After 18 and Young Adults with Disabilities

1. After 18 and Young Adults with Disabilities Paul Gibson, LCSW Bay Area Academy

2. Course Objectives • To increase understanding of young adults with disabilities and their transition to adulthood • To improve skills in working with young adults with disabilities • To review the impact of AB 12 on young adults with disabilities and their transition service needs • To review extended care placement options for young adults with disabilities • To increase understanding of program and service resources for young adults with disabilities • To review transition planning and permanent housing options for young adults with disabilities

3. Disabilities Defined • The definition of a person with a disability according to the Americans with Disabilities (ADA) includes the following: • Person with a physical and/or mental impairments • Person with a history of such impairments or perceived as having such impairments even if they do not • The impairments substantially limit major life activities • Physical impairment includes conditions such as orthopedic, visual, speech and vision, hearing, cerebral palsy, epilepsy, , cancer and heart disease • Mental impairments include mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities • Major life activities include walking, seeing, hearing, speaking, breathing learning, and working • An estimated 30-47% of all foster youth in out of home care have disabilities

4. Individuals with Disabilities Education Act (IDEA)Types of Disabilities A disability is an impairment that interferes with the child’s ability to learn over time. IDEA identifies 12 disabilities that qualify for special education.

5. The Prevalence of Primary DisabilitiesCalifornia Special Education 136,776 Youth and Young Adults Ages 16-22 12/1/11 • 53.6% Learning Disabilities • 10.5% Mental Impairment • 9.9% Other Health Impairment (Includes ADHD) • 7.5% Autism • 7.3% Emotional Disturbance • 3.2% Speech or Language Impairment • 2.2% Orthopedic Impairment • 1.8 % Hard of Hearing or Deaf • 1.2% Multiple Disabilities • 0.7% Visual Impairment or Deaf-Blindness • 0.5% Traumatic Brain Injury

6. Youth with Disabilities in Child Welfare • Are at risk for birth conditions including premature birth, Fetal Alcohol Syndrome, and positive toxicity for substances that increase their risk of disabilities • Are at risk for maltreatment in early childhood that results in developmental delays and disabilities • Are more likely to be abused or neglected by their birth families and in subsequent placements • Are more likely to develop disabilities if they are abused or neglected and be relinquished to the foster care system • Are more likely to experience placement instability and be placed in more restrictive environments • Have lower rates of achieving permanency including family reunification and waiting longer for adoption

7. Disability Categories Developmental Physical and Medical Mental Health or Emotional Learning

8. Developmental Disabilities • Developmental disabilities include mental disabilities, autism, developmental delays, and speech and communication disabilities • 21% of older youth in special education have developmental disabilities • More than half of children entering foster care have developmental disabilities or delays compared to 10% of the population • Only 50% of foster youth with developmental delays are diagnosed before they began school • 60-65% of mental retardation is caused by prenatal damage (alcohol use and infections), pregnancy damage (fetal malnutrition), and environmental influences (deprivation) • 25% of all developmental disabilities are believed to be caused by abuse and neglect

9. Physical and Medical Disabilities • Physical and medical disabilities include hearing orthopedic, visual impairment/blindness, hearing impairment/deafness, deaf-blindness, traumatic brain injury, and other health impairments • Other health impairments include ADHD, cancer, cerebral palsy, diabetes, epilepsy, heart disease, and muscular dystrophy • 16% of older youth in special education have physical or medical disabilities • 8% of foster youth have some type of physical impairment compared to 1-2% of the general youth population • Up to 80% of foster youth have at least one chronic medical condition and 25% have had three or more health problems • Youth with ADHD often have other disabilities including learning disabilities, depression, anxiety and substance use issues

