transition planning for youth with disabilities from the child welfare and juvenile justice systems...

Transition Planning for Youth with Disabilities from the Child Welfare and Juvenile

Justice Systems

Jenny PokempnerJuvenile Law Center

Goals of Today’s Webinar Review laws and rules regulating provision of

treatment, services, and transition planning for youth in the child welfare (CW) and juvenile justice (JJ) systems.

Review strategies for improving treatment, services, and planning for youth with disabilities while they are in the system.

Review action steps for ensuring a proper transition to adult serving systems and services.

Show how to use Juvenile Law Center tools.

Youth in Care have Many and Multiple Health and Behavioral Health Care Needs

Of youth who enter the child welfare system: Almost 90% have some health problem or need55% have two or more chronic health care conditionsAlmost 25% have three or more chronic health care conditions 30-60% have developmental delays50-80% have mental and behavioral health problems30-40% are receiving special education services

Youth with Disabilities in Foster Care Have Poorer Outcomes than their Non-Disabled Peers

They are:More likely to be maltreated while in the systemMore likely to have placement instabilityMore likely to be institutionalizedLower rates of achievement of permanency and longer stays in care. Poorer educational achievement

Barriers Faced to Successful Transitions Lack of appropriate placement settings

and services in the community as youth progress through the CW and JJ systems.

Lack of appropriate services for the transition-age population.

Lack of understanding of the adult-serving system.

Lack of clarity about who is responsible for arranging services and supports.

Good News: We Actually Have Some Good Laws and Court Rules in Place

Currently we have federal and state laws that require that:Health care needs are met through MA and monitored by the CW and JJ systems and courtsYouth are in the least restrictive placement and treatment setting (CW and ADA requirement)Services and treatment that meet the child’s needs can be ordered by the court and provided by the child welfare agencyAn appropriate transition plan be created that includes health care needs and insurance coverage before the case can be closed.

Using Current Law Many services, treatments, and

placements that we want for our clients to flourish can be supported by using our current laws, regulations and court rules.

For youth to benefit from these provisions, requesting court orders, putting on hearings, appealing and litigating issues may be necessary.

Relevant Laws: Monitoring of Health and Disabilities Needs Federal child welfare law (Fostering Connections)

requires that states have a plan for the ongoing oversight and coordination of health care services for any child in foster care placement, including how needs will be met and continuity of care will be provided following transition. 42 U.S.C.A. §622 (b)(15)(A).

Federal and state child welfare law requires monitoring health and well-being related to case planning and court reviews. 42 U.S.C.A. § 675 (1) (C) & § 675 (5)(D).

Federal law requirement to update health and educational records in the case file and providing youth who age out a copy of their records at no charge. 42 U.S.C.A. § 675 (5)(D).

Laws Related to Provision of Services Independent Living Services should be provided

to youth beginning at age 16 Transition services and planning must be

provided in the IEP for youth beginning at age 14 Medicaid’s EPSDT requirement for youth under

21 Schedules re: screenings and access to treatment Medically necessary services are provided Denials of service can be appealed

Laws Relevant to Serving Youth With Disabilities in Care Beginning January 2014, youth will be categorically

eligible for Medicaid until age 26 regardless of income if: They were in foster care at age 18 and Enrolled in Medicaid

Action steps. Ask for the following language in the court order: For the purposes of establishing eligibility under 42

U.S.C. §1396a(a)(10)(a)(i)(IX), this Court finds that (Name of Youth) was in foster care at age 18 and was enrolled in the Medicaid Program at that time.

Anti-Discrimination Laws Americans with Disabilities Act and the Rehabilitation Act:Prohibit disability discrimination in the provision of services and Require that individuals be served in the most integrative setting appropriate to their needs.Require that Protection and Advocacy Agencies exist in each state to provide advocacy and representation for individuals with disabilities. In PA, the P & A is DRN.

Child Welfare Transition Planning Federal and state child welfare laws require

that a transition plan be developed with the youth at least 6 months prior to discharge from care that includes specific plans in several areas, including health, health insurance, housing, education, employment, mentoring, and support services.

The plan must also include information about health care decision-making options.

