Home and Community-Based Waiver Services
Data has shown that children with a serious emotional disturbance are more apt to attain optimal development when supported in their home and community environment. The Office of Mental Health recognizes that these children and adolescents are at unique risk of missing the opportunities necessary to meet the developmental imperatives of their age. The HCBS Waiver ensures that New York’s children and families have access to services that are culturally relevant and that lead to improved resiliency, the achievement of age specific developmental imperatives and a supportive home environment.
The HCBS Waiver utilizes a strength-based, individualized care model to promote wellness, leading to success for the child and family. It ensures effective interventions by implementing a collaborative partnership with the family, treatment provider(s), core waiver services and other natural supports.
The following describes major values emphasized by the HCBS Waiver program.
Child and family participation and freedom of choice are essential to planning and strategizing for effective outcomes.
- Children and families are engaged in true partnerships during all phases of service planning and delivery.
- The unique strengths and needs of each child and family direct the design of every service plan.
- Priorities identified by the child and family guide the development of goals and services to be delivered.
- To ensure families the choice of providers, Waiver ICC agencies are expected to develop a network of providers for the remaining five services.
Success for children requires both effective treatment and the services that Waiver provides. Initial and on-going collaboration between providers and natural supports is fundamental to enhancing resiliency, meeting the imperatives of developmental stages, and promoting wellness for each child and their family.
- Each child's service plan is integrated with the child and family's psychiatric treatment.
- Both treatment and service providers review and sign each treatment and each service plan.
- Integration of treatment goals and models with Waiver service provision is a requirement and is ensured through collaborative planning and on-going communication between the treatment providers and Waiver program.
Psychiatric diagnosis alone does not define the child. The family environment plays a key role in the child's progress and continued success.
- Individual Care Coordinators work closely with families during all stages of enrollment to ensure understanding of and continued agreement with the service plan.
- Agreed upon goals and services are mutually worked on to support changes in the home environment that reinforce the child's healthy development.
All domains of life impact on a child's level of functioning and overall wellness and must be considered in service planning.
- Children and their families are engaged in initial and on-going assessments that examine all domains.
- Information pertaining to domains is integrated in the service plan.
- Medical and dental needs are monitored and addressed throughout Waiver enrollment.
Safety is a primary concern throughout enrollment.
- The child and family engage in developing and implementing safety plans.
- Goals and objectives address identified high risk factors.
- All Waiver services workers are cleared through a criminal history background check and through the Child Abuse Register.
The least restrictive environment is the environment of choice for a child and family's success.
- Services are provided in the home and the community, making full use of natural supports.
Cultural competence is a crucial building block for effective engagement and intervention.
- Waiver programs and their subcontractors apply in-depth knowledge of the role of culture (i.e. in forming parenting roles, engagement, family norms, etc.).
- Training in cultural competence is ensured by provider agencies.
- Ethnic demographics are considered in the hiring of Individualized Care Coordinators for the Waiver.
A skilled workforce enables effective care.
- OMH maintains training requirements for workers in each of the six Waiver services.
- OMH provides training opportunities in all regions of the state and statewide.
- OMH supports and approves curriculum development and utilization.
- On-going supervision of workers, including assessment of skills, is conducted by the providers.
Outcome measures provide indicators of program effectiveness.
- OMH ensures on-going outcome measures such as annual parent and child satisfaction surveys, expenditure report comparisons, and utilization of services reports.
- OMH utilizes computerized reporting systems to collect outcome indicators and refine the analysis process.
- OMH routinely interfaces with Waiver providers for feedback and to provide technical assistance.
The goals of the Home and Community Based Services Waiver are:
- to serve children with complex and significant mental health needs in their homes and communities,
- to decrease the need for placements in psychiatric inpatient levels of care, including Residential Treatment Facilities,
- to increase the array of Medicaid reimbursable community-based services available to children and adolescents with serious emotional disturbance and their families,
- to use a culturally sensitive, individualized, strength-based approach to build resiliency, assist in the achievement of age related developmental tasks and promote emotional well-being,
- to provide the services and supports that are specifically needed by each unique family to develop the ability to care for the child in their home in a supportive environment,
- to offer children and families a choice of providers, when possible;
- to provide services that promote better outcomes that are also cost-effective, and
- to demonstrate an integrated model of partnership with the family, treatment provider, core waiver services and other natural supports that are involved with the child and family.
The target population for the HCBS Waiver is children and adolescents:
- with serious emotional disturbance,
- between the ages of 5 and 17 years (prior to 18th birthday),
- who demonstrate complex health and mental health needs,
- who are at imminent risk of admission to a psychiatric institutional level of care or have a need for continued psychiatric hospitalization,
- whose service and support needs cannot be met by just one agency/system,
- who are capable of being cared for in the home and/or community if services are provided,
- who have a viable and consistent living environment with parents/guardians who are able and willing to participate in the HCBS Waiver*, and
- who can reasonably be expected to be served under the HCBS Waiver at a cost which does not exceed that of psychiatric institutional care.
