Description of Waiver Services
Behavioral Support is a service that includes functional behavioral assessment (FBA); the development of strategies to support the individual based upon assessment; and the provision of training to individuals, staff, parents and caretakers. Services must be required to meet the current needs of the individual, as documented and authorized in the ISP. Behavior Support should utilize Best Practices that may include some or all of the following
1.Meeting with the Individual, observing them, and interacting with the Individual at Day Program / Residential Provider / Home with Family or Provider / Community Setting / Clinician Office / or other service related environments where behavioral symptoms impact on their life.
2. Conducting comprehensive functional behavioral assessments of presenting issues (including aggression, property destruction, self-injurious behavior, sexual behaviors, inappropriate social behavior, or relationship issues). The Assessment should attempt to distinguish those behaviors that may be a manifestation of a Behavioral Health diagnosis (i.e. Dual Diagnosis).
3. Development and maintenance of Behavior Support plans, which utilize positive strategies to support the participant, based on Functional Behavioral Assessment. Behavior Support Plan must include use of positive practices and be updated at least yearly to include Data Analysis, progress, changes in strategies as appropriate, and Recommendations and/or Outcomes as agreed by the Team.
4. Collaboration with Team members including Day Program, Residential Provider Staff, Family and others (e.g. Psychiatrist, Job Coach) for the purpose of developing a Behavior Support Plan to include: reviewing data, identifying Behavioral Health Symptoms related to Target Behavior, identifying relevant background, environmental issues, and possible physical health issues affecting behavior. Plans must include positive practices with provisions for Staff Training as needed. Any Plans including a Restrictive Procedure would be reviewed more frequently and cannot include physical, chemical, or mechanical restraint.
5. Training related to the implementation of behavior support plans for the participant, family members and staff; This includes the use of the Behavior Plan methods and interventions as well as education about, and information on, identified Dual Diagnosis issues (for example, the individual’s specific psychiatric symptoms, behavioral manifestations, diagnoses and medications).
6. Modeling the appropriate communication and methods of support for Support Staff or Family
7. Participation in relevant Team Meetings as needed to assure the effective implementation of the Behavior Plan.
8. Collection and review of Data / Incident Reports / related information to assess the effectiveness of the Behavior Plan and it’s interventions.
9. Participation (Direct, Written, Video, Phone) in psychotropic medication reviews and development of related reports to update the psychiatrist on any related Behavioral Health (Dual Diagnosis) issue and promote the use of the least amount of medication necessary (i.e. medication reduction as appropriate).
10. Employment of relevant Clinical and Counseling Techniques are included in positive practice strategies in addressing Target Behavior. This includes developing a positive relationship with the Individual, the Family, and the Team to affect desired change. Also, identifying strategies for stress management, improving coping skills, instruction of anger management techniques, enhancing social relationships and interpersonal skills, and promoting the concept of Mental Health Recovery.
The service is performed by a professional with a Master’s Degree in Psychology or related Human Services field (Social Work, Education, etc.) and four years related experience or with a Bachelor’s Degree in Psychology or closely related field and at least five years of related experience under the supervision of an individual with a Master’s level Behavior Specialist. Services may be provided in the office of the Behavioral Support professional, the individual’s home, the location of other authorized services, or in local public community environments necessary for the provision of the Behavioral Support Services. Behavioral Support services may be provided during the same day and time as other services, but may not duplicate other services. For example, Behavioral Support may be provided during the same day and time as Residential Habilitation, but the Behavioral Support provider may not render services that overlap with the responsibilities of the Residential Habilitation provider.
Current Behavior Specialists that have been providing this service for over 2 years and do not have the previous stated qualifications may be grandfathered in to continue to provide this service without supervision.
Sexuality supports are an extension of the Behavior Support definition but with a focus on inappropriate sexual behaviors that are a barrier to an individual’s personal adjustment, maturity, socialization, relationships, and emotional well-being. This support is individualized to address the unique understanding and learning necessary to keep oneself safe, keep others safe, develop and utilize socially appropriate interactions, and develop appropriate outlets for one’s sexual expression. This support is also based on assessment and the development of realistic goals including sex education, the elimination of inappropriate sexual behaviors, and enhancing peer relationships as appropriate.
Companion Services are provided to individuals living in private residences for the limited purposes of providing supervision and necessary care and minimal assistance that is focused solely on the health and safety of the adult individual (18 years of age and older) with an Intellectual Disability. Companion Services are used in lieu of habilitation services to protect the health and welfare of the individual when a habilitative outcome is not appropriate or feasible (that is, when the individual is not learning, enhancing, or maintaining a skill). This service can also be used to supervise individuals during socialization or non-habilitative activities when necessary to ensure the individual‘s safety. This service may not be provided at the same time as any other direct service.
Homemaker and Chore Services
These services can only be provided when a household member is temporarily absent or unable to manage the home, or when no landlord or agency caretaker staff is responsible to perform the homemaker activities. Homemaker Services must be provided by a qualified homemaker and may include cleaning, laundry, and other general household care.
Home & Community Habilitation Services
This is a direct (face-to-face) service provided in-home and in community settings to assist individuals in acquiring, maintaining, and improving self-help, domestic skills, socialization, and the adaptive skills necessary to reside successfully in home and community-based settings. Services consist of support in the general areas of self-care, communication, fine and gross motor skills, mobility, personal adjustment, relationship development, socialization, and use of community resources. Habilitation may be provided up to 16 hours a day based on the needs of the individual.
Through the provision of this service, individuals learn, maintain, or improve skills through their participation in a variety of everyday-life activities. These activities are necessary for individuals to live in the community, to live more independently, or to be more productive and participatory in community life.
The provision of Respite Services does not prohibit supporting individuals’ participation in activities in the community during the period of respite. The provision of 24-hour respite services does not prohibit individuals’ participation in day and employment services.
Individuals can receive two categories of respite services: 24-hour respite and 15-minute respite:
- 24-hour respite is provided for periods of more than 16 hours and is billed using a day unit. Each day unit is defined as a period of time that is more than 16 hours up to 24 hours in length.
- 15-minute respite is limited to 480 (15 minute) units per individual per fiscal year, except when extended by the ODP Regional Office based on individual needs. 15-Minute Respite is provided for periods of 16 hours or less within a 24-hour period, and is billed using a 15-minute unit.
Residential Services/Supports is a relatively new program with SBR (2011), but has the potential for ongoing growth based on the needs of individuals with intellectual disAbilities who choose to live in supervised community settings. Individuals may also have secondary Behavioral Health diagnoses that present a significant barrier to their full participation in community living.
This is a direct service funded through the Medicaid Waiver program and is licensed by the PA. Department of Human Services (DHS) annually (6400 regulations). It is designed to assist individuals to live as independently as possible in the community. The program focuses on safety, skill building, socialization, choice, independence, community integration, and personal growth. Staffing ratios depend on individual need with homes ranging from a one person site to a three person site and which encourage easy access to community activities and services. In instances where an individual shares a home with 1 or 2 other individuals, each maintains their own bedroom with staff support as necessary.
SBR’s trained Direct Support Professionals will work “hands on” with individuals on taking care of personal needs (i.e. self-care, cooking, budgeting), maintaining personal relationships with their family and previous friendships, as well as, offering opportunities for socialization and fostering new relationships. Supports could be 24 hours per day or significantly less based on the ability of the individual and agreed upon through the Team process.