Information for Children, Teens and Their Families
Community Support Services

Home and Community Based Services Waiver (HCBS) was developed as a response to experience and learning gained from other state and national grant initiatives. The goals of the HCBS waiver are to:

• Enable children to remain at home, and/or in the community, thus decreasing institutional placement.
• Use the Individualized Care approach to service planning, delivery and evaluation. This approach is based on a full partnership between family members and service providers. Service plans focus upon the unique needs of each child and builds upon the strengths of the family unit.
• Expand funding and service options currently available to children and adolescents with a diagnosis of serious emotional disturbance and their families.
• Provide services that promote better outcomes and are cost-effective.

The target population of children eligible for the waiver are children with a diagnosis of serious emotional disturbance who without access to the waiver would be in psychiatric institutional placement. Parent income and resources are not considered in determining a child's eligibility.

The HCBS waiver includes six new services not otherwise available in Medicaid:

• Individualized Care Coordination includes the components of intake and screening, assessment of needs, service plan development, linking, advocacy, monitoring and consultation.
• Crisis Response Services are activities aimed at stabilizing occurrences of child/family crisis where it arises.
• Intensive In-home Services are ongoing activities aimed at providing intensive interventions in the home when a crisis response service is not enough.
• Respite Care are activities that provide a needed break for the family and the child to ease the stress at home and improve family harmony.
• Family Support Services are activities designed to enhance the ability of the child to function as part of a family unit and to increase the family's ability to care for the child in the home and in community based settings.
• Skill Building Services are activities designed to assist the child in acquiring, developing and addressing functional skills and support, both social and environmental.

Intensive/Supported/Blended Case Management program is designed to assist seriously emotionally disturbed children and youth and their families residing in the community. Well-qualified and specially trained professionals assess and coordinate the supports and services necessary to help children and adolescents live successfully at home and in the community. The Case Manager works intensively with the child's family, and coordinates with teachers and other helping professionals. Services are based on the specific needs and desires of the child and his or her family and are made available for as long as necessary. Flexible service dollars are available to provide services and supports otherwise not available.

Case Managers are expected to:

• Monitor and coordinate the delivery of necessary assessments;
• Coordinate the development of an individualized, comprehensive service plan;
• Provide crisis intervention services, as needed;
• Provide supportive services to the child's family, in such areas as behavior management, system access, and negotiation, parent education and support groups.

Single Point of Access - Each local government in New York State has been asked to designate a Single Point of Access for Children and Families (SPOA). The purpose of the SPOA for Children and Families is to identify those children with the highest risk of placement in out-of-home settings and to develop appropriate strategies to manage those children in their home communities. The purpose of the SPOA is to:

• Identify children with the highest risk for placement.
• Develop strategies to manage these children in their home communities using an individualized, strength-based approach.
• Develop better decisions about individualized care planning for children at risk.
• Support communities to manage access to intensive services.

Telepsychiatry - Telepsychiatry is a promising and exciting new way to get quality psychiatric care through the use of television/video and other communication equipment. Telepsychiatry is an area of telemedicine. It is designed to support a true collaboration between the child, family, the treating clinician, the child psychiatrist consultant and the community and a coordinated system of care for each child and his/her family.

Telepsychiatry allows experts in the field of child psychiatry to share their knowledge and skills through state-of-the-art technology in the form of video conferencing. Telepsychiatry makes consultation with a child psychiatrist available without the extensive travel that is often required of families in order to access this expertise.

Telepsychiatry has many benefits. Among them it brings the following:

• Child psychiatry services to your community.
• Collaboration between psychiatric caregivers.
• A way of providing collaboration and communication between families, local providers and child psychiatry consultants.
• A way to lessen costs for families including reduced travel, child care expenses and missed school or work days.
• Rural areas can have equal access to quality care.

Crisis Residences offer a supervised residential setting for persons requiring stabilization. Crisis beds serve children and adolescents exhibiting acute distress for whom stabilization in an alternate setting may be effective. The expected length of stay is up to 21 days. Children's crisis beds are linked with local psychiatric emergency rooms and acute inpatient programs. Follow up care is provided after discharge and the child and family are linked to community resources and supports.

The major goal of the program is to stabilize the situation and return the child to his home quickly, rather than to provide long-term care. Emphasis is on maintaining the relationships the child has in the community, with his family, referral agency, those resources that have provided services previously, and the school. Services, which can be provided in the community, will not be duplicated in the residence.