10. Mental Health and Emotional Disabilities • Youth with mental health and emotional disabilities have a mental health diagnosis (mood disorders, PTSD, anxiety disorders, behavior disorders, schizophrenia) or emotional disturbance (special education) • 80% of youth in foster care have received mental health services and more than 50% of foster youth are given psychotropic medications • 54% of foster youth have mental health problems as young adults including PTSD (25%), Major Depression (20%), and Social Phobia (17%) • Youth in foster care are 3 times more likely to have an Emotional Disturbance disability than other youth • 70% of juvenile justice youth have a mental health or substance use disability and 47% have an emotional disability • Youth with emotional disturbance have poorer outcomes than youth with other disabilities and 52% have been involved with the criminal justice system

11. Learning Disabilities • Learning disabilities include impairments in listening, mathematics, reading, and oral and written comprehension • 54% of all older youth in special education have a learning disability • In one study, 20% of youth in foster care had learning disabilities compared to 12% of all youth • 40% of juvenile justice youth have a learning disability and 50% of youth with learning disabilities have been involved with the criminal justice system • 50% of youth with learning disabilities have basic cognitive deficits including reading signs, counting change and telling time • Young adults with learning disabilities often hide their disability and try to compete in education and employment without assistance or accommodations

12. Understanding Young Adults with Disabilities Many Foster Youth and Young Adults with Disabilities • Are often embarrassed by having a disability and have issues with low self esteem • Do not understand what their disability is or know how to advocate for themselves • Have poor social skills that negatively impacts their ability to reach their goals • Have fewer permanency connections and challenging relationships with their families • Have poorer educational outcomes than other youth in special education and less work experience than other foster youth • Are not connected with appropriate disability resources and have not received adequate support in developing their transition plans

13. Disability Service Systems For Young Adults with Disabilities • Special Education • The Regional Centers • Mental Health and Family Support • Social Security Administration (SSI) • California Children’s Center • California Department of Rehabilitation • Centers for Independent Living

14. Special Education Rights for Young Adults • Young adults can remain in special education until age 22 and are responsible for making their own education decisions • Young adults can still be assessed for special education if they have a disability and special needs that have previously been identified • Special education continues to provide them with Individualized Education Program and Individualized Transition Program services • Young adults in special education remain eligible for mental health support services through their school under AB 114 • AB 167 allows them to graduate under state rather than local school requirements if they change high schools in the junior or senior year • Young adults will need a recent IEP to qualify for college special education services through Disabled Students Programs and Services

15. Individual Education Programs (IEP) Eligibility Determination Present Levels of Performance Annual Goals and Objectives Services Needed Supports and Modifications Placement Options and Decisions Transition Services Graduation Plan

16. Section 504 Plans • 504 plans are not part of education but offer youth with disabilities accommodations in receiving their education • Eligible students must have a physical or mental impairment • An estimated 10-15% of foster youth meet criteria for 504 plans • Youth should be assessed for both special education and a 504 plan • The process involves an initial referral, education team meeting, and developing a plan • 504 plans includes student information and disability, background information, goals and objectives, and academic accommodations • 504 plan do not have timelines and as many safeguards and support services as an IEP

17. Individual Transition Plans Individual Transition Plans (ITP) must include the following areas • Post Secondary Education / Vocational Training • Community Experiences • Employment Development • Post High School Adult Living • Acquisition of Daily Living Skills Schools are required to provide the services in the plan or arrange where services can be provided Reviews of Individual Transition Plans are conducted annually

18. Foster Youth in Special Education • Had lower grade point averages and lower testing scores • Changes schools more frequently and more instability in placement • Had fewer credits towards graduation • Were more likely to be in segregated special education classes Foster Youth Transition Plans • Only 31% of plans had post secondary education goals and only 16% of plans had goals for independent living skills • 20% of had no goals listed and 32% of plans had no action steps • Family members, foster parents, and educational surrogates were only present 42% of the time at IEP meetings • Caseworkers only attend 31% of IEP meetings • The student was solely responsible for their goals 22% of the time

