Services Available to Missourians Affected by Autism Linda Miller - - PowerPoint PPT Presentation

Services Available to Missourians Affected by Autism

Linda Miller 10/12/2018

Department of Mental Health Division of Developmental Disabilities Office of Autism Services

Learning Objectives

Identify five key facts about autism spectrum disorder (ASD) Identify Missouri’s service systems for ASD Describe the process in Missouri for accessing services and supports through the Division of Developmental Disabilities Identify autism resources that help individuals, families, and professionals navigate the service system

Fast Facts about Autism Spectrum Disorder (ASD)

• ASD occurs in all racial, ethnic, and

socioeconomic groups

• Autism is almost five times more common among

boys (1 in 54) than among girls (1 in 252)

• There is no medical test or cure for autism
• Autism is cited as fastest growing disability in the

US

1 is 166 1 in 150 1 in 125 1 in 110 1 in 88 1 in 68 1 in 59 2000 2002 2004 2006 2008 2010 2018

Autism Prevalence 2000 - 2018

CDC Prevalence Statistics for ASD

About ASD

• ASD refers to a cluster of neurobiological disorders

that develops during childhood before the age of three

• Diagnosis of ASD is based on symptoms, currently or

by history, in these two areas:

• Impairments in social communication/interaction
• Restricted, repetitive behaviors

Impairments in Social Communication/Interaction

Problems reciprocating social or emotional interaction, including difficulty establishing or maintaining back-and forth conversations and interactions, inability to initiate an interaction, and problems with shared attention. Severe problems maintaining relationships – from lack of interest in other people to difficulties in pretend play and engaging in age-appropriate social activities, and problems adjusting to different social expectations. Nonverbal communication problems such as abnormal eye contact, posture, facial expressions, tone of voice and gestures, as well as an inability to understand these.

The diagnosis of ASD is based on symptoms, currently or by history, in the two areas highlighted above. Symptoms may begin in early childhood but not be recognized fully until social demands exceed capacity. Symptoms must cause functional impairment. Source: American Academy of Pediatrics

Core Characteristics of ASD

3 of 3 must be present

Restricted, Repetitive Behaviors

Stereotyped or repetitive speech, motor movements, or use of objects. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change. Highly restricted interests that are abnormal in intensity

• r focus.

Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment.

The diagnosis of ASD is based on symptoms, currently or by history, in the two areas highlighted above. Symptoms may begin in early childhood but not be recognized fully until social demands exceed capacity. Symptoms must cause functional impairment. Source: American Academy of Pediatrics

Core Characteristics of ASD cont.

2 of 4 must be present

Service Systems for ASD in Missouri

• First Steps - Birth to 3 years
• Early Childhood Special Education - 3 to 5 years
• MO HealthNet - Early and Periodic Screening Diagnostic

and Treatment (EPSDT) - Birth to 20 years

• Division of Developmental Disabilities (DD) - Birth to Life
• Children and Youth with Special Health Care Needs

Program - Birth to 20 years

• Private Insurance

State Service Systems: Eligibility

Eligibility criteria for any state system may be based

• n one or a combination of factors, including but

not limited to age, disability/delay, income, functional levels.

First Steps (Department of Elementary and Secondary Education) Children and Youth with Special Health Care Needs (Department of Health and Senior Services) Division of Developmental Disabilities (Department of Mental Health) MO HealthNet (Department of Social Services)

About Educational Supports

School-aged children (K-12) with ASD

• May not always have an Individualized Education Program (IEP)
• Those who have IEPs with behavioral goals have greater

protection under Individuals with Disabilities Education Act (IDEA) than they would have without behavioral goals

• Do not have to be provided with accommodations unless an

educational evaluation for eligibility reveals that accommodations are necessary to receive a fair and appropriate public education (FAPE)

For more information about IEPs, IDEA, and Section 504 of the Rehabilitation Act see http://ptimpact.org/

Applying for Medicaid

Apply for Medicaid through the MO HealthNet Division at:

https://dss.mo.gov/mhk/accept.htm

• If approved for Medicaid, individuals are able to access

Medicaid (MO HealthNet Division) Services (sometimes referred to as State Plan Services) or might be eligible to receive a Medicaid Waiver.

• Early and Periodic Screening, Diagnostic and Treatment

(EPSDT) – Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that states must cover a broad array of preventive and treatment services.