The crisis residence provides comprehensive assessment, respite, and service planning on a temporary basis for children who are in emotional, behavioral, or family crisis and who may without this kind of intervention require psychiatric hospitalization. Each program provides a highly structured, individually designed intervention for each resident in accordance with the needs of both child and caregiver. A balance of education, recreation, and activities of daily living are maintained within the residence.

Home Based Crisis Intervention (HBCI) provides in-home crisis services to families (natural, foster, or adoptive) where a child is at imminent risk of psychiatric hospitalization. Linked to emergency rooms, these programs provide intensive in-home intervention for 4 to 6 weeks with the goals of admission diversion, teaching problem solving skills to the family, and linking the child and family with community-based resources and supports. A counselor is available seven days a week, 24 hours a day to work with the child and family.

The HBCI model contains the following essential elements, which are incorporated into the goals and objectives of each agency providing this service:

• Acceptance of only those families on the verge of having a child placed as a result of psychiatric crisis;
• A crisis-oriented intervention process that sees each family as immediately as possible after the referral;
• These programs are linked to a hospital to assure availability and accessibility;
• Flexible staff hours, including 24 hour a day, 7 day a week response capability;
• An intake and assessment process designed to ensure that no family is left in a dangerous situation;
• An approach to intervention that is multi-faceted, including counseling, skill training, helping the family obtain needed resources and learn problem solving skills;
• A small caseload with each counselor working with only two families at any one time;
• Limits on the length of intervention, usually a brief period of five to six weeks;
• Linking of families with agencies if further treatment or services are needed;
• Follow-up with families, both to assess their progress and to evaluate the program's success.

The target population for the HBCI program is youth 5 to 17 years of age, who are living at home within their natural, foster, or adoptive family, and who are experiencing a psychiatric crisis that would require hospitalization without immediate intensive intervention. In addition, they and their parents must be willing to receive in-home crisis services. Children may have had previous or ongoing contact with the juvenile justice system, the special education system, the Office of Children and Families, and/or the mental health system.

Community Residences provide a supervised, therapeutic environment for six to eight children or adolescents, between the ages of 5 and 18 years, that includes structured daily living activities, problem solving skills development, a behavior management system and caring consistent adult interactions. Most often, needed clinical supports for the child and family are provided by community-based services.

Community residences provide a community-based, more normative residential option for some seriously emotionally disturbed children and youth. Without the availability of community residences, children and youth may be unnecessarily placed or kept longer than is appropriate in more restrictive levels of care. Community residences are appropriate for youngsters who are diagnostically the same as youngsters placed in an inpatient or residential treatment facility yet are more independent and able to function in a community based, supervised living environment. These are children who, with supervision, are able to participate in community school, social and recreational activities.

The community residence program model is based upon the following principles:

• Seriously emotionally disturbed children and youth should be served in the least restrictive environment that is clinically appropriate.
• Families should be supported in their efforts to continue and/or resume primary care for their child by the provision of education/information, skill development, and emotional support.
• Treatment for seriously emotionally disturbed youth occurs in a therapeutic milieu that includes structured daily living activities, the teaching of problem solving skills, a behavior management system, and caring, consistent adult relationships.
• Community residences must be strongly networked with other local mental health services including day treatment, inpatient psychiatric care, residential treatment facilities, outpatient clinics, and the other community based services provided under county and voluntary sector auspice.

Family-Based Treatment Program (FBTP) is an essential component of the system of care for children and youth with serious emotional disturbances. FBTP targets children who meet SED criteria, can function in a family setting, and are at risk for restrictive settings. It provides, through a careful matching process, a placement in a family home for children who are able to live in the community under the supervision, and with the support of, surrogate parents. These surrogate parents receive special training in behavior management and other related aspects of caring for youth with SED. Additional supports, including clinical services, are arranged through community mental health programs and other community agencies.

FBT programs currently serve from 10 to 25 youth. Family Specialists are responsible for providing needed supports to both surrogate parents and families of origin with the goal of having the child return to his/her family of origin whenever possible. Each Family Specialist generally works with a cluster of five sets of surrogate parents and one set of respite parents. In addition to pre-service training, on-going training and support groups are offered to the surrogate and respite parents on a monthly basis. Families of origin may be invited to these trainings or may have separate training and support groups.

Teaching Family Homes Programs are designed to provide individualized care to children and youth with serious emotional disturbances in a family-like, community-based environment. Specially trained parents live and work with four children and youth with serious emotional disturbances in a home-like setting. The teaching parents are responsible for the social education of the children and the implementation of a service plan developed in conjunction with the family and clinical service provider. The focus is on teaching the youth to live successfully in a family, attend school, and live productively in the community.