42 U.S.C.A. §675 (5)(H)

Child Welfare Transition Planning State Court Rules require that a transition

plan be developed that includes provision of health care, insurance and addresses health care decision making before a child welfare case can be discharged.

The Rules require that the case cannot be closed until the court is satisfied that an appropriate plan has been presented.

Juvenile Court Rule 1613.

Fostering Connections Extension of Care Options

Youth can remain in the child welfare system past 18 age if they are engaging in at least one of the following:

Completing secondary education or an equivalent credential;

Enrolled in an institution that provides post-secondary or vocational education;

Participating in a program actively designed to promote or remove barriers to employment;

Employed for at least 80 hours per month; or Have a behavioral health or medical impairment that

prevents them from engaging in the above activities. 42 Pa. C.S.A. 6302. (“Child”)

Relevant Laws: The Court’s Authority to Address Health and Disability Needs The court must make “any findings

necessary to identify, monitor, and address the child’s needs concerning health care and disability…” Juvenile Court Rule 1512 (D)(i).

Orders can be made for evaluations and treatment. Id.

Relevant Laws: The Court’s Plenary Jurisdiction to Address Treatment Needs Under the Juvenile Act, the court has the authority

to order treatment, services, and placement that is “best suited to the protection and physical, mental , and moral welfare of the child.” 42 Pa. C.S.A. 6351.

PA case law interpreting the Juvenile Act demonstration that: The court’s plenary jurisdiction is limited only by what is

“best suited to the protection and physical, mental, and moral welfare of the child.” 42 Pa. C.S.A. 6301 (b)(purpose).

Dispositions should be individualized.

Meeting Treatment, Service and Placement Needs while in the

System

Poll 1: Extension of Care and the Transition

In your experience, how can the extension of care past 18 help ensure appropriate transitions for youth with disabilities?Allows for better health and educational outcomesAllows more time to plan and arrange services“Adult” services are hard to navigate for an 18-year-oldPermanency services and court oversight remainAll of the above

Strategies for Improving Treatment while in the System: Is the setting the least restrictive?

Is the placement should be in the least restrictive setting? Are the ADA and CW laws being followed?

What services or supports would be needed to reduce the level of restriction?

Strategies for Improving Treatment while in the System: Is the youth getting all the services he is entitled to?

Is the youth getting all the services he or she is entitled to? All medically necessary treatment under the EPSDT

requirement Permanency services Independent Living Services and Transition Services Education

Public school education until the year he turns age 21 An appropriate IEP, including transition services

Poll 2: What are special education transition services? Transition services in the IEP…Only relate to academic skills.Are exactly the same as IL services.Include an array of services and community experiences that youth need to function as an adult.Are only what the school tells us they can provide.Can only be provided until the youth is age 18.

Transition Planning for Youth with IEPs Must begin at age 14 in PA Must be informed by age-appropriate

transition assessments Must have goals in the following areas:

Post secondary education/training Employment Independent/community living Community participation Adult service connections

The Transition from High School to Post-Secondary Ed/Training or Work: Tips Ensure that youth who have IEPs have an

educational decision maker. The school has a responsibility under the IDEA

to appoint one. The court may also be able appoint one if

necessary. Ensure that the required Summary of Academic

Achievement and Functional Performance has been completed.

Make sure the graduation requirement is meaningful—don’t let the youth be pushed out of school before she is ready!

The Transition from High School to Post-Secondary Ed/Training or Work Consult with Office of Vocational

Rehabilitation and the special education team about post-school options.

Ensure that the youth is connected with the disabilities services office at any post secondary program so that accommodations plans can be developed. There is no IEP in post-secondary education

programs. The ADA and Rehab Act apply

Strategies for Improving Treatment while in the System: Is the youth receiving the right treatment?

