Transcript ATTENTION DEFICIT HYPERACTIVITY DISORDER PETER …

Regional Center Eligibility:
Early Start, Prevention
and Lanterman Services
Presented to the Board of Directors
on February 4, 2010
by
Dr. Peter Himber,
Patricia Glancy,
and Paula Noden
What We Will Cover
Overview of Three Programs
• Early Start
• Prevention
• Lanterman
Overview of Regional Center Services
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Regional center services remain an entitlement
Most services are free to families (i.e., no cost or no
share of cost)
Regional centers are required to seek generic
resources including:
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CalOptima/MediCal
Private Health Insurance
Orange County Mental Health
Other government programs
School
California Children Services (CCS)
Regional centers are mandated to be the “payor of
last resort”
Trailer Bill Language (TBL)
Affecting Regional Centers
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As part of the Fiscal Year 2009-10 budget
reductions, legislative changes were made
to the Early Start Program and the
Lanterman Act
• goal is to reduce regional center system
expenditures in FY10
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Enacted on July 28, 2009
TBL changes made to eligibility criteria and
service provision for both Early Start and
Lanterman services
TBL outlined a new Prevention Program
RCOC Facts and Statistics
(as of 12/31/09)
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3,146 children receiving Early Start services
* highest in state
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236 children receiving Prevention services
13,428 individuals age 3+ receiving
Lanterman services
Average number of new Intake applications
per month in CY09– 442 (83% eligible)
• 0 to 35 months – average 382 (87% eligible)
• 36 months and over – average 60 (63% eligible)
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Average number of children exiting Early
Start at age 3 per month in CY09- 213
• Eligible for Lanterman – average 19
• Ineligible for Lanterman – average 194
Child Find Activities
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Liaisons to Hospitals and NICUs
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Contact with Parent Organizations
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Countywide Health and Developmental
Screenings through Prop. 10/Family
Support Network
Physician Outreach
Public Presentations (CCS/CalOptima/
Department of Education)
Dissemination of Early Start Brochures
Early Start
Early Start Program
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Program Defined
• Birth to three years
• Goals
• Federal program (underfunded – i.e., last year,
CA received $54 million/RCOC spent $48 million)
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Current Eligibility Categories
• Established risk
• Developmental delay
• Solely low incidence
Early Start Eligibility
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Established Risk
• Condition of known etiology with a high
probability of intellectual disability
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e.g., Down Syndrome, extremely premature
baby with a bleeding into the brain and
severe brain injury
• Eligibility criteria did not change as a
result of the TBL for this category
Early Start Eligibility (cont’d)
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Developmental Delay
• Eligibility: Depends on the age of the child
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Birth to 23 months
• At least 33% below age level in at least 1 of 5 areas
 cognition, communication, gross & fine motor,
adaptive, social/emotional
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24 to 35 months
• 50% delay in 1 area or 33% delay in 2 or more areas
(listed above)
• Note: Prior to TBL a 33% delay in only one area was
required from birth to 36 months
Early Start Eligibility (cont’d)
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Solely Low Incidence
• Eligibility: Hearing, vision or orthopedic
impairment with normal cognition
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These criteria did not change as a result of the
Trailer Bill Language
• Served by the local school district
Early Start Eligibility Timelines
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Initial evaluation and assessment
and development of the initial
Individualized Family Service Plan
(IFSP)
Must occur within 45 days from the
time of the referral
• Services begin when the initial IFSP is
completed
Early Start Services
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Service Coordination
Infant Development Programs
Occupational/Physical/Speech Therapy
Audiology
Behavioral Services
Family Training
Nursing Services
Early Start Program Changes
due to Trailer Bill Language
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Eligibility
• Delays must be greater for children 24 to 35
months of age (as mentioned earlier)
• Infants identified as at “High Risk” for
developmental delays are no longer eligible for
Early Start services
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Services
• Use of private insurance “required” for medical
services identified in the IFSP
• Prohibits regional centers from purchasing nonrequired services with the exception of Durable
Medical Equipment
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Examples of non-required services:
• Most medical services
• Counseling, social-recreational programs, music therapy
Prevention
Prevention Program
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Background
• New Program outlined in the Trailer Bill
Language
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Stakeholder input
Expectations
Funding
Current Unknowns
• Many children formerly eligible for Early
Start under “High Risk” criteria will be
eligible for the Prevention Program
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Example: NICU babies or young children at
high risk of showing delays in development
Prevention Program (cont’d)
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Goals of Prevention Program
Prevention Services
• Intake Service
• Assessment
• Case management
• Referral to generic agencies
• Family Resource Center/Comfort
Connection
Prevention Program Eligibility
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Two conditions associated with severe
prematurity, birth problems or significant
illnesses
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e.g., being on a ventilator for 48 hours and/or low
birth weight less than 1500 grams, gestational age
under 32 weeks (normal =40), seizures, some
genetic disorders
Born to and residing with a parent with a
developmental disability
24 to 35 months of age with a 33-49%
delay in one area
• cognition, communication, gross & fine motor,
adaptive, social/emotional
Prevention Program
Eligibility Timelines
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If ineligible for Early Start, Prevention
Program eligibility is determined
If eligible, Prevention Program Plan
(PPP) is developed with family
45-day timeline
Specialized caseload model
Prevention cases monitored 90 days
after initial PPP and every 6 months or
sooner if needed
Prevention Program Recap
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Current status of Prevention Program
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Review of current unknowns
• Funding, etc.
