Agenda:

1. Agenda:

2. Understanding the History and Intent of the Lanterman Act Frank D. Lanterman

3. (4 November 1901 – 29 April 1981) • Assemblyman representing the 47th District (R–La Canada) from 1950 through 1978. • A long-time advocate for individuals with developmental disabilities and their families. • Generally, considered the forefather of the service system for individuals with developmental disabilities and their families in California • Co-Authored Lanterman-Petris-Short Act & Lanterman Mental Retardation Services Act.

4. The Regional Center Concept • Originally developed as a mechanism to provide a community based alternative to institutional care. • The 1965 report “The Undeveloped Resource: A Plan for the Mentally Retarded of California” submitted by an Assembly Subcommittee on Mental Health called for the state to accept responsibility for persons with mental retardation prior to state hospital admission through regional community based services that would provide “diagnosis, counseling, and continuing services.” • The primary goals of the regional center are to provide the services and support necessary to allow children with developmental disabilities to remain with their families and for adults to achieve the highest level of normalization possible.

5. In the Beginning… • In 1965, AB 691 established two pilot regional centers to serve individuals with mental retardation. These pilot regional centers were based in Los Angeles and San Francisco. • In 1969, the Lanterman Mental Retardation Services Act (AB225) established the regional center system for all of California. Alta California Regional Center developed as a result of this action. • In 1973, the Lanterman Developmental Disabilities Act proposed expansion to the eligibility categories for regional centers, beyond solely mental reatardation(AB846). This act was ultimately passed in 1977. It also established an individualized planning process. • In 1978 administration of the developmental services program was removed from the Dept of Health and placed with the newly formed Department of Developmental Services.

6. Overview of the Lanterman Act Sets out the rights and responsibilities of individuals with developmental disabilities Creates the agencies, including regional centers, responsible for planning and coordinating services and supports for individuals with developmental disabilities and their families States the values, philosophy, and intent in providing a wide array of services and supports for individuals with developmental disabilities and their families

7. Entitlement Welfare and Institutions Code (WIC) Section 4501 of the Lanterman Act establishes that “the State of California accepts a responsibility for persons with developmental disabilities and an obligation to them which it must discharge” As a result, the Lanterman Act establishes an entitlement to services and supports for persons with developmental disabilities, those at risk of developing a developmental disability, and their families ARC v. DDS (1985) confirmed the entitlement

8. Association for Retarded Citizens v. California Department of Developmental Services et al., State budget deficits led DDS to reduce funding for regional centers, which, in turn, led some regional centers to implement cost-saving strategies such as waiting lists and categorical cuts in services. In this case the California Supreme Court ruled that the Lanterman Act “defines a basic right and a corresponding basic obligation . . . the right which it grants to the developmentally disabled person is to be provided with services that enable him to live a more independent and productive life in the community; the obligation which it imposes on the state is to provide such services.” These services are to be determined through the IPP process and provided as an entitlement. The decision also stated that the regional centers, not DDS, have wide discretion in determining how to implement the IPP, but no discretion at all in determining whether to implement it. The Court prohibited use of cost-saving strategies such as those used by the defendant regional centers. At the same time, the court ruled that this does not give regional centers the authority to overspend their budgets. If regional center budgets are not sufficient, DDS must inform the state legislature which must, in turn, either increase funding or statutorily change the entitlement.

9. Entitlement Continued… The State of California is obligated to: Establish an array of services and supports to meet the needs and choices of each person with a developmental disability at each stage of life and to support their integration into the mainstream life of the community. To enable the person to approximate the pattern of everyday living available to those without disabilities of the same age. To empower to make choices in all life areas.

10. Rights of Individuals with Developmental Disabilities • In addition, WIC Section 4502 states that people with developmental disabilities have, among others, the following service right: A right to treatment and habilitation services and supports in the least restrictive environment. These services and supports should foster the developmental potential of the person and be directed toward the achievement of the most independent, productive, normal life possible. Such services shall protect the personal liberty of the individual, and shall be provided with the least restrictive conditions necessary.