Is the youth getting the right treatment? Have the needed assessments been completed? Are the multiple disabilities or ones that have not been

formally identified that are barriers to making progress Do the placement and service providers understand the youth’s

disability and are they equipped to serve the youth. If they are not, services should be arranged for or a new

provider is needed. Repeated reports of non-compliance may be a sign that

the treatment is not the right fit, another service or provider must be added, or an assessment or evaluation must be done to determine

the nature of the barrier to progress

Easier said then done. Who can help determine what treatments, services or

settings may be possible for youth I work with? Enlist help of DRN and Health Law Project to appeal

denials of services from MA. Enlist the help of the Special Needs Units at the MCO. Enlist help of DRN, ELC, and JLC when educational issues

arise. Enlist help of agencies like DRN, ARC, Mental Health

Association, Centers for Independent Living and Liberty Resources to come up services and supports that would allow a less restrictive setting or suggesting evidence based and promising treatments.

***Pages 4 and 30 of Professional’s Guide for contact info for resources.

Planning for the Transition

Poll 3: Who is responsible? In my county, the following is the main entity responsible for making sure youth who have special health or behavioral health needs are planned for:The CW or JJ agency The attorney for the childThe health care or behavioral health care provider or systemIt is not always clear to me

Some Differences Between Child and Adult Serving Systems Child Welfare/Child Serving Systems

Many services are mandated or considered entitlements (EPSDT, IDEA, CW Sytem).

Child welfare services usually include placement and services.

Juvenile court oversees service provision and can order appropriate services and placement.

Adult Serving Systems/Programs

Few services are mandated or are entitlements.

Placement may not be part of the service array.

No court oversight or entitlement to a lawyer or advocate to ensure provision of services.

A snap shot of the child to adult cliff: Medicaid pre and post age 21 The Early and Periodic Screening,

Diagnostic, and Treatment is Medicaid's comprehensive and preventive child health program for individuals under the age of 21.

It includes periodic medical screening, vision, dental, and hearing services.

It requires that any medically necessary health care service be provided to eligible youth (w/a few exceptions).

Medicaid Coverage After Reaching Age 21

After age 21 the EPSDT requirement no longer applies.

The types and amounts of treatment and services an adult can receive are much more limited.

Examples of Changes in Coverage At Age 21 Hearing aids are not covered. You can only get 1 wheelchair every 3 years. Stays at psychiatric hospitals are limited to a

certain number of days a year. Home health services, including nurses aids,

physical, occupational, and speech therapists are limited by per month caps.

Strategies for Meeting A Youth’s Needs When they Transition Accessing Medical Assistance Home and

Community Based Waivers Accessing SSI

Poll 4: Special Issues for Youth With Intellectual Disabilities

At what age should a youth with intellectual disabilities be registered with their county ID Agency?Six months before they “age out” of care. At age 18. As early as they are identified as having an intellectual disability.

Tips for Transitioning Youth with Intellectual Disabilities Register youth with your county IDS as

soon as possible. DO NOT WAIT UNTIL CLOSE TO DISCHARGE. Consider assigning a point person at your

private or county agency to register youth and update information if youth move, etc.

Registration is what triggers and allows access to all services and supports through the IDS system, including HCBS waivers.

Tips for Transitioning Youth w/ID IQ scores and testing of adaptive functioning

must be submitted for registration. Make sure updated IQ testing is available (get it

court ordered if facing challenges) Provider and school should assist with providing

documentation of adaptive functioning There is an appeals process if you disagree

with the determination. Requesting an independent evaluation may

be appropriate when testing in the borderline range (70-75)

Home and Community Based Medicaid Waivers (HCBS) Treatment and services for individuals with

significant cognitive, developmental, and/or physical disabilities so that they can remain in the community.

Services can be paid for that may be limited under MA coverage.

Some waivers provide services and placement while others just provide services.

Many waivers have waiting lists. They are not entitlements. Eligible individuals do not automatically receive services.

