of disabilities that exist, and the various barriers created by policies, procedures and practices.
Finally, San Francisco should develop a process for monitoring the effectiveness of its contracting criteria, and for making improvements whenever necessary.
* Integrate basic access criteria into standard contracts and proposal/existing contract reviews.
* Educate City employees involved in contracting about ADA regulations and their applications; train them how to identify access barriers and help contractors remove them.
* Establish a process for monitoring the effectiveness of contracting criteria and making improvements as needed.
Also recommended:
* Adopt more extensive criteria for evaluating proposals and existing contracts.
* Adopt a policy of rewarding potential contractors that go beyond minimum accessibility requirements in their proposals and sanctioning contractors that violate the ADA.
* Make funds available to contractors for providing costly accommodations.
* Make the City's ADA Training available to employees of contracting agencies.
THE LAW
The purchasing element of the access infrastructure is commonly overlooked, since the actual act of purchasing it is at least one step removed from the point of contact with the public. The people who are responsible for purchasing medical exam tables for example, are not the same people who are responsible for helping people up onto them. But inaccessible exam tables, like inaccessible information kiosks, computer workstations and voting equipment-to name just a few of the systems and equipment that San Francisco purchases for use by the public-are programmatic access barriers plain and simple, so long as they:
* exclude qualified people with disabilities from participation in a public entity's programs or services, or
* deny them the benefits of a public entity's services, programs or activities, or
* afford them an opportunity to participate in or benefit from an aid, benefit or service that is not equal to that afforded others, or
* provide them with an aid, benefit or service that is not as effective in affording an equal opportunity to attain the same result, gain the same benefit or reach the same level of achievement as that afforded to others, or
* unnecessarily provide them with different or separate aids, benefits, or services to than those provided to others. [28 CFR Part 35 §35.130(a) and (b)(1)(i),(ii),(iii),(iv)]
Therefore, every time a public entity intends to purchase a system or piece of equipment for public use, it must consider its accessibility to people with disabilities. This means incorporating access criteria into the criteria used for product research, into Requests For Proposals (RFPs), and into criteria used in reviewing bids and quotes. It also means educating those employees with purchasing responsibilities about disabilities and access barriers, and encouraging them to seek out resources that can help them identify the most accessible systems and equipment available.
As with other elements of an infrastructure, there are reasons to develop a strong purchasing element that go beyond compliance with the law. One of the most compelling reasons is that, with the power of the purse, San Francisco can promote innovation. Last year alone, San Francisco spent over $200 million on purchases, no small amount of which went to equipment and systems intended for public use. If, in making its purchases, San Francisco challenges manufacturers to make their products as accessible as technology will allow, manufacturers will respond, and everyone will benefit.
[Using the power of the purse, San Francisco can promote innovation.]
THE RESULTS
San Francisco's purchasing protocols do not include the consideration of programmatic and communication accessibility before making purchases. Consequently, consideration of accessibility is inconsistent, and some purchases are more accessible than others. For example, in the last few years, San Francisco purchased voting equipment (Elections Department), crosswalk signals (Department of Parking and Traffic), and an ATM for City Hall (City Treasurer's Office). All of these were purchased for use by the public, yet only the ATM, which is fitted with an earpiece for use by people with vision impairments, is fully accessible. In contrast, the voting equipment is no more accessible than the previous system, leaving people with vision impairments, or hand or limb impairments still unable to vote independently. Likewise, the crosswalk signals, which lack audible signals, are of no use to people with vision impairments.
Responses to survey questions confirmed that the problem is the lack of a coherent policy and review criteria, as opposed to resistance on the part of employees with purchasing responsibilities. For example, less than 5% of program managers reported having a standard component about accessibility in their RFP/Qs, and the majority of narrative responses suggested that consideration of accessibility is inconsistent and, when it occurs, incomplete.
At the same time, other responses suggested that there is some precedent for considering accessibility before making major purchases. Nearly 70% of program managers reported that they consider accessibility when researching new products for large system purchases. The following descriptive responses are representative of efforts being made:
"Our research effort involves contacting other cities about their disability access products and how effective they are. Monitoring traffic engineering publications for current technologies for the City."
"We use our Advisory Panel, our vendor and speak with other organizations that use equipment for people with disabilities."
"All new equipment and technologies are presented to the Mayor's Office on Disability for comment first."
Chart 2: Cost as a Factor in Purchasing Accessible Equipment  |
Of particular interest were responses to questions about cost, since cost is often cited as a barrier to purchasing accessible equipment. As illustrated in Chart 2, the majority of program managers reported that the additional cost of accessible equipment or products was "never" a bar to purchasing them.
THE RECOMMENDATIONS
One must only refer back to the examples cited above to demonstrate the great costs of neglecting to thoroughly consider accessibility before a purchase is made. It is not enough to simply be willing to research accessible systems and products, or to do so on an as-needed or as-requested basis. No, in order to comply with the law, San Francisco must adopt a policy mandating that any systems or equipment purchased for public use are state-of-the-art in terms of accessibility. To support this policy, the City should also develop criteria for purchasers to use when evaluating the accessibility of potential purchases, as well as standard language about accessibility for RFP/Qs and contracts.