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Example of generic prevention
services
Lanterman
Lanterman Act Eligibility Overview
• Purpose
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Primarily 3 years and older
• What
• What
• What
• What
is a developmental disability?
are ineligible conditions?
constitutes an eligible diagnosis?
constitutes a substantial disability?
What is a Developmental Disability?
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Lanterman Act § 54000 and CCR, Title
17 Definitions
• A disability that is attributable to mental
retardation, cerebral palsy, epilepsy,
autism or,
• Disabling conditions found to be closely
related to mental retardation or to
require treatment similar to that required
for individuals with mental retardation.
What is a Developmental Disability?
(cont’d)
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The eligibility criteria for Early Start
services (under age three) are much
less stringent than the eligibility
criteria for Lanterman Services (over
age three)
Approximately 91% of children exiting
Early Start at age three are ineligible
for Lanterman services
What Conditions are NOT
Developmental Disabilities?
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A Developmental Disability shall not
include disabling conditions that are:
• Solely psychiatric disorders
• Solely learning disabilities
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Conditions that are solely physical
in nature
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Blindness
Deafness
Spinal cord injury
Most muscle diseases such as muscular dystrophy
(unless in some severe cases where there is a
significant cognitve impairment)
Eligibility Criteria for
Lanterman Services
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To be eligible, all of the following
criteria regarding the Developmental
Disability must be met per WIC §
54000 and CCR, Title 17:
• Originate before age 18
• Be likely to continue indefinitely
• Be due to an eligible diagnosis
• Must meet severity requirements, i.e.,
“substantial disabilities” > 3 areas
Eligibility Criteria for Lanterman
Services (cont’d)
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Must be due to an eligible diagnosis:
• Mental Retardation – 78%
• Cerebral Palsy – 20%
• Epilepsy – 21%
• Autism – 25%
• Fifth Category – Condition like Mental
Retardation – 6%
(as of 1/31/10)
Autism as an Eligible Diagnosis
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Important note regarding the special
education services due to “Autisticlike behaviors” (educational criteria
for autism CCR Title 5 - Section
3030g)
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Educational criteria are less restrictive than
Lanterman criteria →
• Many children eligible for special education
services due to “autistic-like behaviors” are not
eligible for Lanterman Act / Regional Center
Services
Autism (cont’d)
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Diagnosis of autistic disorder is required
for eligibility
Other diagnoses that fall within the
“autistic spectrum” are not eligible
conditions but could potentially be
eligible under the 5th category.
• Autistic Spectrum Disorder
• Pervasive Developmental Disorder-Not
Otherwise Specified (PDD-NOS)
Autism (cont’d)
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Other diagnoses that fall within the
“autistic spectrum” are not eligible
conditions but could potentially be
eligible under the 5th category.
• Asperger’s Syndrome → Very, very few
individuals with this disorder are eligible
since by definition, there is no clinically
significant delay in cognitive development
or in the development of age-appropriate
self-help skills and adaptive behavior
(other than in social interaction).
Conditions Like Mental Retardation
 Fifth Category
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Lanterman Act definition: “…disabling
conditions found to be closely related to
mental retardation or to require treatment
similar to that required for individuals with
mental retardation, but shall not include
other handicapping conditions that are solely
physical in nature.”
CCR Title 17 definition: “…other conditions
similar to mental retardation that require
treatment similar to that required by
individual with mental retardation.”
Conditions Like Mental Retardation
 Fifth Category (cont’d)
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The legislature did not intend to
provide a detailed definition of the 5th
Category in statute but instead
deferred to the judgment of regional
center professionals.
Someone functioning in a manner
similar to a person with MR is most
likely to have an IQ in the low
borderline range (70-74).
Conditions Like Mental Retardation
 Fifth Category (cont’d)
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The higher an individual’s IQ is above
70, the less similar he or she is to a
person with mental retardation.
• e.g., a person with IQ of 79 is more
similar to a person with low average
IQ than to a person with MR.
To be eligible, person must have
substantial adaptive deficits in at
least three areas that are clearly
related to cognitive limitations.
Understanding
Substantial
Disabilities
What Is a Substantial Disability?
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Lanterman Act Definition
• A condition which results in major
impairment of cognitive and/or social
functioning, representing sufficient
impairment to require interdisciplinary
planning and coordination of special or
generic services to assist the individual
in achieving maximum potential.