Consolidated Waiver For Individuals Diagnosed with Mental Retardation (Age 3 and Over)

Examples of Services Nursing Assistive tech. Behavioral supports Companion services Educ. Support services Supported employment Family living/life share Community living

arrangement (CLA) Home finding Day & residential

habilitation Homemaker/chore services Specialized supplies

Transportation Respite Supports coordination

Considerations Can cover a place to live

as well as services Waiting lists exist Waivers distributed based

on need

Autism Waiver (Age 21 and Older)

Examples of Services Assistive tech. Behavioral specialist Community inclusion Residential habilitation Respite Family training Supported employment

Considerations Waiting list exists Some individuals

w/autism may be served through the OBRA waiver

Attendant Care Waiver for Individuals with Physical Disabilities (Ages 18-59)

Examples of Services

In-home personal assistance

Community transition services

Personal response services

Considerations Consumer has right

to supervise, hire and fire attendant

Individuals w/lower level of need should consider Act 150 Attendant Care Program

Independence Waiver for Individuals with Physical Disabilities (Ages 18-59)

Examples of Services Assistive

tech/specialized equipment

Community integration services

Education services Environmental adaption Nursing services Respite

Considerations Consumer has right to

supervise, hire and fire attendant

OBRA Waiver (Ages 18-59)Examples of

Services Same services as

Independence Waiver

Prevocational services

Supportive employment services

Considerations Consumer has right

to supervise, hire and fire attendant

What is SSI Cash Entitlement (approx. $710 a months)

Guarantees Medical Assistance

Who is Eligible?An individual who: Has very little income and assets, and Has a disability

Criteria for children (under 18) is related to disabilities that interfere with daily functioning

Medical criteria for the evaluation of children under 18 can be found here: http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm

Criteria for adults is related to the degree to which the disability interferes with the ability to work

Can a Youth in Care Receive SSI? Yes, BUT the cost of care is counted as

income for the youth and is deducted dollar for dollar from the SSI benefit.

For many youth, especially those in more expensive placements, receipt of SSI may not make sense while in care, especially for IV-E eligible youth.

Applying for SSI in anticipation of discharge for youth with disabilities, however, is essential!

How can SSI help a youth transitioning out of foster care?

It can help prevent homelessness: The benefit level is more than other cash assistance programs (TANF,

General Assistance) and may cover the cost of room and board.

Paired with other services, it may facilitate a solid transition plan.

SSI eligibility may be a gateway to other programs and benefits, such as permanent affordable housing or other specialized programs.

Young adults receiving SSI have access to several programs that incentivize work and education: Youth can work part-time and still receive SSI

Social Security has programs to help recipients pursue education or attempt work without losing eligibility.

Youth can receive school scholarships and receive SSI simultaneously

Poll 5: SSI and Transition A youth cannot apply for SSI until they are discharged from the CW or JJ system. TF

SSI Basics as a Youth Transitions Who can apply for a youth in care?

If 18, the youth, but professionals working with the youth should facilitate filing.

If under 18, the parent or guardian, but a caseworker or foster parent can start the application.

When can you submit an application for a youth in care? 3 months before discharge date.

When can you start preparing the documents to submit? As early as possible!

SSI Basics What documentation do you need to apply?

Records of diagnoses, treatment, and how the disability impacts on the youth’s functioning in the areas of daily living and work.

Important to have “adult” diagnoses. Important to show capacity or lack of capacity

related to work—vocational eval/assessment, work experience in school/IEP.

Important to show level of adaptive functioning. Providers and IL programs can assist with

documenting adaptive functioning.

Lunch Webinars for 2014 Effectively Accessing the IDS System Effectively Using SSI for Youth In Care and Upon Transition Addressing Special Transition Issues for Youth with Behavioral

Health Needs Educational Transition Planning: High School and College Developing Enhanced Transition Services and Supports in your

Community or County Legal Strategies for Promoting Positive Transitions Legal Decision-making Issues for Transitioning Adults with

Disabilities What the Protection and Advocacy System Can Do for You and Your

Clients: DRN, CAP and More! Housing Issues for Youth and Young Adults with Disabilities Understanding Home and Community Based Medical Assistance

Waivers

For More Information Jenny Pokempnerjpokempner@jlc.org215-625-0551 x 111

Webinar Next Monday! Education for Kids in Care: What Judges and Attorneys Need to Know

Learn how to protect and advance the education rights of clients through effective courtroom practices in this webinar co-presented with Education Law Center-PA.

When: Monday, December 16, from 12 PM to 1 PM EST

Topics include: Juvenile court rules focused on education The role of educational decisionmakers Model orders and sample findings regarding

education

Register now >>