San Francisco could go even farther toward ensuring unobstructed access by developing a centralized process for reviewing intended major purchases. A model for this is the process that already exists for the review of architectural plans. Also, to encourage creativity in product development, San Francisco could adopt a policy of awarding extra points to potential vendors who go beyond the minimum accessibility criteria to develop products that are as accessible as possible given existing technology.
Once a purchasing policy is developed it must be distributed to employees who have purchasing responsibilities, and these employees must receive, in addition to the City's standard ADA training, information and resources specific to the types of purchases they are likely to make.
Both the purchasing policy and employee training should emphasize that cost is not a sufficient reason for choosing an inaccessible product over an accessible one. For one thing, the long-term costs of purchases that invite lawsuits will far outweigh any short-term savings. For another, the costs of preventing people with disabilities from enjoying the same privileges, rights, benefits and services of other citizens are immeasurably large. As the majority of program managers reported that cost is not a barrier, this, too, should not be a problem for San Francisco.
Finally, San Francisco should develop a process for monitoring the effectiveness of its purchasing policy and pre-purchase evaluation criteria, as well as for making improvements whenever necessary.
* Establish a purchasing policy and accessibility criteria for use in conducting research, RFP/Qs and proposal evaluation.
* Educate employees with purchasing responsibilities about access barriers created by systems and equipment; provide them with information and resources specific to the types of purchases they are likely to make.
* Establish a process for monitoring the application of the purchasing policy and review criteria, and for making necessary improvements.
Also recommended
* Develop a pre-purchase review process akin to existing architectural plan review.
* Adopt a policy of awarding additional points to potential vendors that go beyond the minimum accessibility criteria.
[Photo of man dressed in gray shirt]
SPOTLIGHT ON:
[Intensive Programs]
Introduction
In San Francisco's Self-Evaluation, special attention was paid to what were called "intensive programs"-programs that provide shelter, health care, employment, food and other public benefits, and have long-term, recurring and intensive contact with individual members of the public. Consumers of these services were specially targeted in the outreach efforts associated with the public forums, and the Self-Evaluation Survey contained a stand-alone section directed at managers of intensive programs.
There are three primary reasons why intensive programs were given this special attention. The first is the typically high number of people with disabilities enrolled in them. Intensive programs are meant to meet the basic needs of people who would not otherwise be able to meet them, and the chief reasons that people cannot meet their needs are that they have a disability that prevents them from doing so, or they cannot afford to do so. Many people with disabilities have both working against them. Because of discrimination, the limits of social structures and the limits imposed by disabilities themselves, many people with disabilities have difficulty securing employment. Thus, many have little or no earned income. At the same time, the hospital stays, doctors visits, medication and medical equipment necessitated by many disabilities are expensive. Indeed, it is estimated that over 30% of people with disabilities live in poverty.
The second reason for looking closely at intensive programs is the critical nature of the services they provide. Even if there were only a handful of people with disabilities enrolled in them it would be important, as most people enrolled in intensive programs depend on them for survival.
A third reason intensive programs were evaluated separately is the typically high number of barriers encountered by people trying to access to them. Usually, because these programs provide long-term services at significant cost to the public, a person trying to access them, and to maintain services once they have been accessed, must overcome a number of hurdles-filling out forms, turning up for regular appointments, takings tests, etc. Each hurdle is a potential barrier. To explain by way of example, the United States Department of Justice's ADA technical assistance manual offers this illustration:
"A county general relief program provides emergency food, shelter, and cash grants to individuals who can demonstrate their eligibility. The application process, however, is extremely lengthy and complex. When many individuals with mental disabilities apply for benefits, they are unable to complete the application process successfully. As a result they are effectively denied benefits to which they are otherwise entitled. In this case, the county has an obligation to make reasonable modifications to its application process to ensure that otherwise eligible individuals are not denied needed benefits. Modifications to the relief program might include simplifying the application process or providing applicants who have mental disabilities with individualized assistance to complete the process."
In evaluating intensive programs, the Self-Evaluation Survey considered four points of an individual's experience in a program-the application process, eligibility criteria, ongoing requirements, and termination of services. In each of these areas, barriers are common. Typical barriers include:
Application Process: Long, complicated, confusingly written and designed forms are a barrier, as are application processes with multiple steps (which can be confusing and exhausting), and restricted application hours/days (which can be a barrier to people who have trouble remembering appointments).
Eligibility requirements: Most programs require a person to provide various forms of documentation (e.g., medical records, birth certificate, other identification). However, such documentation is often cumbersome to collect, and without assistance, people with disabilities may fail to meet the requirement. Also, some programs require an applicant to demonstrate capacity to complete a specific task or do a specific type of work; yet the process of determining a person's capacity is vulnerable to stereotyping and judgments based on assumptions.
Ongoing requirements: Most intensive programs have rules and requirements that participants must meet in order to continue to remain in the program or receive services. These requirements can create various barriers, depending on a person's disability. Also, poor record keeping can result in a person with a long-term disability having to repeatedly request modifications of policies or procedures.