Additionally, the youth must be eligible for Medicaid under the HCBS Waiver (i.e., are currently enrolled in Medicaid or could be enrolled by meeting federal eligibility standards) in a county with a HCBS Waiver program and be capable of being served in the community at or below the federally approved average yearly cost which is adjusted periodically.
The Six Waiver Services
There are six specific services that comprise the HCBS Waiver. The services are: Individual Care Coordination, Respite, Intensive In Home, Skill Building, Family Support Services and Crisis Response. Each child must have Individual Care Coordination. The remaining five services are selected as indicated by the child, family and ICC to support goals and objectives in the Service Plan.
The HCBS Waiver services are defined as follows:
Individualized Care Coordination (ICC): This service provides the first and ongoing point of engagement for the child and family. It performs the case management functions for the HCBS Waiver and oversees delivery of the remaining five services. It ensures on-going partnership with the Waiver child and family as well as on-going collaboration with treatment providers. Individualized Care Coordination encompasses development and oversight of service plans that are:
- strengths based,
- individualized, addressing all domains of the child,
- culturally relevant,
- designed to address developmental tasks, resiliency and wellness,
- complimentary with psychiatric treatment that the child and family are receiving,
- reflective of the child and family's priorities, and
- integrate information from the CANS assessment instrument.
Individualized Care Coordination additionally includes:
- ensuring that the child and family's strengths and needs dictate service planning and delivery,
- initial and on-going assessments, including the Child and Adolescent Needs and Strengths (CANS) instrument,
- ensuring that the Waiver, treatment providers, subcontractors and natural supports work together on an on-going basis to:
- integrate individual service plans
- coordinate and monitor service delivery
- develop and implement safety plans
- coordinate discharge plans,
- case record documentation,
- ensuring that all services are compliant with the OMH Waiver Guidelines,
- input of data in the OMH CAIRS system, and
- management of child and family's budgetary and flex fund expenditure requirements.
Respite Services (RS) provides a needed break for the family and the child to ease the stress at home and promote overall wellness for the child and his/her family. Respite Services' activities include providing supervision and recreational activities that match the child's developmental stage and/or community outings with child e.g school, appointment or a program. Respite care may be provided on a planned or emergency basis, day or night, in the child's home or in the community by trained respite workers with one Waiver child or a group of Waiver children
Family Support Services (FSS) has the following characteristics:
- Family driven, meaning there is a true partnership with families.
- Comprehensive, flexible, and individualized to each family based on their culture, needs, values and preferences.
- Builds on strengths to increase the stability of family members and the family unit.
- Utilizes informal and formal family supports.
Family Support Services offers activities designed to enhance the health and growth of children and adults in the family unit to ultimately develop safe, stable, and supportive families who are connected to their communities. Family Support Services provide resources, including, but not limited to: education, training, advocacy and supports. Family Support also assists the family by introducing and connecting them to activities in the community (e.g., educational, cultural, recreational) which would foster family cohesion. Such activities must be consistent with the family's budget to assure the possibility of continuing the activities post Waiver enrollment. Family Support group activities for parents (i.e. game nights, annual picnics) are provided as a venue for engaging parents with similar experience as a way of assisting in building natural support systems in their communities. Family Support Services may be provided to Waiver parents/guardians and family members who have frequent and regular caretaking responsibilities for the Waiver child.
Skill Building Services (SBS) focuses on helping the child to be successful in the home, community and school by acquiring both social and environmental skills associated with his/her current developmental stage. Skill Building Services utilizes an individualized, strength based approach in assisting the child in recognizing his/her functional assets/strengths and those that need developing. Support is offered through a variety of activities in areas such as completing homework, problem solving, functional social skills such as receiving a compliment, asking for help, etc., verbal skills, the development of play skills and imagination, organizational skills, cooperation, peer relationships, managing public transportation, empathy, etc. Skill Building may also assist youth in developing skills for independent living and by facilitating access to, monitoring and supporting vocational training. Skill Building Services may be provided to the child's family to support the child's development and maintenance of skills sets. Skill Building may be provided to an individual Waiver child or a group of Waiver children.
Intensive In-Home Services (IIH) provides services that support the child's emotional and social development and learning. IIH provides intensive, on-going interventions that are specified in the child's Waiver Service Plan that may support the child and family in implementing both their Treatment Plan (from the clinical provider) and the Waiver Service Plan (established by the Waiver program). This service reinforces the desired behavioral or cognitive changes by assisting the child and family in everyday application of the clinical treatment plans' strategies and resultant insights. Interventions may include anger management, socialization, psycho-education, crisis de-escalation, support in working through safety plans, parent-child relationship building, parenting skills, feedback on emotional self-regulation in situational contexts, sibling relationship building, developing healthy coping mechanisms, making healthy choices, building self self-esteem, identity issues, etc. These services may be provided in the home or in the community to an individual Waiver child and their family.
Crisis Response Services (CR) reinforces the agreed upon safety plan that the child and family have developed and attempts to stabilize occurrences of child/family crises when they arise. These services may include assessment, consultation, linkage and immediate intervention wherever necessary, for example, in schools, at home and work. This service is available 24 hours a day, seven days a week