11. The Regional Center Under contract with the State to: Provide fixed points of contact in the community for persons with developmental disabilities and their families so they may have access to the services and supports best suited to them. Be accessible to every family in need of regional center services. Reflect a strong commitment to the delivery of direct service coordination and services and supports identified in individual program plans (W&I 4620)

12. Primary Responsibilities of Regional Centers Service Coordinator – A regional center employee whose primary responsibility includes preparing, implementing, and monitoring consumers' individual program plans (IPP), securing and coordinating consumer services and supports, and providing placement and monitoring activities. W&I 4640.6(d)

13. Responsibilities Cont. • Service Coordination duties include (W&I 4647): • Activities necessary to implement an individual program plan, including, but not limited to, participation in the individual program plan process; • Assuring that the planning team considers all appropriate options for meeting each individual program plan objective • Securing, through purchasing or by obtaining from generic agencies or other resources, services and supports specified in the person's individual program plan • Coordination of service and support programs • Collection and dissemination of information • Monitoring implementation of the plan to ascertain that objectives have been fulfilled and to assist in revising the plan as necessary • Notification of due process rights.

14. Recent Developments • Effective 9/1/08, per W&I 4646.4: • Regional centers shall ensure, at the time of development, scheduled review, or modification of an IPP the establishment of an internal process for adherence to state and federal law, and to ensure the following when purchasing services and supports: • -Conformance with the regional center's purchase of service policies, as approved by the Department • -Utilization of generic services and supports when appropriate

15. Recent Developments (part 2) W&I 4648 indicated the following: When Securing needed services and supports, that these “assist individuals with developmental disabilities in achieving the greatest self-sufficiency possible and in exercising personal choices. The regional center shall secure services and supports that meet the needs of the consumer, as determined in the consumer's individual program plan, and within the context of the individual program plan, the planning team shall give highest preference to those services and supports which would allow minors with developmental disabilities to live with their families, adult persons with developmental disabilities to live as independently as possible in the community, and that allow all consumers to interact with persons without disabilities in positive, meaningful ways.

16. Recent Developments (part 3) W&I 4648 (cont.): In implementing the IPP regional centers, through the planning team, shall first consider services and supports in natural community, home, work, and recreational settings. Services and supports shall be flexible and individually tailored to the consumer and, where appropriate, his or her family. A regional center may purchase services or supports for a consumer from any vendor which the regional center and consumer or, where appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumer's program plan.

17. Provider Selection Per 4648(a)(6), When Selecting a provider of service the regional center and consumer/conservator/authorized rep shall consider the following; (A)A provider's ability to deliver quality services or supports which can accomplish all or part of the consumer's IPP. (B)A provider's success in achieving the objectives set forth in the IPP. (C)Where appropriate, the existence of licensing, accreditation, or professional certification. (D)The cost of providing services or supports of comparable quality by different providers, if available (E)Consumer/conservator and family, where appropriate, choice of providers

18. Provider Selection cont. Per W&I 4648(a)(6)(D), as revised effective 7/28/09: The cost of providing services or supports of comparable quality by different providers, if available,shall be reviewed, and the least costly available provider of comparable service, including the cost of transportation, who is able to accomplish all or part of the consumer's individual program plan, consistent with the particular needs of the consumer and family as identified in the individual program plan, shall be selected. In determining the least costly provider, the availability of federal financial participation shall be considered. The consumer shall not be required to use the least costly provider if it will result in the consumer moving from an existing provider of services or supports to more restrictive or less integrated services or supports.

19. Considerations for Service Purchasing • Funding Sources W&I 4659(a) The regional center shall identify and pursue all possible sources of funding for consumers receiving RC services. • Least Costly W&I 4648 (a)(6) Requires the Regional Center explore and select the least costly available provider of comparable services that is able to meet all or part of the consumer’s IPP. Least costly service must be consistent with the particular needs of the consumer and family, as identified in the IPP. • Generic Resources W&I 4648(a)(2) Regional Center (RC) funds shall not be used to supplant the budget of any agency which has a legal responsibility to serve all members of the general public and is receiving funds for providing those services.