Termination of services: Termination usually results from rule violations. However, sometimes rule violations result from the limits imposed by a disability. For example, it might be standard to terminate service if a client misses an appointment. However, if the reason the client misses an appointment is disability-related, (she is ill, for example, or in the hospital at the time of the appointment), terminating this client's service for missing the appointment would be a violation of her rights under the ADA. Communication access barriers can also cause problems. For example, a written notice of termination proceedings is unlikely to be effective in communicating with someone who is blind.
Table 3: Survey Results for Intensive Program Stages
Application Stage: Self Evaluation Survey Results showed 56% have staffed drop-in hours, 70% have staff to help with applications
Eligibility Criteria: Self Evaluation Survey Results showed some assistance with tracking down documents provided, 46% allow modifications of eligibility requirements
Ongoing Requirements: Self Evaluation Survey Results showed 36% record information about client's ongoing need for modification(s), 29% allow modifications of ongoing program requirements
Termination of Services: Self Evaluation Survey Results showed 43% investigate whether rule violations are disability-related before terminating service, 79% notify client of termination potential before actual termination
THE RESULTS
Generally speaking, the Self-Evaluation revealed that San Francisco's intensive programs are only moderately accessible. For example, only 55% of the program managers who oversee intensive programs reported that they allow modifications of their program's policies and procedures. This alone is cause for immediate action.
More specifically, as described in Table 3, responses to questions about the four stages of a person's experience in a program revealed that throughout any one program, accessibility is uneven. For example, survey responses revealed that the most common steps taken to create access are assisting potential clients with completing applications (70% of programs) and notifying clients of termination risk before actual termination (79%). However, the survey also revealed that only 46% of programs allow modifications of eligibility requirements, only 29% allow modifications of ongoing requirements, and only 43% investigate whether the reasons for rule violations that lead to termination are disability-related. Also, notwithstanding the good work being done, 30% of programs do not have staff to help applicants with their applications and 21% do not notify clients of termination risk before terminating their service-both significant percentages considering what is at stake, as well as the fact that programs are required by law to take these actions.
At the public forums, there was significant commentary about the inaccessibility of intensive programs. At least once at each of the six forums a member of the public described barriers he or she had encountered in trying to access a particular program. At a few of the forums, barriers to intensive programs were the only ones discussed. Examples of barriers described include:
"That the appointment is scheduled so far in the future is a problem in that it makes it difficult for many people with psychological disabilities to receive services since they may not have the ability to keep track of the appointment date. If they miss the appointment, the whole process starts over with the initial intake."
"Her social workers won't deal with her through email only, and she has trouble dealing one-on-one with people."
Other speakers reported problems such as not being allowed to take required medication while in jail, difficulty following complicated prescription drug guidelines, having to navigate complicated automated phone menus rather than talk to a live person directly, and having drug treatment services terminated because of legal use of medication prescribed to treat psychiatric disabilities.
[Speakers at public forums reported barriers such as not being allowed to take required medication while in jail, having to navigate complicated automated phone menus, and having drug treatment services terminated because of legal use of prescribed medications.]
THE RECOMMENDATIONS
First and foremost, San Francisco must develop a Reasonable Modifications Policy (Infrastructure Element 3) and ensure that staff and managers of intensive programs both understand the policy and are prepared to provide reasonable modifications in a timely manner. Beyond this, programs should evaluate each stage of the client relationship with an eye toward incorporating the access-creating steps detailed in Table 4. Additionally, programs could significantly diminish barriers in all four areas by incorporating a "disability needs assessment" into the intake process. Such an assessment would enable a program to identify an individual's accommodation needs at the same time other critical information is gathered, allowing program staff not only to understand the individual more completely, but also to shape their interactions with the client accordingly and possibly avoid misunderstandings or service interruptions.
San Francisco should also consider conducting a more in-depth evaluation of the accessibility of intensive programs than was possible through the City-wide self-evaluation. Such an evaluation might include reviews of policies, procedures, practices, information systems and staffing, as well as recommendations for increasing access. Perhaps the most important thing to examine would be staffing, since accessibility can be dramatically increased by keeping caseloads small. Yet, staffing is also likely to be the most challenging aspect, as many programs are already operating under severe staff shortages. Still, it is recommended that managers at least do the work of developing a staffing model that would ensure access, since such a model could be used over time to guide staffing and budgeting decisions.
Finally, staff of intensive programs should receive extensive, situation-based disability training that enables them to recognize both physical and mental disabilities, and understand the various limits that these disabilities do and do not impose, both so they do not mistake disability-related behaviors for violations of rules, and so they do not screen people out of services on the basis of stereotypes or assumptions of limitations. Staff of intensive programs should also receive legal training so as to be well versed in the requirements of the ADA and their obligations as City employees working in programs that provide critical services.
In order to ensure that intensive programs continue to be as accessible as possible, San Francisco should develop a process for monitoring their accessibility and for making improvements whenever necessary.
Table 4: Intensive Program Stages and Access -Creating Steps
Access-Creating Steps:
Application Stage:
* Evaluate application forms with an eye toward simplifying language, clarifying what is being asked/requested, and using meaningful and consistent color-coding. Organization of information and requests within application materials and forms should be carefully considered. If at all possible, programs should have entire application package, including forms and informational materials, reviewed by people with disabilities representative of the client population.