Children and Youth with Special Health Care Needs (CYSHCN)

• CYSHCN Program (Missouri Department of Health and Senior

Services) provides assistance for children with special health care needs – Birth to 21 years

• Program focuses on early identification and service

coordination for children who meet medical eligibility guidelines

• As payer of last resort, program provides limited funding for

medically necessary diagnostic and treatment services for children whose families also meet financial eligibility guidelines

For more information about the Children and Youth with Special Health Care Needs Program, visit: https://health.mo.gov/living/families/shcn/cyshcn.php

Private Insurance

On June 10, 2010, Governor Nixon signed a law requiring private insurance companies operating in Missouri to provide coverage under group health insurance policies for care to children diagnosed with autism – including coverage for Applied Behavioral Analysis (ABA) Given that ABA is considered a best-practice treatment for autism, this law can potentially provide a substantial and positive impact to thousands of Missouri families affected by autism

For more information about the insurance law, visit: https://insurance.mo.gov/consumers/autismFAQ/

DD’s Office of Autism Services (OAS)

Department: Mental Health Division: Developmental Disabilities (DD) Statute: 633.210 RSMo:

• “The office of autism services, under the supervision of the director
• f the division of developmental disabilities, shall provide

leadership in program development for children and adults with autism spectrum disorders, to include establishment of program standards and coordination of program capacity.”

• OAS works closely with Missouri’s five Autism Projects, Missouri’s

Autism Centers’ diagnostic and intervention clinics, and the Missouri Commission on Autism Spectrum Disorders

DD’s Office of Autism Services (OAS)

End of 2017 - 13,720 (37%) with ASD enrolled in DD (out of total DD population of 37,067).

• 6,873 with ASD aged 4-17 (63%)
• 4,253 served in the Missouri Autism Projects

Two Funding Streams

Autism Project General Revenue

Missouri tax dollars; no federal match; every service provided under Missouri Autism Projects is 100% funded by General Revenue.

Autism Projects

Central Missouri Autism Project East Missouri Autism Project Northwest Missouri Autism Project Southeast Missouri Autism Project Southwest Missouri Autism Project

Medicaid Waiver

Most services provided by the Division of Developmental Disabilities are Medicaid Waiver

• Services. The federal government

reimburses the state approximately 2/3 of every dollar spent on those services.

Home and Community- Based Medicaid Services

Comprehensive Waiver Lopez Waiver Support Waiver Partnership for Hope Waiver

https://dmh.mo.gov/dd/autism/autism projects.html https://dmh.mo.gov/dd/progs/waiver/in dex.html

Applying for DD Services

• To apply for services from the Division of

Developmental Disabilities (DD), contact the intake department of the Regional/Satellite Office in your area

• Individuals do not need to be eligible for Medicaid to

apply for DD services

• The link to the Regional/Satellite Offices is:

http://dmh.mo.gov/dd/facilities/

Regional/Satellite Offices

Department of Mental Health, Division of Developmental Disabilities Regional and Satellite Offices Central Missouri Regional Office 573-441-6278 Springfield Regional Office 417-895-7400 Kirksville Satellite Office 660-785-2500 Joplin Satellite Office 417-629-3020 Rolla Satellite Office 573-368-2200 Sikeston Regional Office 573-472-5300 Hannibal Satellite Office 573-248-2400 Poplar Bluff Satellite Office 573-840-9300 Kansas City Regional Office 816-889-3400

• St. Louis County Regional Office

314-587-4800 Albany Satellite Office 660-726-5246

• St. Louis Regional Tri-County Office

314-244-8800 (City, St. Charles, Jeff Co.)

Becoming Eligible for DD Services

• Must have a qualifying diagnosis (ASD is one)
• Disability must have manifested before the

age of 22 and is likely to continue indefinitely

• Must have functional limitations (2 to qualify

for Missouri Autism Project services; 3 to qualify for a Medicaid Waiver)

For complete information about eligibility for services, refer to 9 CSR 45-2.010 https://www.sos.mo.gov/cmsimages/adrules/csr/current/9csr/9c45-2a.pdf

Functional Status

• Self-care
• Language development – receptive and expressive
• Learning
• Self-direction
• Independent living/economic self-sufficiency
• Mobility

For complete information about eligibility for services, refer to 9 CSR 45-2.010 https://www.sos.mo.gov/cmsimages/adrules/csr/current/9csr/9c45-2a.pdf

Preparing for the Intake Process

Before applying for DD services, individuals should gather documentation from clinicians, educators, and other professionals

• Diagnostic information (observations from a clinician, tools

used)

• Evaluations, education plans, and other related

documentation that identifies challenges and recommendations

• Other relevant information that will allow the Support

Coordinator coordinate services that target the needs of the individual and family

If Deemed Eligible for DD Services…

• Individual will be assigned a Support Coordinator

who will help set up a plan to identify service and support needs for the individual

• Individual could be eligible for for a Medicaid Waiver

if on Medicaid (3 out of 4 Waivers administered by DD require Medicaid eligibility)