20. Additional Responsibilities The Lanterman Act requires regional centers be accountable for the monies received to provide services and supports for individual. The regional center is required to: Live within a budget each year Locate and/or develop innovative and cost-effective ways to achieve the desired outcomes for individuals Secure services from qualified service providers, and only continue those services where there is reasonable progress and agreement

21. Responsibilities Continued… Take into account parental responsibility for minor children when making a decision about the purchase of a service or support. Only services that are required for a child that are above what a parent would provide for a child without a disability Pursue all possible sources of funding before accessing regional center funds. For example, generic agencies such as Private Insurance, Education, Medi-Cal, and In-home Supportive Services. Regional centers are considered to be the “payer” of last resort Ensure that community service providers provide good quality services for a fair price

22. Carrying Out Our Responsibilities We must ensure that services and supports are provided in a manner consistent with stated values, intent, and philosophy of the Lanterman Act. These include: Developing innovative, cost-effective services and supports that are flexible, individualized and promote community integration Assurance of the quality and effectiveness of services and supports that are provided to the individual

23. How the Individual Program Plan (IPP)and Individual Service Plan (ISP) fit together

24. Program Planning Meeting and IPP/ISP Development • Understand the principles of Person Centered Planning • Understand how to develop the IPP • Understand how to develop the ISP • Understand how the ISP supports the IPP

25. IPP/ISP FLOW

26. Importance of IPP/ISP Individual – person centered Providers – outlines expectations Case management – offers continuity Funding sources – justifies use of expenditures

27. The Basic Principles of Person Centered PlanningW&I Code 4501 • Consumer shall have a leadership role in service design. • Consumers should be empowered to make choices in all life areas. • Consumers should participate in in decisions affecting their own lives.

28. Five Best Practice Outcomes Of Person Centered Planning Being Present and Participating in Community Life Gaining and Maintaining Satisfying Relationships Expressing Preferences and Making Choices in Everyday Life Having Opportunities to Fulfill Respected Roles and to Live with Dignity Continuing to Develop Personal Competence

29. Our Service System Mandates that we… Use a Person Centered approach Make sure that the choices made by the Individual and the Planning Team are written into the IPP Give people all the information they need to make choices for themselves Support the many ways that people choose to live

30. Maintain a Person Centered Approach • Assess consumer’s preferred style of communication • Talk directly to the consumer throughout the entire meeting • Do not allow others to speak for the consumer without his/her consent • Check for agreement and permission from the consumer • Involve the Consumer and Circle of Support as much as possible

31. Maintain a Person Centered Approach • Value input from ALL members of the Planning Team • Reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family • Make Certain the IPP process focuses on the Positive! • Whenever possible, Assessments should be conducted in the consumer’s Natural Environment

32. Bringing The Planning Team TogetherWho Are the Team Members? Consumer* Authorized Representative (If applicable)* ACRC Service Coordinator* Family Members Friends/Neighbors/Co Workers Service Providers/Support Persons Or any Individual invited by the consumer or authorized Representative *Mandatory Team Members Planning Team Definition 4512 (j)

33. Required components of the IPP IPP – WIC 4646.5 Assessment Life goals/Preferences 4646.5(a)(1) Capabilities/Strengths Barriers/Concerns/Problems General Health Status 4646.5(a)(5) Expected Outcome for services Goals Objectives Services and Supports

34. IPP Goals, Objectives & Services and Supports Goals are “General” Objectives are more “Specific.” A statement as to how the goal will be met or a step in meeting the goal and the target date. Services and Supportstell how the objective will be accomplished. There should be specific service providers named, approximate start dates and identification of the funding source

35. Create an IPP that is Focused on Person Centered Goals4646.5(a)(2) Based on: • Needs • Preferences • Life Choices of the Individual with Developmental Disabilities

36. Develop Quality Objectives4646.5(a)(2) Statement of specific, time-limited objectives for implementing the person's goals Stated in terms that allow measurement of progress or monitoring of service delivery

37. S.M.A.R.T Objectives Specific Measurable Aligned Realistic Timely

38. Services and Supports 4646.5(a)(4): Identify type and amount of Services and Supports Regional center and generic agencies Regional Center must first considerservices and supports in natural community, home, work, and recreational settings when identifying resources to achieve goals and objectives [WIC 4648.(a)(2)] Regional Center shall not supplant generic resources [WIC 4648.(a)(8)] Identify the funding source Identification of the provider or providers of the service responsible for attaining each objective Specify the approximate start date Reasonable Progress WIC [WIC 4648.(a)(7)]

39. Development/Review Cycle Initial IPP developed [WIC 4646 (c)] 60 days following completion of assessment that determines regional center eligibility IPP revised and modified [4646.5 (b)] No less often than once every three years and in response to the person's achievement or changing needs (Planning Team Decision) IPP reviewed [4646.5 (b)] Within 30 days of submitted request