* Reduce multiple-step application processes to include minimum number possible (1 step is best).
* Offer staffed drop-in hours during which potential clients can apply for services.
* Provide staff members or trained volunteers to assist potential clients with completing their applications and tracking down documentation.
* Make applications available in locations where potential clients are known to be; make it possible for clients to apply at multiple locations.
Eligibility Criteria Stage:
* Programs that require documentation should provide staff to assist potential clients with tracking down documentation.
* Programs that require identification must offer several options for acceptable identification, and provide assistance to potential clients in tracking down acceptable identification.
* Programs that require a potential client to demonstrate capacity should be very clear in their Reasonable Modifications Policy that the task or work can be modified to allow for participation by people with disabilities. Programs also should train their staff in the ways that the task or work can be modified, encourage them to work closely with potential clients to discover which modifications might work for them, and establish standard methods for determining capacity that are based on facts rather than stereotypes or assumptions.
Ongoing Requirements Stage:
* Programs that have rules and requirements that participants must meet in order to continue receiving service should have:
* A clear Reasonable Modifications Policy.
* A staff that understands that the policy applies to all stages of the client relationship.
* Excellent record-keeping and communication among client service staff so that all responsible parties are aware of an individual client's disability/impairment and required modification(s).
* A procedure for determining whether violations of ongoing requirements are disability related.
Termination of Services Stage:
* Before terminating service, programs must:
* Make efforts to determine whether the cause for termination is disability-related, and if so, avoid termination.
* Make significant efforts before termination to notify client that termination is being considered.
To Do List - Intensive Programs
* Adopt the City's Reasonable Modifications Policy and ensure that all employees both understand how it applies to their program and are prepared to provide modifications in a timely manner.
* Evaluate each stage of the client relationship with an eye toward removing barriers/creating access.
* Provide staff of intensive programs with extensive, situation-based disability training.
* Establish process for monitoring the accessibility of intensive programs and making improvements when needed.
Also recommended:
* Incorporate a disability needs assessment into intake processes, improve record-keeping and maintain excellence in information sharing among client-service staff.
* Consider conducting a more in-depth evaluation of intensive programs.
Introduction
As discussed above, building a strong infrastructure involves establishing clear policies and procedures, and supporting them with adequate resources, equipment and accountability systems. What is required for developing good practice is training and leadership.
No doubt, the practice element of the access equation is the most elusive. With regard to infrastructure, the law at least offers a set of basic policies and procedures that every city is required to have. With regard to just how these policies and procedures should be implemented however, the law says very little. For example, consider a program that administers an eligibility exam. Under the reasonable modification requirement, if a person with a cognitive disability requests more time in which to take the exam, the program is required to grant him or her more time. But how much more time? To this the law would say: as much as possible without "fundamentally altering" the program. But how much is that?
Of course, the law's generality is necessary, since it would be foolhardy to attempt to regulate every aspect of public service and impossible to address every imaginable access barrier. But necessary or not, generality can be challenging because it forces individuals to make judgments, and where there is judgment, there is a potential access barrier. If employees are well trained-informed and educated about disabilities and about the reasons behind various policies and procedures-their practices are likely to be good and problems are less likely to occur. If they are not well trained however, problems are much more likely to occur. To quote the Department of Justice's ADA manual, "In many cases, lack of training leads to discriminatory practices, even when the policies in place are nondiscriminatory."
In order to encourage good practices among its employees therefore, the City must provide thorough, relevant and practical training. It must also provide leadership. If the City's leaders send a message that disability access is important, both in their words and in their actions-by adopting intelligent policies for example, and establishing processes for monitoring accessibility-City employees are much more likely to see ensuring access as just part of their jobs, and to see providing service to people with disabilities as no different than providing service to anyone else.
THE RESULTS
Evaluating practices is difficult, because by nature practices are more spontaneous than planned. Given this, San Francisco employed two methods for capturing information about practices, the first being to invite members of the public to speak about their experiences, and the second, to ask managers directly about the practices of employees in their programs. Generally, what was revealed was that though many City employees are interested in creating access, and though many bring a significant amount of goodwill to their work, the disability training they receive is extremely limited. Consequently, employees' knowledge of disability-related subjects is extremely limited, and their everyday practices are more likely to be driven by factors as variable as mood and time pressure than by good information or a sense of contributing to the larger goal of creating an accessible city.
An overwhelmingly good sign was the survey completion rate, which was outstanding, particularly considering the number of programs involved and the length of the survey: of 479 program managers who were contacted, 403 (84%) completed a survey. Moreover, nearly all program managers completed their survey thoroughly and conscientiously within the given timeline. All 57 departments were represented in the pool of programs that completed a survey.
There also was more candid participation than anyone expected, which alone is significant, since programmatic and communication access depend so much on staff attitudes toward the basic principles of accommodation. In general, instead of attempting to put a rosy glow on every answer, program managers admitted that they need assistance and advice. For example, just over half (56%) of the respondents expressed interest in receiving training, with most expressing interest in:
* Training in how to work with people with disabilities.
