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Page 1: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Adults with Autism

Janet George Assistant Commissioner

Policy, Planning January 9, 2016

Page 2: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Introduction and Objectives

Background of Autism Omnibus Bill-

Goals:

Basic Demographics

Eligibility Process

Services

Questions

Page 3: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Introduction

The Autism Omnibus Legislation was signed into law in

August 2014.

The legislation required DDS to develop and

implement revised eligibility processes and criteria for

an expanded population of people with Autism and

Prader-Willi without Intellectual Disability and for

Smith Magenis Syndrome. The review process for

eligibility began in November 2014.

Revised regulations were required. They are currently

in regulatory review process.

Page 4: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

2014 Autism Omnibus Bill

Highlights

Autism Commission Report 2013 created structure for bill in 2014

Establishes Autism Commission as permanent body within EOHHS -

Changes eligibility criteria for DDS ****

Creates tax-free savings account (ABLE)

Creates Autism endorsement for special education teachers

Requires DDS and DMH to develop and implement plan for mental illness and developmental disabilities –including respite, family support, and care coordination ****

Requires MassHealth to cover medically necessary treatments for children under 21 years of age – including ABA ****

Page 5: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

DDS Adult Eligibility only served those with ID

Massachusetts was one of the few states that

was an ID state, not a DD state

Stakeholders and DDS saw that individuals with

ASD were falling through the cracks

Why The New Law?

Page 6: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Requirements for Eligibility for ASD

Be domiciled in Massachusetts

2. Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM

3. Provide the Department with an evaluation for ASD completed by a qualified physician or psychologist, that includes standardized instruments.

4. When not provided a diagnostic assessment by qualified physician or psychologist detailing reasons

Page 7: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Adult Eligibility requirements

Have substantial functional impairments in

three or more areas of the seven major life

areas 1. Self-care ( ADLS)

2. Expressive Communication

3. Receptive Communication

4. Learning

5. Mobility

6. Capacity for Self-direction

7. Economic Self- Sufficiency

Page 8: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Requirements cont.

Adaptive Measures required

Additional information may be needed

Provide documentation and information that demonstrates ASD manifested prior to age 22

Provide documentation that demonstrates that the developmental disability is likely to continue indefinitely

Provide personal, clinical, psychological medical, and educational records that diagnosis was through psychiatric and psychological assessments

Provide reports of previous adaptive measures

Although IQ is not determinative factor helps delineate strengths and weaknesses

Page 9: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

What is a reliable diagnosis of ASD

for adults? Full psychological evaluation as a child

with differential dx and use of ASD scales,

from a qualified practitioner.

Evaluation by a hospital based

developmental clinic

Well documented history of ASD

symptoms from multiple reliable sources:

(pediatrician, school, therapists,

psychosocial history)

Page 10: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Demographics

Currently there are 454 individuals, aged 18 or older, who have been

found eligible under the new regulations. 205 are over 22 and 245

are between 18 and 21 years old.

Of those 205 individuals, 101 individuals are receiving a total

of 224 DDS services

Of the total service enrollments, 18% of the services are being

provided through Participant Directed or Agency with Choice;

while the remaining individuals are enrolled in traditional

Purchase of Service

There are @104 individuals with Autism age 22+ who DDS

staff continue to work with and who have service enrollments

pending at this time

Page 11: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Autism Eligible Adults Between

18-21 Years Old

245 individuals are between the ages of 18-21.

While the eligibility for adult services occurs at age 22, there are

circumstances where individuals aged 18-21 may be receiving

services, such as employment and/or day services and Family Support

Services.

Individuals no longer in school as well as those determined to need

the service prior to 22 may be enrolled.

79 of these individuals are enrolled in a combination of 104 services.

Page 12: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Supports Intensity Scale

Life Activity Subscales: Support is a combination of type, frequency and daily support time. Home Living Activities

Community

Life Long Learning

Employment

Health and Safety

Social

Each item is phrased: If the individual were to engage in this activity over the next few months, what type of support would he or she need to be successful?

Protection and Advocacy

Exceptional Medical and Exceptional Behavioral

Page 13: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

How Does the SIS Measure

Success? Comparable to the typical adults without

disability

Individual + Supports = Success

Page 14: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Service Array

DDS provides:

Service Coordination

Variety of Employment Supports and Activities During

the Day

Variety of Family Supports for Individuals Residing in

the Family Home

Variety of Individual Types of Supports

Variety of Goods and Services

Limited array of housing supports for individuals with

severe challenges

Exploring new service options based on needs

Page 15: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Infrastructure

In order to implement the legislative requirements, DDS needed to

strengthen its infrastructure.

Additional staff were added to the Regional Intake and Eligibility Teams.

An Autism Service Coordinator was added to each Area Office.

Regional Program Coordinator Positions were added.

Regional Contract Specialist Positions were added.

A Data Management System was developed that tracks eligible individuals

on a monthly basis, as well as individuals served and individuals in planning.

A Fiscal Monitoring System was put in place to monitor the $12.6 million

appropriation with additional work underway to track expenditures by

service category.

Page 16: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Collaboration with DMH

Establish joint DDS and DMH training, eligibility determination,

and service development

Collaborate with other state agencies, insurance payers,

stakeholders, & families for needed comprehensive services

Encourage Autism Centers of Excellence for access to skilled

care for co-occurring behavioral health needs

Develop family supports including respite & care coordination

DDS and DMH have entered into an Interagency Service

Agreement to collaborate in the development and funding of

supports and services for individuals who are eligible for service

in both systems.

Page 17: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

DDS/DMH ISA

Key highlights:

Collaboration at all levels

Commitment to work together

Better understanding of perspectives

Dual eligibility

Decision making process for case management assignment

Forensic Capacity

Psychiatric Consultation

Psychiatric Fellowships

Co-Central Office Leadership Team

Engagement of Joint Community Providers

Demonstrations/Pilots for New Service Models

Page 18: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Collaboration with DMH (continued)

DDS and DMH are learning the similarities and differences between the respective

agencies through regular local, regional and central office networking

Agencies commit to joint trainings, service design and implementation and mutual

consultation.

Joint Provider Meeting occurred in November 2014

DDS will purchase and support additional clinical resources from DMH including:

Two psychiatric fellowships ( Mass General and UMass)

Short term psychiatric consultation

Forensic Risk Consultation

Development of Joint Training Agenda

Page 19: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Training Plan

To expand the knowledge based at DDS, DMH and the provider community, a variety of training opportunities as occurred.

a series of three trainings for the new autism service coordinators, staff from DMH and providers from ADDP were provided. These trainings were provided by prominent external experts and paid for by the SEIU.

There has been joint training with DMH regarding each agency’s eligibility determination and service delivery systems.

There has been a joint DMH/DDS provider meeting

DDS has participated in a workgroup established by the Association of Developmental Disabilities Program to examine current services, promote new supports and provide training opportunities.

Page 20: Adults with Autism€¦ · Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Questions??

Suggestions ??

Contact: [email protected]


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