19. AB 3632 Becomes AB 114 • AB 114 eliminated all regulations related to AB 3632 and transferred responsibility for education related mental health services from county mental health to local education authorities • $420 million was allocated to education in the 2011-12 school year to provide education related mental health services • Mental health services must be agreed upon in the student’s Individualized Educational Program (IEP) as necessary • Mental health services provided through EPSDT (individual therapy, family therapy, and wraparound services) are included • Residential care is one of the related services for children with disabilities that must be provided at no cost to the parents • The prescription and monitoring of psychotropic medications is considered a medical service that may not be covered in AB 114

20. College and University Disability Services • Available at all California Community Colleges and Universities • Disabled Students Programs and Services (DSPS) are in all community colleges and provide support services, specialized instruction, and educational accommodations • A Student Educational Contract (SEC) is developed with each DSPS student to link goals with curriculum and needed accommodations • Services to Students with Disabilities and Disability Student Programs areavailable at State Universities • The specific disability must be verified for both programs with an education limitation that requires specialized services • Disability Services include test taking assistance, counseling, interpreter services, note taking, reader and speech services, transportation and parking, job development/placement, assistive technology, registration help and specialized instruction

21. California Regional Centers Eligibility • Provide services and support for individuals who have a substantial developmental disability that begins prior to age 18 • Eligible disabilities include mental retardation, cerebral palsy, epilepsy, autism, and conditions related to mental retardation Services • An Individual Program Plan (IPP) is developed with eligible clients • Services include assessment and diagnosis, counseling and case management, service coordination, employment support, supported services, independent living, planning and placement in out of home care, service coordination, and advocacy

22. California Regional Centers Process for Obtaining Services • Eligible youth under age 18 are assigned a case manager who meets who develops the Individual Program Plan (IPP) • Case manager coordinates services and Regional Center must purchase or secure all services in the IPP • RC can not pay for services that are the responsibility of family or other providers including transition services in special education Placement for Young Adult Clients • RC and juvenile court have agreement to provide eligible youth with foster care options through Foster Family Agencies (FFA) • RC must secure services and FFA provides supervision of home and ongoing support with social worker or probation officer

23. Mental Health and Family Support Early Periodic Screening Diagnosis and Testing (EPSDT) • Individual, group and family therapy; day programs, crisis counseling, case management for young adults with Medi-Cal Therapeutic Behavioral Services (TBS) • Behavioral interventions, communications skills, and community functioning support for young adults at risk for or in high level care Transition Age Youth Programs (TAY) • County mental health programs for ages 16-25 with serious disabilities providing therapy, medications, and case management Wraparound Services • Team approach in helping young adults develop transition support, permanent connections, and social and independent living skills

24. SSI (Supplemental Security Income) • Provides monthly cash aid, Medicaid, and help with housing and education to persons with qualifying disabilities • An estimated 15-20% of special needs youth meet the criteria • Important safety net for young adults with disabilities Eligibility Criteria • Little or no income, few or no resources, citizen or qualified non-citizen, qualifying disability • Child/Youth Disability Standard. Marked or severe functional limitation expected to last at least 12 months • Adult Disability Standard. Inability to engage in gainful work expected to last at least 12 months • Continuation Disability Review. The SSA begins a CDR on (or around) the youth’s 18th birthday to determine if the youth meets the adult standard

25. SSI (Supplemental Security Income) • The Benefits Continuation Rule allows youth not meeting the adult standard to continue with benefits in limited circumstances • The payee for SSI benefits can be the young adult, legal guardian or caregiver, or the county as a last resort • Young adults are eligible to receive SSP (State Supplemental Payment) for Non-Medical Out of Home Care in daily living • Young adults receiving SSI may also receive AFDC-FC foster care with offsetting rules regarding total income allowed Benefits for Young Adults Higher Cash Assistance Rate Medicaid Ticket to Work Plan to Achieve Self Sufficiency Student Earned Income Exclusion Access to Permanent Housing

26. California Children’s Services CCS provides comprehensive medical services to youth with severe physical disabilities under age 21 who meet medical eligibility. Eligibility Requirements • Medi-Cal, Healthy Families or low income • Eligible medical conditions Services Provided • Diagnosis and treatment • Medical case management • Medical Therapy Program Process for Obtaining Services • Referral requirements • Navigating medical systems