* Resources for alternative formats and auxiliary aids.
* Training in legal requirements.
* Training in providing accommodations.
Furthermore, narrative responses indicated a great deal of interest in the access issues covered by the survey. For example, one program manager wrote: "Filling out the survey was really helpful by just raising the awareness of everyone who participated. We look forward to your advice and training ideas." Another noted,
With regard to the training that employees receive, 75% of program managers reported that members of their staff receive some kind of information about the ADA. However, only 21% reported that their staff receive both a general overview and "specific information on how the law applies to the services they provide," while 48% characterized the information as providing a "general overview." More revealing were answers to the question about frequency of training. The overwhelming majority gave answers such as "on as-needed basis," "periodically" and "when new information comes out." Only 20% of program managers reported that training happens at orientation, and only 13% said it happens annually. Also, when asked how staff members are informed about how to handle requests for modification, program managers overwhelmingly chose "by word of mouth/experience," over other options, including "employee handbook," "training," and "other documented procedure." With regard to communication access, training is almost nonexistent: only 17% of all program managers reported that their staff is trained in using auxiliary aids and services.
THE RECOMMENDATIONS
Simply put, San Francisco must provide all of its employees with basic disability rights and disability awareness training. This training should include:
An orientation to the requirements of the ADA and other federal and state disability laws, as well as to the ways that they apply to San Francisco.
* An orientation to San Francisco's disability access infrastructure, including information about all City policies and procedures, the meaning and purpose of the ADA Rights notice, and the procedure for handling grievances.
* A review of the range of disabilities that employees might come across in their work, as well as information about the limitations that these disabilities do and do not impose, and possibly, exercises that help people to move beyond stereotypes and assumptions.
* An overview of reasonable modifications and the ways that individual employees can remove programmatic and communication access barriers, as well as avoid creating them in the first place.
* An overview of auxiliary aids and services, as well as information about which aids and services are provided in-house, which are provided through contracted agencies and, for those provided by contracted agencies, how employees can access them.
* Information about City-sponsored technical assistance and other technical and informational resources.
[When asked how staff members are informed about how to handle requests for modification, program managers overwhelmingly chose "by word of mouth/experience.]
San Francisco should also develop training standards and a training program. In doing so, it should decide on matters like training frequency, and whether training will be administered centrally or at the department level, perhaps by ADA Coordinators. The model should also account for the training of new employees, as well as the need for keeping long-term employees current on changes in the law and in City policies.
Additionally, specially tailored training materials should be developed for the following employee groups:
Training for ADA Coordinators
Individuals appointed as ADA Coordinators should receive supplemental training that orients them to their duties and responsibilities as ADA Coordinators, as well as to the technical assistance resources and other supports available to them.
Training for Employees with Customer-Service Responsibilities
For point-of-service staff, the basic training should be sufficient, but the tone of the training should be practical and situation-based, as the majority of their contact with people with disabilities will be direct, informal and varied. The goals of this training should be to develop knowledge and awareness, and to educate employees about the various barriers that people with disabilities face. What is critical is that they get the message that with forethought, patience and above all flexibility, they can make significant headway toward removing many, if not all, programmatic and communication access barriers.
Training for Employees Working in Intensive Programs
Because of the frequency of their contact with people with disabilities and the impact of their services on people's lives, staff of intensive programs should receive extensive training in the types of disabilities and impairments that their clients might have, as well as information about the specific ways that their program's policies and procedures can be modified to create access and reduce frustration for all parties. To prevent discriminatory terminations of service, special emphasis should be given to the ways that various disabilities might affect a person's ability to obtain and maintain the benefit or service offered.
Training for Managers
Training for management-level staff should emphasize the legal requirements of federal and state disability laws, educating managers about the implications of these requirements for their programs, and about their legal obligations and responsibilities as program managers.
Training for Program Officers and Contract Monitors
Training for employees with responsibilities for selecting and monitoring organizations that, through contracts, provide services to the public on the City's behalf, should be focused on the application of ADA regulations to these organizations. Their training should also illustrate the ways that they can identify access barriers and help organizations remove them.
Training for Employees with Purchasing Responsibilities
Employees with purchasing responsibilities should receive training that emphasizes the access barriers created by the types of systems and equipment they might purchase. Training should also provide them with information about resources that can help them identify the most accessible systems and equipment available. It may be helpful to also provide purchasers with "cheat sheets" tailored to the sort of purchases they make.
In addition to providing training, San Francisco should consider developing an ADA Manual as a reference for employees. Ideally, such a manual would include everything from basic information on disabilities and ADA requirements to resources for auxiliary aids and services. After all, the more knowledgeable employees are, the less likely they will be to create barriers, and the more able they will be to remove barriers as they come up.
Finally, San Francisco should also consider making its standard ADA training available to employees of its contractors, thereby ensuring that these employees, too, are well-informed about ADA regulations, San Francisco's ADA policies and procedures, the ways that the regulations, policies and procedures apply to their program activities, the wide range of disabilities that exist, and the potential barriers that people with such disabilities may encounter.