• Individual might desire to be connected to Autism

Project Services (not necessary to be Medicaid eligible to receive Autism Project Services)

Medicaid Waivers

• Medicaid Home and Community Based (HCB) Waiver programs for

individuals with intellectual or other developmental disabilities administered by the Department of Mental Health/DD:

• Comprehensive Waiver
• Missouri Children with Developmental Disabilities Waiver (MOCDD or

Sarah Jian Lopez Waiver)

• Support Waiver
• Partnership for Hope Waiver
• States may use Medicaid funding for home and community-based services

provided only to a target group of people who have intellectual and developmental disabilities and whose care needs would otherwise require services in an institution

• Division of DD uses general revenue funds and local county dollars to match

federal dollars to pay for HCB waiver services

Missouri Autism Projects

• Department of Mental Health’s Division of Developmental

Disabilities funds five regional autism projects that serve approximately 3500 families statewide.

• Established in 1991
• Authorities were established and funding was secured for family-

centered services for individuals with autism spectrum disorder throughout the state

• Parent Advisory Councils (PACs) were formed to represent and
• versee each autism project and to make recommendations for

service needs and providers

Missouri Autism Project Regions

Central MO Autism Project

• Central MO Regional Office
• Hannibal Satellite Office
• Kirksville Satellite Office
• Rolla Satellite Office

Southwest MO Autism Project

• Joplin Satellite Office
• Springfield Regional Office

Northwest MO Autism Project

• Albany Satellite Office
• Kansas City Regional Office

East MO Autism Project

• St Louis County Office
• St Louis Tri-County Office

Southeast MO Autism Project

• Sikeston Regional Office
• Poplar Bluff Satellite Office

Preparing for the Planning Process

Before enrollment in the Regional Autism Project, to help with the planning process, individuals should:

• Review Information for Families on the regional autism webpage

http://dmh.mo.gov/dd/autism/autismprojects.html

• Have available documentation from clinicians, educators, and other

professionals

• Assessment for intervention planning from a clinician
• Evaluations, education plans, and other related documentation that

identifies challenges and recommendations

• Other relevant information that will allow the Support Coordinator to

coordinate services that target the needs of the individual and family

Assessment for Intervention Planning

• Assessment for intervention planning is described in

Autism Spectrum Disorders: Missouri Best Practice Guidelines for Screening, Diagnosis, and Assessment available at: http://autismguidelines.dmh.mo.gov

• If you don’t have an assessment for intervention

planning, you may wish to contact an Autism Center

Missouri Autism Centers

• Department of Mental Health contracts with six Missouri

Autism Centers

• Autism Centers
• Work to decrease the amount of time individuals wait on a

waitlist before receiving an appropriate diagnosis

• Provide critical diagnostic information to families in a timely

manner

• Provide intervention services or access to such services by

identifying available support services and advocating in the child’s community

Cardinal Glennon Knights of Columbus Behavior Clinic,

• St. Louis, MO

314-577-5609

www.cardinalglennon.com

Children’s Mercy Hospitals and Clinics, Developmental Center/Autism Center, KC, MO 816-234-3674 866-512-2168 (Toll Free)

http://www.childrensmercy.org/Autism/

Mercy Kids Autism Center, St. Louis, MO 314-872-3345

https://www.mercy.net/practice/mercy-kids- autism-center/

MU Thompson Center for Autism and Neurodevelopmental Disabilities, Columbia, MO 573-884-6052

http://Thomsoncenter.missouri.edu/

Southeast MO State University Autism Center for Diagnosis and Treatment, Cape Girardeau, MO 573-986-4985

autismcenter@semo.edu

Washington University School of Medicine Child and Adolescent Psychiatry Center, St. Louis, MO 314-286-1700 (scheduling)

http://wuchild.wustl.edu

Missouri Autism Centers

Service Menus – Where to Find

If individual has a diagnosis of autism and is eligible for DD services…he/she

can receive Autism Project Services. Service Directories or Service Reference Guides for the autism projects are housed on DD’s website:

https://dmh.mo.gov/dd/autism/autismprojects.html

• Central Missouri Autism Project

https://dmh.mo.gov/dd/autism/central/docs/19centralservicedirectory.pdf

• East Missouri Autism Project

https://dmh.mo.gov/dd/autism/east/docs/emapservices.pdf

• Northwest Missouri Autism Project

https://dmh.mo.gov/dd/autism/northwest/docs/nwservicesreferenceguide.pdf

• Southeast Missouri Autism Project

https://dmh.mo.gov/dd/autism/southeast/docs/fy19semapdirectory.pdf

• Southwest Missouri Autism Project

https://dmh.mo.gov/dd/autism/southwest/docs/fy19servicedirectory.pdf

If individual is on Medicaid…he/she is

eligible to receive Medicaid State Plan Services such as Occupational Therapy, Speech Therapy,

