Waiver Children’s Program Training Decision Guide for CLS November 2011

1. Waiver Children’s Program Training Decision Guide for CLSNovember 2011 Lori Irish, Manager of Services to Children with Developmental Disabilities Mental Health Services to Children & Families Price Pullins, Chief Psychologist Office of Medical & Psychiatric Services

2. What We Will Do Today • Introductions • Review Category of Care Decision Guide for CLS • Review narrative format for documenting Category of Care • Questions • Provide Training Certificates

3. Introduction The decision guide is a tool to: • Assist the child’s team in determining the amount of publicly supported CLS hourly care. • Ensure consistency across the State of Michigan. • Review the care needs of the child and the resources available to the family.

4. There are four Category of Care definitions for children with challenging behaviors There are two Categories of Care definitions for children with medical and physical needs that do not meet criteria for PDN. Determining Category of Care

5. To determine the amount of CLS services in the home, an assessment of the child’s needs, the family’s circumstances, and natural supports are required. This assessment should be a part of the annual planning process. Determining Category of Care for Children with Challenging Behaviors

6. Assessment of Need • Type of behaviors identified • Frequency, intensity and duration of the identified behaviors • How recently serious behaviors occurred • Specific effects of the behavior on persons in the family and property

7. Assessment of Need • Level of family intervention required to prevent behavioral episodes • Extent that family must alter normal routine to address the behavioral needs of the child • Prognosis for change in the child’s behavior • Does the child function better in one setting then he does in another setting • Age, size and mobility of child

8. Category of Care IV Demonstrates mild level behaviors that may interfere with the daily routine of the family. Mild Behavior: Infrequent or intermittent behaviors including pinching, hitting, slapping, kicking, head banging, and/or elopement without careful supervision when there is evidence of lack of judgment regarding danger, or an extremely high activity level requiring extensive supervision and redirection.

9. Category of Care III Demonstrates a daily pattern of medium level behaviors including self-injurious, physically aggressive or assaultive behaviors that have not resulted in hospitalization or emergency room treatment for injuries in the past year, or has engaged in occasional, significant property destruction that is not life-threatening. Pattern of Behavior: In addition to a single serious episode in the last year, significant daily behaviors are documented. Medium Behavior: Includes behaviors defined in the Category II definition of “moderate behavior" when emergency room treatment orhospitalization have not been required for treatment of injuries resulting from the behavior.

10. Category of Care II Demonstrates a daily pattern of moderate self-injurious, physically aggressive or assaultive behavior when medical intervention, or hospital emergency room treatment has been required for treatment of injuries in the past year without resulting hospitalization, or if the child has engaged in frequent,significant property destruction that is not life-threatening. Moderate Behavior: Includes behaviors that pose a significant risk of injury to self or others in the immediate environment.

11. Category of Care I Demonstrates a pattern of severe self-injurious, physically aggressive or assaultive behavior, or life threatening property destruction that has occurred one or more times in the past year. Documented evidence of additional behavioral problems on a frequent basis each day supports a need for one-to-one intensive behavioral treatment. Severe Behavior: Poses a very significant risk of serious injury or death to self, a family member, or others in the immediate environment.

12. Determining Category of Care for Children with Medical and Physical Needs When determining which category is most appropriate to the child’s medical and physical care needs, the following definitions should be used to decide whether the needs support the necessity for CLS hourly care. The categories do not, in and of themselves, establish eligibility for publicly funded hourly care.

13. Category of Care IV A medical condition that: • Requires significant levels of daily assistance or guidance with ADLs. • Is stable and observations and interventions are required infrequently. • Requires minimal intervention and training. • Is associated with minimal or no risk to health status.

14. Category of Care III A medical condition that: • Routinely requires daily hourly care or support in order to maintain and/or improve health status. • Clinical observations and interventions may be intermittent. • Medical interventions are typically associated with minimal risk to health status and delayed interventions are not associated with imminent risk to health status.

15. Decision Guide Table(Manual Appendix 10-a) • The determination of the amount of publicly supported hourly care should result from the PCP and FCP process and be reassessed at least annually. • Children and families may qualify for services in more than one resource section.

19. Category of Care Decision Responsibility The MDCH CWP Clinical Review Team will prior authorize waiver services for those children who: • Meet the criteria for Category of Care I • Have been approved for CLS exception hours The responsible CMHSP will prior authorize waiver services for those children who meet the criteria for Categories of Care II, III, or IV

20. Documentation Documentation must support the Category of Care determination and must be maintained in the child’s record. If care needs meet criteria for Category of Care I, all supporting documentation must be sent to MDCH CWP Category of Care assessment and determination of hourly care documented annually or if the child’s condition has changed

21. Questions?