To ensure that its training program continues to achieve the highest standards, San Francisco should develop a process for monitoring the program's effectiveness and for making improvements whenever necessary.
* Develop training standards, materials and program.
* Provide all employees with basic disability rights training.
* Develop specialized content for ADA Coordinators, customer-service staff, employees of intensive programs, management-level staff, contracting staff and purchasing staff.
* Establish a process for monitoring the effectiveness of the training program and for making improvements as needed.
Also recommended:
* Develop an ADA Reference Manual for employees.
* Make the City's ADA Training available to employees of contractors
[Photo of MDC Member Norma Block in her office]
SPOTLIGHT ON: 5 COMMON BARRIERS
Introduction
This section examines five common barriers that result from:
* The unreasonable application of otherwise reasonable rules or policies.
* Inexperience or narrow thinking.
* Action based on stereotypes and assumptions.
These are barriers that are usually well intentioned or innocent enough, but are nonetheless hurtful and, under the ADA, potentially illegal. For example, consider the act of requiring people to wait in line. Requiring people to wait in line for service can be an effective way of imposing order on what might otherwise become chaos, and in itself it is not a barrier. However, it becomes a barrier when it is applied in such a way as to not account for those people who, because of their disabilities, cannot wait in lines. To these people, a program that offers waiting in line as the only way to receive services is an inaccessible program. Similarly, depending on a person's disability:
* A program that is situated in a facility that has a "no animals" policy may be inaccessible to people who rely on service or companion animals
* A program that provides transportation that is not wheelchair accessible may be inaccessible to people who use a wheelchair to move around independently
* A program that provides services designed specially for people with disabilities and refuses to offer people with disabilities a choice between the standard program and the specially designed one may be inaccessible to people who are qualified for the standard program and prefer it over the specially designed program
* A program relies on subjective criteria when enforcing safety standards or illegal drug use rules may be inaccessible to people who meet the standard or do not violate the rules
In the following five sections are details about these common barriers, as well as the relevant self-evaluation results, and recommendations for ensuring that these barriers do not bar access to programs in San Francisco.
[Photo of former MDC Member Michael Kwok]
1 - "PLEASE WAIT FOR THE NEXT AVAILABLE..." (WAITING IN LINE)
The combination of a large demand and limited staffing means that many City programs require people to wait in line before receiving service. But waiting in line can be difficult for many people with disabilities, such as people with chronic illnesses, who may not have the strength to stand for long periods of time, people with mental disabilities, who may find it difficult to spend time waiting in enclosed spaces or among crowds, or people with back problems who are in pain when they stand. Under the ADA, a program that requires people to wait must provide an equally effective option for people who, because of their disability, cannot wait in line. [28 CFR Part 35 §35.130(a)] Therefore, the Self-Evaluation Survey asked program managers whether their programs require people to stand in line, and if so, whether there are alternatives available, and whether any staff can offer the alternatives, and whether approval by a designated staff member is required.
THE RESULTS
Responses to these question were generally positive. For example, 81% of program managers reported that they offer alternatives to people who have trouble standing in line. Also, descriptions of alternatives offered demonstrated goodwill and thoughtfulness, such as:
We have a staff person stand in line for them or we provide them with a chair.
If someone has difficulty standing in line they are provided a place to sit and then called when their turn arrives.
Our program uses a numbering system. If there is a wait for service a person can take a number and have a seat until their number is called. If mobility is an issue a staff member can come from behind the counter and personally assist anyone. Or, if appropriate, a staff member can take a person's paperwork or payment to the necessary window.
THE RECOMMENDATIONS
To ensure that waiting in line is not an access barrier, programs should:
* Provide fair alternatives to standing in line at all times.
* Ensure that approval by a designated staff member be required only in the most extraordinary of situations.
2 - "I'M SORRY. WE DO NOT ALLOW PETS..." (PROHIBITIONS AGAINST ANIMALS)
Service and companion animals provide critical assistance to people with disabilities. Guide dogs for example, assist people who have visual impairments to move safely through the city. Hearing aid dogs alert their owners to common sounds, such as a phone ringing or a siren blaring. Other animals are trained to recognize the signs that their owner will soon have a seizure, and can warn the owner to get to a safe place, while still others provide calm and comfort to people with mental disabilities. The Self-Evaluation Survey therefore asked program managers whether the facility in which their program is located has a "no animals" policy, and if so, whether the policy can be modified to allow for service and companion animals, and whether any staff can make this modification or whether it must be approved by a designated staff member.
THE RESULTS
Responses to this question suggest near perfect accessibility. Of the 130 program managers who said that they have a policy that prohibits animals, 100% reported that the policy could be modified for service and companion animals. However, with regard to approval, only 56% said that any staff could approve a request for modification of a "no animals" policy, leaving the remainder to rely on the approval of a designated staff member.
THE RECOMMENDATIONS
Though discriminatory "no animals" policies do not seem to be a problem in San Francisco, to ensure that they do not become a problem, the City should incorporate information about service and companion animals into its ADA Training. Employees should be educated about ways to determine whether an animal is a service or companion animal, and informed about standards for animal behavior.