27. California Department of Rehabilitation The Department of Rehabilitation helps persons with disabilities develop employment and maximize their ability to live independently. Eligibility Criteria • Disability that impedes work • Significant disabilities prioritized Services and Programs • Vocational planning and assessment • Job counseling and support • Independent living skills support Young Adult Services • Transitional Partnership Program • College support services

28. California Independent Living Centers (ILC) • ILCs are non-profit organizations run by persons with disabilities • Persons with disabilities can receive help with daily living issues and learn skills they need to take initiative and control of their life • ALL ILCs provide six core services • Housing Assistance • Information and Referrals • Peer Counseling and Support • Personal Assistant Services • Independent Living Skills Training • Individual and Systems Change Advocacy • Centers may also provide benefits counseling, work readiness training, legal aid, and assistive technology services

29. The Impact of AB 12/212On Young Adults with Disabilities Extended care provides young adults with disabilities with housing and additional time to Complete their high school diploma or GED Strengthen family and permanency support Develop work readiness skills and gain work experience Complete the SSI process and receive benefits Participate in post secondary education and vocational training Connect with adult disability resources Develop long term housing

30. Engaging Young Adults with Disabilities • Extended care is a collaborative process that involves a change in your role from authority figure to support person • Recognize and respect their adult status in making decisions about education, health, mental health, and disability services • Include young adults with disabilities in developing their Transition Independent Living Plans and a road map to their future • Provide young adults with disability information and resources • Use a strengths based that emphasizes positive traits and assets • Reframe disabilities in terms of differences and opportunities that reduces stigma and promotes self acceptance • Provide a supportive environment to address their special needs, develop life skills, and experience positive outcomes

31. Case Manager Responsibilities • Understand the disability of foster youth under your care and disability resources available to meet their needs • Meet with youth six months prior to age 18 to discuss benefits of Extended Foster Care and appropriate placement options • Complete SOC 161 and 162 with the youth (Certification and Mutual Agreement for Extended Care)*Note: 602 Exception • Complete updated Transition Independent Plan and Agreements with young adults that reflects goals related to their disabilities • Coordinate TILP with disability providers including Special Education, Regional Centers, California Children’s Services, etc. • Ensure their placement meets their service and disability needs

32. Young Adult Responsibilities • Learn about my disability and advocate for appropriate services to maximize opportunities for a successful transition to adulthood • Keep my SW or PO informed about my disability and service needs to develop the goals in my TILP • Work on completing the goals of my TILP and my participation conditions for remaining in extended care • Comply with the terms of Shared Living Agreements in placements • Inform my SW/PO of any placement problems and work to find solutions • Notify my SW/PO within 24 hours if move to a new placement

33. Transition Independent Living Plansfor Young Adults with Disabilities • The purpose of the TILP is to help young adults with disabilities to develop permanency and increasing their independence • The TILP is developed with the young adult and the placement to identify activities, responsible parties, and timelines for each goal • There is a risk of setting lower expectations for young adults with disabilities in developing participation goals (i.e. Condition 5) • It is important for the TILP to include participation goals for education, employment, and independent living skills • The TILP should include at least one goal to develop permanency connections with committed and caring adults • The TILP should also include goals to connect young adults with adult disability service providers

34. Transition Independent Living Plansfor Young Adults with Disabilities Permanency Goal. Develop permanency connections with adults. • Identify family members and adults who can provide permanency support. • Meet with permanency options and address issues related to obtaining support and their special needs. Condition 1 Goal. Graduate from high school. • Meet with Special Education to coordinate transition and graduation plans. • Contact Foster Youth Services to learn of resources and supports for young adults completing high school. Condition 2 Goal. Explore post secondary education / vocational options. • Connect with Disabled Student Program Services at potential colleges. • Research local college Career and Technical Education programs.