• Must differentiate between “can’t do” a
skill or task from “can do but chooses
not to”
Areas of Major Life Activity
Eligibility requires the existence of
significant functional limitations,
as determined by the regional center,
in three or more major life activity
and as appropriate to the person's age
Areas of Major Life Activity (cont’d)
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Learning
Receptive and expressive language
Self-care
Self-direction (including social skill
difficulties)
Mobility
Capacity for independent living
• For children > 6 years and adults
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Economic self-sufficiency
• For individuals > age 18
Areas of Major Life Activity (cont’d)
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Concepts like “executive functioning skills”,
“visual processing,” “motor planning” and
“sensory issues” are important only as they
relate to functional skills.
• Not assessed in determining eligibility
because they are not among the adaptive
skill areas specified by law.
Similarly, fine motor skill difficulties are only
important as they relate to some functional
skill.
Substantial Disability
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There was a significant change in the
statute in 2003
• Prior to 2003, only one area of substantial
disability was required.
• The area that encompassed language was
“communication” which was less restrictive
than the current “receptive and expressive
language.”
Substantial Disability (cont’d)
Bottom line
It was significantly easier for an
applicant to qualify for regional center
services under the Lanterman Act
prior to the 2003 changes in statute
How Is Substantial Disability
Determined?
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No single test determines substantial
disability
Based on available information
• History provided by family, caretakers,
teachers, therapists, etc.
• Direct observation
• Past psychoeducational testing
How Is Substantial Disability
Determined? (cont’d)
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Past psychoeducational testing
• Essential objective information
• Test scores need to be very low
• Although individuals may function below their
expected age level; their deficits may not
meet the criteria of a substantial disability
RCOC’s Approach to
Eligibility Determination
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Be fair
• Use objective measures and criteria
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Be consistent
Be thorough
Follow the law
RCOC’s Approach (cont’d)
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Information is obtained from:
• History provided by family members or
others
• Educational and therapy records
• Medical records
• Interview/evaluation of applicant by RCOC
staff
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The more information the better, but
there are time constraints
• 120 day timeline for eligibility determination
RCOC’s Approach (cont’d)
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If eligibility status is unclear, RCOC
may seek additional information, e.g.,
• Direct assessment by RCOC’s M.D.s
and/or psychologists via a
transdisciplinary assessment (TDA)
• Direct observation of applicant in home,
school or community
What Happens Once An Eligibility
Decision Is Made?
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If a child is found ineligible:
• The family/advocate can appeal the
decision through the fair hearing process
• Families can reapply for regional center
services when the child is older
• A child who was ineligible at age three due
to a lack of three substantial disabilities,
may meet the criteria in their teens or
young adulthood when more is expected
from them
What Happens Once An Eligibility
Decision Is Made? (cont’d)
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If we say to a family, “You can
reapply when your child is older.”
• Parents often reply, “I need services now
when my child is age three so that he/she
can continue to make progress and not need
your services when he/she is older.”
• There is no support for this view in statute.
The child must be substantially disabled in
three areas at the time eligibility is being
determined
What Happens Once An Eligibility
Decision Is Made? (cont’d)
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Some eligible individuals may improve to
the point that they may no longer need
or are eligible for regional center
services, e.g.,
• A child with seizure disorder has surgery so
that his/her seizures are well-controlled
• A child with autism may improve to the point
that he/she no longer has “substantial
disabilities” in three areas
Summary
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As mandated:
• Eligible applicants must have a
substantially disabling developmental
disability with onset prior to age 18 that is
expected to last a life time
• A number of conditions are excluded
including those that are solely physical,
psychiatric disorders or learning disabilities
• The criteria that regional centers use are
different from those of school districts and
other government-funded agencies
Summary (cont’d)
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3,146 children receiving Early Start
services
236 children receiving Prevention
services
13,428 individuals age 3+ receiving
Lanterman services
Average number of new Intake
applications per month in CY09– 442
• 0 to 35 months – average 382
• 36 months and over – average 60
QUESTIONS??
Board Assessment
Questions/Answers
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Which of the following diagnoses may
qualify someone (3 years or older) for
regional center services?
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Mental Retardation
Epilepsy
Cerebral Palsy
Autism
Fifth Category (i.e., conditions closely
related to mental retardation and
requiring similar treatment)
All the above
Board Assessment
Questions/Answers (cont’d)
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As defined in the Lanterman Act, a person age
3 or older must have substantial disabilities in
three or more major life activities to be eligible
for regional center services.
True or False?
True
Regional centers are required to provide
services to all individuals with diagnoses of
Autism, Cerebral Palsy or Epilepsy.
True or False?
False
Board Assessment
Questions/Answers (cont’d)
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All children under 36 months of age are eligible
for Early Start services if they have a 33% delay
in one of five developmental areas (i.e.,
cognitive, physical or motor, communication,
social or emotional, or adaptive development).
True or False?
False
The Prevention Program is a new program for
children under 36 months of age who are at risk
of a developmental disability but are otherwise
not eligible for Early Start services.
True or False?
True