40. ACRC #588 Document ALTA CALIFORNIA REGIONAL CENTER SERVICES AND SUPPORTS For THE INDIVIDUAL PROGRAM PLAN • Attached is a List of Services and Supports that were agreed to at The Planning Team Meeting: • I agree with the list of services as written on the attached form and I authorize Alta Regional Center to purchase those services for which it is responsible in the implementation of the Individual Program Plan. I have been advised that in implementing Individual Program Plans that Regional Centers, through the Planning Team, will first consider existing supports that are already available in the natural community, at home, at work and in recreational settings. • I disagree with a portion of the Services and Supports Plan. I authorize ACRC to implement all of the Services and Supports Plan except the following services upon which we have not yet reached agreement: • A new IPP meeting will be held within 15 days to review any items not agreed upon at today’s meeting. I understand that I may waive this second meeting if my concerns regarding the Services and Supports are resolved to my satisfaction before the end of the 15-day period. • I recognize that if I am ever dissatisfied with my service coordinator, I may request a change at any time. • I authorize my service coordinator to exchange information with service providers to implement the IPP. I have been advised that should I or my authorized representative fail to respond to a Regional Center request to consent to release information within a reasonable period of time, the Director of the Regional Center may authorize release of information on my behalf when necessary to protect my health, safety, or welfare [W&I Code Section 4514(s)]. • I would prefer that my Individual Program Plan be reviewed and rewritten at least once every: □Year □ 2 Years □3 Years • I am aware that I may call a meeting of my Individual Program Planning Team at any time by contacting my service coordinator. • Alta Regional Center has permission to contact me via electronic mail. My e-mail address is:   

41. ACRC #588 Document SERVICES AND SUPPORTS From the IPP for      UCI #:      Date:       Signatures of Planning Team Participants: Consumer ___________________ Service Coordinator____________________ Parent/Guardian of Minor_____________ Other Participants_____________________ Conservator of Adult_________________ ___________________________________

42. IPP Example for Day Program Services GOAL: XXX will enhance his/her XXX skills. Current Status: Address the following areas, as applicable, in a narrative format • Program name, type, location, start date, staffing ratio, funding source, contact person • Schedule: weekly attendance, daily hours • Desired outcomes • ISP content: goals, objectives vendor is responsible for implementing • Relationships • Hobbies and interests • Transportation needs, funding source • Other pertinent information Objective #X: Given day program support, XXX will enhance his/her XX skills in order to achieve goals as specified in his/her ISP (e.g., self advocacy, self care, community integration, employment training) through mo. /yr. Schedule or Services and Supports: X.1 ISP will be developed jointly by planning team participants. X.2 Day program will be responsible for implementation of ISP including care/supervision during established program hours. X.3 ACRC SC will request continued ACRC funding for day program services for XXX at the XX program for as long as this program is appropriate for XXX. X.4 ACRC SC will request continued ACRC funding for transportation to and from program through XX for as long as these services are appropriate for XXX. X.5 XX will provide services in accordance with Title 22 regulations (applies to site based programs only), Title 17 regulations and their program design. X.6 XX program will provide ACRC Service Coordinator with semiannual reports documenting consumer progress in accordance with Title 17, Section 56720(c), and will coordinate ISP meetings annually. X.7 Day program and transportation vendor will submit SIRs in accordance with Title 17, Section 54327(b). X.8 XXX will participate in program activities to accomplish goals/objectives established on his/her ISP documents. X.9 ACRC Service Coordinator will review progress _______*. *Annually if consumer resides with family or quarterly if consumer resides elsewhere.

43. IPP Example for Independent Living Services (ILS) GOAL: XXX will live independently in the community. CURRENT STATUS: Address the following areas, as applicable, in a narrative format • Address, telephone #, name of roommate if applicable (If roommate is another consumer, only indicate their first name for confidentiality reasons) • Family contact information • Conservatorship status, name of conservator, if any • Name of ILS vendor and staff/Number of assessed hours • SSI status and payee/Other sources of income • Status of SSP restoration funds • In Home Support Services (IHSS) # of hours and designated chore worker • ADL support required/Behaviors (List MW qualifying conditions) • Individual Service Plan (ISP) date, goals and objectives  • ILS support provided (areas of functional skills training as specified in Title 17 are: cooking, cleaning, shopping in natural environments, menu planning, meal preparation, money management; including check cashing and purchasing activities, use of public transportation in natural environments, personal health and hygiene, self-advocacy training, independent recreation and participation in natural environments, use of medical and dental services, as well as other community resources, community resource awareness such as police, fire, or emergency help, home and community safety) • Desired outcomes for ILS support     • Discuss contents of survival kit and “Home Safety and Emergency Plan” to prepare for unexpected disasters OBJECTIVE #X:  Provided with financial assistance, money management, IHSS, independent living services and supports as appropriate, XXX will continue to live independently in the community, through mo./yr.  