35. Transition Independent Living Plansfor Young Adults with Disabilities Condition 3 Goal. Prepare young adult for employment. • Learn about their disability and how to advocate for accommodations. • Participate in ILP work readiness classes. Condition 4 Goal. Obtain part time employment. • Apply for supported employment opportunities for foster youth with disabilities (Workability, WIA Youth Programs) • Connect with Department of Rehabilitation and apply for program services. Condition 5 Goal. Medical and mental health services necessity. • Participate in ongoing medical care as needed for health condition. • Participate in mental health treatment services. • Initiate or continue application for SSI.

36. Developing aTransition Independent Living Plan for Young Adults with Disabilities

37. Youth With DisabilitiesTransition Service Needs • Case Management • Education Support • Mental Health Services • Physical Health Services • Family and Permanency Connections • Employment and Vocational Training • Independent Living Skills • Advocacy

38. Case Management Support • Young adults with disabilities in extended care need additional case management to address their needs and coordinate services • The following programs provide case management services • All Disabilities. Independent Living Programs, Transitional Housing Programs, Foster Family Agencies, College Disability Services • Developmental Disabilities. Regional Centers, Department of Rehabilitation • Physical and Medical Disabilities. California Children’s Center, EPSDT medical providers, Department of Rehabilitation • Mental Health Disabilities. EPSDT mental health providers, Transition Age Youth programs, Therapeutic Behavioral Services • Learning Disabilities. ILP, Transitional Housing Programs, Foster Family Agencies, College Disability Services (counseling)

39. High School Completion • Special needs young adults in special education may remain in high school up to age 22 to obtain their diploma • Foster youth can use state graduation requirements if they transfer between school districts or high schools during the 11th or 12 grade • Special Education Departments are required to have an Individual Transition Plan (ITP) for all youth with IEPs after age 16 • It is important for SW and PO to coordinate the youth’s TILP with the school’s ITP to ensure that youth with disabilities obtain needed services • Foster Youth Services can work with youth with disabilities to provide additional support including tutoring and education advocacy • Young adults can also complete their GED (General Education Development) in adult education classes if high school graduation is not a viable option

40. Post Secondary Education Support • Young adults with disabilities should be encouraged to explore community colleges, universities, vocational training, and career and technical education • College resource programs include the California Chafee Grant Program, Foster Youth Success Initiative (FYSI), Extended Opportunity Programs and Services (EOPS), and Guardian and Renaissance Scholars • They need assistance in completing college and financial aid applications, college enrollment and orientation, course planning, and payment of fees • Disabled Students Programs and Services (DSPS) provides support services, specialized instruction, and educational accommodations to Community College students with disabilities • DSPS develops a Student Educational Contract (SEC) with each student to link their goals, curriculum, and academic accommodation to their disability • Services to Students with Disabilities are available at each of the California State Universities providing support services and accommodations

41. Mental Health TreatmentYoung Adults with Mental Health Disabilities • Make their own decisions about mental health services and the court can not order them to take psychotropic medications • Have service needs related to current diagnoses, unresolved trauma, behavioral issues, and alcohol and substance use • Should have mental health services included in their TILP, Needs and Services Plan, and Shared Living Agreement • Need to be educated about their diagnosis, service needs, and treatment and learn how to advocate for services • Can access EPSDT and TBS mental health services with Medi-Cal until age 21 and Transition Age Youth programs ages 16-25 through County Mental Health Agencies with severe disabilities

42. Medical Services • Young adults with physical disabilities need a home that meets their medical needs and accesses medical equipment and assistive technologies • It is important to identify who is going to coordinate services for them and provide them with care • Special rates are available for In Home Supportive Services and to care for young adults with Special Health Care Needs • There needs to be assessment and monitoring of youth with medical disabilities living with relatives to ensure their needs are getting met • California Children’s Center and EPSDT medical care provides case management for some young adults with medical physical disabilities • The Department of Rehabilitation helps young adults with physical disabilities to access employment services and college • Young adults with physical disabilities are often eligible for SSI and have ADA protections with regards to housing