[Guide dogs assist people who have visual impairments to move safely through the city. Hearing aid dogs alert their owners to common sounds, such as a phone ringing or a siren blaring. Other animals recognize the signs of a seizure coming on, or comfort people with mental disabilities.]
Guide dogs have visual impairments to move safely through the city. Hearing aid dogs alert their owners to common sounds, such as a phone ringing or a siren blaring. Other animals recognize the signs of a seizure coming on, or comfort people with mental disabilities
3 - "WE'D LIKE TO OFFER YOU A RIDE, BUT..." (INACCESSIBLE TRANSPORTATION)
Because access barriers in public transportation are covered under another part of the ADA, the Self-Evaluation looked only at transportation provided as a service of public programs. To be accessible, programs that provide transportation as part of their services must provide equally effective wheelchair-accessible transportation. [28 CFR Part 35 §35.130(b)(1)(i)(iii)]
THE RESULTS
Survey results suggest that program-provided transportation is a barrier to participation by people who use wheelchairs. For example, of the 73 programs that provide transportation, only 48% are providing transportation that is accessible to wheelchair users. When asked what type of transportation was provided, the majority of program managers (59%) chose "other," and gave examples of "other" that included Charter Buses, City-owned ambulances, patrol cars, vans and autos. Other choices included "mini-van" (chosen by 48% of program managers), and "bus pass/token" (chosen by 42%).
THE RECOMMENDATIONS
Programs that provide transportation that is not wheelchair accessible must take action to make it so. If the only transportation provided is funding for taking public transportation, then the burden to provide access to wheelchair users is on the public transportation system, not the program. However, those programs that are providing transportation through mini-vans, cars or other vehicles must provide an equally effective wheelchair-accessible option. Thus, if they are not currently providing wheelchair accessible vehicles, they need to upgrade their existing equipment or create equal alternatives.
4 - "We have a program, designed especially for..." (segregation)
A primary goal of the ADA is the equal participation of individuals with disabilities in the mainstream of American society. As described in the ADA Technical Assistance Manual, the major principles of mainstreaming are:
* Individuals with disabilities must be integrated to the maximum extent appropriate.
* Separate programs are permitted where necessary to ensure equal opportunity. A separate program must be appropriate to the particular individual.
* Individuals with disabilities cannot be excluded from the regular program, or required to accept special services or benefits.
Informed by these principles, the ADA allows for the creation of separate services for people with disabilities, but prohibits programs from requiring people with disabilities to participate in these services or excluding them from the standard program. [28 CFR Part 35 §35.130 (b)(2) and (d)] To explain by illustration, the ADA Technical Assistance Manual offers the following:
"Museums generally do not allow visitors to touch exhibits because handling can cause damage to the objects. A municipal museum may offer a special tour for individuals with vision impairments on which they are permitted to touch and handle specific objects on a limited basis. It cannot, however, exclude a blind person from the standard museum tour."
THE RESULTS
Commentary at public forums and survey results indicated that San Francisco is mostly in compliance with this regulation. Judging from the survey results, only 18 programs appear to have components that might invite segregation, and of the 18, 15 reported that people with disabilities can participate in the standard program if they choose. Of the remaining 3, two programs are, in their entirety, designed for people with disabilities and there is no standard program, and one did not provide enough information about the components to make it possible to determine whether segregation is happening.
THE RECOMMENDATIONS
Because the Self-Evaluation revealed that San Francisco is largely in compliance with this regulation, little needs to be done immediately. However, it should be noted that, whenever possible, City employees should prioritize mainstreaming, using creativity and resourcefulness to find ways of integrating people with disabilities into existing programs rather than creating new, separate programs. In those cases where separate programs are created however, people with disabilities must always be given the option of not using them and participating in the standard program.
5 - "I'm sorry, but we have standards..." (inappropriate application of safety standards and illegal-drug-use policies)
Though the ADA protects people with disabilities in a wide range of situations, it does not protect people with disabilities in the following two situations:
1. When participation in a program by a person would be unsafe for the person, staff or other participants. [28 CFR Part 35 §35.130(b)(8)]
2. When denial is due to behavior that is the result of the current, illegal use of drugs. [28 CFR Part 35 §35.131]
However, in both situations, the law requires that the decision to prohibit an individual's participation in a program be based on facts, rather than on speculation, stereotypes or generalizations. Also, with regard to illegal use of drugs, it must be proven that drug use is current, as opposed to something the individual did in the past. Because safety standards and drug use are frequently an issue in programs that meet basic life needs, such as shelter and housing programs, it is critical that judgments be well-informed, fair and objective.
THE RESULTS
The Self-Evaluation revealed that very few programs have safety requirements and even fewer have illegal-drug-use rules. However, an indication of a potential barrier came in responses to a question about how employees working in programs that have safety standards determine whether a person meets the official safety requirements. Though the survey presented program managers with several methods from which to choose, the majority of program managers chose "staff observation" as their only determination method. This is an unreliable method, especially when used as the sole method, because it opens the determination process up to exactly what the law prohibits, i.e., judgments based on speculation, stereotypes and generalizations. The program may thereby wrongfully deny access to a qualified individual. On the other hand, the majority of program managers who reported having drug use policies chose at least one other, more reliable and objective method, in addition to staff observation.