44. IPP Example for Independent Living Services (ILS)(cont.) SCHEDULE OF SERVICES AND SUPPORTS: X.1 ISP will be developed jointly by planning team participants. X.2 ACRC SC will request ACRC funding for # hours for ILS training based on assessment and need in accordance with ACRC service and support policy, with maintenance ILS being the goal. X.3 XX ILS Vendor will provide services in accordance with Title 17 regulations and their program design. X.4   ILS vendor will provide ACRC SC with semi-annual reports documenting progress, as required by Title 17, Section 56720. X.5 ILS vendor will provide monthly progress reports to ACRC SC as required by ACRC Support guidelines.  X.6 ILS vendor will submit SIRs in accordance with Title 17 Section 54327(b). X.7 ACRC will fund XX transportation services for community access based assessment and need. X.8 The Department of Social Services will continue to provide financial assistance through SSI and SSP restoration funds, for as long as XXX is eligible for these services. X.9 The Department of Social Services will continue to provide In Home Support Services for XXX, for as long as s/he is eligible for these services. X.10 ILS worker will help XXX to develop and maintain a “Home Safety and Emergency Plan”, as per recommendations made in the provided “Prep Guide”. X.11 ILS worker will help XXX create an emergency disaster supply kit to include the following:  first-aid kit, three day supply of dry/canned food, three day supply of water, can opener, two blankets, two complete sets of outer and undergarments, towels, soap, toilet paper flashlight, a battery operated radio, batteries, sanitation and hygiene items. X.12    XXX will have a special needs supply such as prescription medications, eyeglasses and hearing aid batteries as needed. X.13    XXX will comply with the safety training provided by the ILS worker. X.14    XXX will keep ILS worker informed with updates to the emergency supply kit. X.15    XXX will keep the following information current:             1.         Who to call in case of an emergency.             2.         Emergency shelter location. X.16    XXX will meet at least two neighbors to get to know them and set up a system to look for each other in case of an emergency. X.17 ACRC SC will request ACRC funding for SSP restoration (if consumer meets eligibility criteria). X.18 ACRC SC will monitor objective quarterly.

45. Individual Service Plan (ISP) Specifics • The Individual Service Plan is developed by the service provider and the consumer to implement related IPP goals and objectives • Input is provided by the planning team participants

46. ISP Best Practices Person Centered Identifies strengths/successes Outlines support needs/barriers Methods to achieve goals and objectives Measurable goals and objectives Meets guidelines set in regulations, program design, and contract

47. ISP Timeframe and Guidelines Complete initial ISP within 30 days of start of service Draft of ISP for existing services prepared and presented at IPP/ISP meeting as a best practice Ongoing review cycle will be determined by regulation or planning team agreement Day service progress is reviewed at least Semi-annually and Annually ILS service progress is reviewed through monthly reporting as well as Semi-annually and Annually

48. Training Areas ILS • Cooking • Cleaning • Shopping in natural environments • Menu planning • Meal preparation • Money management • Use of public transportation • Personal health and hygiene • Self advocacy training • Independent recreation and participation in natural environments • Use of medical and dental services • Community resource awareness • Home and community safety http://www.dds.ca.gov/Title17/T17SectionView.cfm?Section=56742.htm

49. Training Areas Continued • Day Services (will include at minimum one of the following): • Self Advocacy • Community Integration • Employment Training • Self Care http://www.dds.ca.gov/Title17/T17SectionView.cfm?Section=56742.htm

50. Services and Supports Area • SLS– • Assisting with common daily living activities such as meal preparation, including planning, shopping, cooking, and storage activities • Performing routine household activities aimed at maintaining a clean and safe home; • Locating and scheduling appropriate medical services; • Acquiring, using, and caring for canine and other animal companions specifically trained to provide assistance • Selecting and moving into a home • Locating and choosing suitable housemates • Acquiring household furnishings • Settling disputes with landlords