• r ABA Services and may be able to receive

Medicaid Waiver Services (offered through DD). Descriptions of the waivers and list of waiver services are on DD’s website:

https://dmh.mo.gov/dd/progs/waiver/index.html

Order in which services should be accessed…

• Private Insurance
• Medicaid (MO HealthNet) Services
• Medicaid Waiver Services
• Autism Project Services

Best Practice Interventions

Commonly requested best practice interventions include but are not limited to:

• Parent/Caregiver Training
• Behavioral Services
• Respite Services
• Social Skills Training
• Community Inclusion
• Transition Services
• Employment Services

For information about evidence-based interventions, see Autism Spectrum Disorders: Missouri Best Practice Guide to Evidence-based Interventions at http://www.autismguidelines.dmh.missouri.gov/pdf/Guidelines.pdf

Why These Interventions?

Parent Training helps keep families together Respite helps families with high stress levels Social Skills Training helps strengthen social interaction Employment Services help individuals with ASD gain and maintain competitive employment. Transition Services help individuals with educational, medical, vocational, and post-secondary transitions. Community Inclusion helps individuals integrate into their community

Why These Interventions? A Word about ABA…

Resource: Autism Speaks ABA through Medicaid EPSDT Tool Kit https://www.autismspeaks.org/sites/default/files/docs/epsdt_toolkit.pdf

Applied Behavior Analysis Services

• Most research-based intervention for children with ASD
• Can have positive outcomes with very young children due to the

neuroplasticity of a young brain

• 2011 – Some private insurance plans under Missouri law cover ABA
• 2014 – Centers for Medicare and Medicaid (CMS) clarified that

states must provide medically necessary services for children with ASD under Medicaid’s EPSDT benefit for children under 21.

• 2015 – MO HealthNet began paying for ABA Services for ASD under

EPSDT

Resources - Points of Contact

Age of Individual with ASD Agency to Contact Phone Number

The place to start Birth – Life For non-educational supports: Division of Developmental Disabilities, Office of Autism Services 573-751-4054 Birth – 3 years For Early Intervention: First Steps 573-522-8762 866-583-2392 3 – 5 years If education-related: Early Childhood Special Education 573-751-0187 5 – High School If education-related: Effective Practices 573-751-5739 Birth – 17 years To report abuse or neglect of children age 0 – 17: Missouri Department of Social Services – Child Abuse and Neglect Hotline 800-392-3738 18 – Life To report abuse or neglect of individuals 60 and older and persons with disabilities between 18 and 59: Missouri Department of Health and Senior Services – Adult Abuse and Neglect Hotline 800-392-0210

Website Resource

Navigating Autism Services: A Community Guide for Missouri

https://dmh.mo.gov/dd/autism/docs/navigationguide.pdf

More Website Resources

Websites Missouri Department of Mental Health, Division of Developmental Disabilities, Office of Autism Services

https://dmh.mo.gov/dd/autism/

Missouri Department of Elementary and Secondary Education

https://dese.mo.gov/

Missouri Department of Social Services, MO HealthNet Division

https://dss.mo.gov/mhd/global/pages/contact.htm

Department of Health and Senior Services – Children and Youth with Special Health Care Needs Program

https://health.mo.gov/living/families/shcn/cyshcn.php

Missouri Department of Insurance, Financial Institutions, and Professional Registration

https://insurance.mo.gov/consumers/autismFAQ/

More Website Resources

Websites American Academy of Pediatrics

https://www.aap.org/en-us/Pages/Default.aspx

Autism Speaks

https://www.autismspeaks.org/

Centers for Disease Control (CDC)

https://www.cdc.gov/features/new-autism- data/index.html

Could my Child Have Autism?

https://dmh.mo.gov/dd/autism/docs/couldmychildhave autism.pdf

Encircle Technologies

twalden@woodhaventeam.org encircletech.org

Help for You and Your Child with Autism

https://dmh.mo.gov/docs/dd/helpforyouandyourchildwi thautism.pdf

Interactive Autism Network (IAN)

https://iancommunity.org/

MPACT

http://www.missouriparentsact.org/about_mpact/

Project ACCESS

https://education.missouristate.edu/access/

UMKC Missouri Family to Family

http://mofamilytofamily.org/

Office of Autism Services Contact Information

Linda Miller, Coordinator linda.miller@dmh.mo.gov 573-522-1727 Katherine Pigg, Project Specialist katherine.pigg@dmh.mo.gov 417-895-6589

Thank you