43. Health Care Program in Foster Care • HCPFC is part of county child welfare agencies • It provides public health nurse expertise in meeting medical, dental, mental health and developmental needs of children in foster care including young adults in extended care • Public health nurses consult with the foster care team to promote access to preventative and specialty health services Youth with Special Health Care Needs • Includes youth up to age 23 who have a medical condition that can rapidly deteriorate or needs home health care and is a court dependent or regional center client • Young adults can remain in foster care after age 18 by agreement of young adult, foster parent, SW or PO, and guardian with monitoring by regional center

44. Family and Permanency Connections • Special needs young adults often have fewer permanency options • Help young adults with disabilities strengthen relationships with family members and adult allies that may have been disrupted • Relationship connections can be difficult for them if social skills are impacted including initiating contact and showing reciprocity • Advocate for families to understand the disability of their child and include them in their lives • Help young adults with disabilities understand, accept and manage their relationships with their family • Wraparound Services provide intensive, individual, and strengths based support in bringing together family and important adults in their lives to assist in developing permanency connections

45. Employment and Vocational Training • Half of former foster youth are unemployed and young adults with disabilities have less work experience than other foster youth • Work readiness training and employment experience helps to build a positive sense of self and improve transition outcomes • Social workers, probation officers, and placements need to prioritize work experience and vocational training for special needs young adults • Employment and education are not mutually exclusive goals and can both be part of TILPS and transition planning • Employment programs for special needs young adults include WIA (Workforce Investment Act) Youth Programs, Workability (Special Education ), Employment Development Department (EDD) Youth Services, Job Corp, California Conservation Corp (CCC), Department of Rehabilitation, and Ticket to Work (SSI)

46. Independent Living Skills • Increasing independence and self sufficiency is an important goal for young adults with disabilities in extended care • Placements and case managers can support young adults in learning daily living skills, self care, transportation, problem solving, social skills, budgeting and financial management skills • Independent Living Programs offer comprehensive services including case management, access to housing, employment counseling, life skills workshops, post secondary education support, and transportation • Young adults with disabilities underutilize ILP and they should be encouraged to participate in their program • Independent Living Centers are run by persons with disabilities and help them with daily living issues and taking control of their own lives • ILC core services include housing referrals, information, peer counseling, personal assistance service, independent living training, and advocacy

47. Advocacy and Support • Special needs young adults need education about their disability and to develop advocacy skills for obtaining adult disability services • Young adults with disabilities need adult advocates in their lives as well as peers and adults to support them in advocating for themselves • Case managers will spend more time advocating for services for young adults with disabilities than other foster youth Advocacy Resources Youth Transition Toolkit Court Appointed Special Advocates Youth Organizing Disabled & Proud Youth Leadership Forum Disability Rights California Disability Rights Legal Center The Alliance for Children’s Rights Disability Rights California Disability Rights Education and Defense Fund Disability Benefits 101 Support for Families of Children with Disabilities Disability. Org

48. Placements for YoungAdults with Disabilities Group Homes Transitional Housing Programs Transitional Housing Program Plus Foster Care Family and Foster Home Options Supervised Independent Living Plans Postsecondary Education Housing Transitional Housing Program Plus

49. Young with Disabilities Out of Home Placements 1,694 or 18% of youth and young adults ages 16-18 living in out of home care had been in special education as of 7/1/12 29% lived in group homes 23% lived in Foster Family Agency homes 21% lived in kinship placements 12% lived with guardians 10% lived in foster homes

50. Case Manager Responsibilities with Placements • Complete appropriate placement agreement for young adults (SOC 152, SOC 153, SOC 154 B, SOC 156 A, SOC 157 A) for each new placement after age 18 • Provide the placement with background , disability information and service needs , and the TILP for the young adult • Support the placement in developing a Shared Living Agreement with the young adult that reflects their transition and disability needs • Monitor the progress of the young adult and ensure the placement is meeting their service and disability needs in achieving their goals • Assist the placement in identifying and developing permanency connections for special needs young adults • Include the placement in transition planning with the young adult and assist the placement in connecting them with adult disability and community resources