THE RECOMMENDATIONS
Generally speaking, San Francisco must train its employees that any time they wish to prohibit the participation of an individual with a disability for reasons of safety standards or illegal drug use they must base their determination on facts. Suitable methods for determination include:
* Self-reporting by individual.
* Testing.
* Personally observing unsafe behavior or illegal drug use by individual.
* Records check (only for the purposes of verifying a history of unsafe behavior or completion of drug rehabilitation program).
With regard to safety standards specifically, though there is not a significant problem that requires immediate City-wide action, it is recommended that all programs that have safety requirements adopt the following practices:
* Ask all applicants about their ability to do a particular activity safely, so that no one is singled out.
* If there is an obvious concern about the ability of an individual to do the activity safely, ask the client to demonstrate how she, staff, and other participants would be safe.
* Programs can rely on records of violence or other hazards presented by the individual, but the participant should be given the opportunity to demonstrate how the danger is disability related and how, with correct treatment or medication, it will not be a problem.
Finally, to restate an earlier point, the more disability training City employees receive, the less likely it is that these sorts of barriers will exist.
To Do List - 5 Common Barriers
* Ensure that all programs that require people to wait for service offer equally effective alternatives to waiting in line.
* Incorporate information about standards for animal behavior and ways to identify service and companion animals into basic ADA training.
* Ensure that programs that provide transportation also provide equally effective wheelchair-accessible transportation.
* Ensure that programs with separate programs for people with disabilities never require people with disabilities to participate in separate program, and always allow them to participate in standard program if they are qualified and prefer it.
* Ensure that programs with illegal-drug-use policy or safety standards always use objective, fact-based methods to determine compliance with policy or standards.
Toward Unobstructed Access - Getting Off To A Good Start
Reducing the occurrence of time-consuming conflicts and confusion, emphasizing goals over bureaucratic procedures, making the City a more inclusive, vibrant place to live-these are just a few of the benefits of implementing the recommendations contained in this report. The ADA Self-Evaluation revealed that San Francisco is in the position to reap these benefits with relatively little effort. It also revealed that San Francisco has the potential to be a national leader in creating access, and a model for other cities and communities. In order to realize this potential however, City leaders must, in their words and in their actions, convey a message that disability access is important for not only the 150,000 people living in San Francisco who have disabilities, but for everyone.
In order to get off to a good start toward truly unobstructed access, City leaders should take the following steps:
Educate employees about the Self-Evaluation findings and their significance.
Making the City truly accessible will involve effort on the part of every employee. Therefore, every employee should be engaged from the very start. This means that they should be educated about the findings, congratulated on the efforts they are already making, and informed about the implications of the report for their work.
Disseminating the findings not only will inform employees about the work the City needs to do, but also will increase awareness of the concepts and issues that the report addresses. The Self-Evaluation revealed that though most employees want to create access, they are held back from doing so because they do not know how, are not aware of the barriers present in their programs, have extremely limited knowledge of disabilities, or because of some combination of the three. This report can be an educational tool as well as a guide for complying with the law, and City leaders should use it as such.
It is important to note that while it is sufficient to disseminate the findings through Department Directors or ADA Coordinators, it is not sufficient to distribute them without any explanation of their significance for the City generally, as well as for individual departments. Therefore, City leaders must communicate this significance clearly, and they must assist these individuals with communicating it to employees working in their departments.
Define the work and fund it.
Recommendations are useful, but unless they are translated into action, they are worth very little. In order to get the most out of the recommendations contained in this report, the City must develop a workplan that describes how, exactly, it will implement them. The workplan should be realistic, but it should also be ambitious-the ADA was passed into law in 1992, and there is no excuse for further delaying an effort to make San Francisco fully compliant. The workplan should clearly map out specific tasks and timelines, roles and responsibilities, cost estimates and allocations (between MOD and individual departments), and it should be completed and distributed as soon as possible after the release of this report. Though it is assumed that the Mayor's Office on Disability will take the lead on developing the workplan, it is strongly recommended that, in developing the workplan, MOD consult with key stakeholders such as ADA Coordinators and directors of departments.
Perhaps most important, City leaders must ensure that adequate funding is set aside for the workplan's implementation. This is crucial for obvious reasons, but, less obviously, it is important because by allocating adequate funding to this project, City leaders will be conveying the message that creating access is a priority.
Support prompt implementation and ongoing oversight.
City leaders must develop a process and a system for ensuring that the workplan is implemented on schedule and according to the budget, and that accessibility is maintained over time. Ideally, this system would somehow involve representatives of the parties in the City that are most affected by the work, including the Mayor's Office on Disability, directors of individual departments, ADA Coordinators, employees who have contact with the public, and members of the public who have disabilities.
Getting Off To A Good Start
(To Do Right Now)
* Educate employees about the Self-Evaluation findings and their significance.
* Define and fund the work.
* Designate an individual or group to be responsible for ensuring that the workplan is implemented on schedule.
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