Regional Center Services

1. Regional Center Services Brian Capra Public Counsel (213) 385-2977, ext. 249 bcapra@publiccounsel.org Lisa Winebarger Alliance for Children’s Rights (213) 368-6010, ext. 126 l.winebarger@kids-alliance.org CASA Volunteers Presentation – July 13, 2017

2. What are Regional Centers?

3. LA County Regional Centers

4. What Programs Does the Regional Center Administer?

5. What is Early Start?

6. Why is Early Start So Important for Kids in the Dependency System?

7. Who Qualifies for Early Start Services?

8. How to Identify Developmental Delays

9. Early Start Referral Process

10. Early Start Referral Timeline

11. Education Rights Holders (ERH) & Developmental Services Decision-makers (DSDM)

12. What Is an Individualized Family Service Plan (IFSP)?

13. What does an IFSP include ?

14. IFSP Services

15. The Lanterman Act • Establishes the Regional Center system. • Gives individuals with developmental disabilities the right to specialized services and supports that will allow them to live a more normal, independent and productive life. • Consumers have the right to decide what kinds of supports they want and need. They have the right to make choices about their own lives.

16. What Is a Developmental Disability? • Intellectual Disability (formerly Mental Retardation), • Autism, • Cerebral Palsy, • Epilepsy, or • The “Fifth Category” • A disabling condition found similar to mental retardation or • requires treatment similar to that required for persons with mental retardation Which…

17. What Is a Developmental Disability? (continued) • Is expected to continue indefinitely, • Originates before age of 18, and • Constitutes a “substantial disability.” • Does not include conditions which are “solely” physical, learning disabling, or psychiatric in nature.

18. Substantial Disability Significant functional limitations in three or more of the following areas: • Self-Care, • Receptive and Expressive Language, • Learning, • Mobility, • Self-Direction, • Capacity for Independent Living, and • Economic Self-Sufficiency.

19. Application Process • Contact the appropriate regional center (RC). • RC will need consentfrom parent or developmental services decision-maker • Get minute order or JV-535 if needed • Regional center determines if assessments are needed with 15 working days. • Regional center conducts assessments. • Under Lanterman Act: RC generally has 120 days to complete assessments BUT • 60 days if 120 day timeline could cause significant further delay in development, risk to health & safety, or result in a more restrictive placement.

20. Individual Program Plan (IPP) • Contract between consumer and the RC must list all of the services and supports needed to be purchased or secured by the RC. • Must be held within 60 days of establishing eligibility. • Held every 3 years, but IPP reviews are done annually. Can request an IPP meeting at any timeand must be held within 30 days. • Must be a person-centered plan (consider the needs & preferences of the consumer/family, effectiveness, cost-effectiveness) • Must be done in the native language of the consumer and family. • RCs must provide translated copy of plan into threshold language w/in 45 days of request. • RC must track & report to DDS the number of instances translated IPP was requested in non-threshold language if not provided within 60 days of request.

21. Emergency and crisis intervention Infant stimulation programs and other early intervention programs Respite (in-home or out-of-home) for caregivers Social skills training Specialized medical and dental care Transportation services necessary to ensure delivery of services Independent Living Skills Services Examples of Regional Center Services for Children & Youth through the IPP • Behavior training and behavior modification programs • Special training for parents • Adaptive equipment such as wheelchairs, hospital beds, etc. • Community integration services • Advocacy assistance • Counseling • Day Programs • Work Services Programs

22. Restrictions on Certain Services • Respite Limits – but not for long!!! • Non-Medical Therapies, Social Recreational Services & Camping Suspended • No “Experimental Treatments” • Behavior Intervention Requirements • Required use of Medi-Cal/Private Insurance • Transportation Requirements • Requirement to Access Certain Services through School for Youth 18-21

23. Is there a Charge for Regional Center Services? • 24-hour out of home care for minors – WIC 4782 • Day care – WIC 4685 (c)(6) • Diapers – WIC 4685 (c)(7) • Family Cost Participation Program (FCPP): Share of cost for day care, respite, & camping for children between ages 0 and 17. Medi-Cal children exempt – WIC 4783 • Annual Family Program Fee: Depending on income and household size, $150 or $200 fee. Medi-Cal children exempt. FCPP interplay. – WIC 4785 • Any other co-payment scheme violates the Lanterman Act - Clemente v. Amundson, 60 Cal.App.4th 1094 (1998)

24. What are Purchase of Service Guidelines? • Help determine the types and amounts of services regional centers will fund • Explain requirements for receiving services • Vary from regional center to regional center • DDS must approve POS policies – WIC § 4434(d) • POS policies cannot violate the Lanterman Act entitlement to necessary services and supports Williams v. Macomber, 226 Cal.App.3d 225 (1990) • POS are now required to be posted online, along with other key RC information, under WIC § 4629.5

25. What is a Generic Agency? • Any agency receiving public funds with legal responsibility to serve all members of the general public - 17 CCR § 54302(a)(31). • RC is the “payor of last resort”—but, RC is also the generic Targeted Case Management provider’ • RC must “gap-fund” IPP services if necessary to implement the IPP • Behavioral Health Treatment Services • New Early Start law effective 1/1/18

26. Fair And Equal Access • Los Angeles Times article, 12/13/11: • http://www.latimes.com/news/local/autism/la-me-autism-day-two-html,0,3900437.htmlstory • Senate Select Committee on Autism & Related Disorders, Equity Hearing, 4/30/12: • http://autism.senate.ca.gov/informationalhearings • Senate Human Services Oversight Hearing, 3/14/17: • http://shum.senate.ca.gov/content/hearings

27. Cultural and Linguistic Competency • AB 1472 (2012): Enacted WIC 4519.5 (disparities data collection) • SB 555 (2013): RCs must communicate w/ family in native language during planning process; family can request translated copy of plan. • SB 1093 (2014): Requires greater transparency/accountability and data reporting by RCs to ensure more effective participation by diverse communities with developmental disabilities; ILS change. • SB 82 (2015): RCs must provide translated copy of plan into threshold language w/in 45 days of request. • RC must track/report number of instances translated IPP was requested in non-threshold language if not provided within 60 days of request. • Stakeholder data review & report to Legislature in 2016-2017. • Contracts with RCs must now measure progress in reducing disparities and improving equity in purchase of services expenditures. • AB 1610 (Ridley-Thomas, Current Legislative Proposal – died • But - MCO Tax Revenue, Budget & AB 959 (Holden) still active

28. Public Counsel Disparity Report • http://www.publiccounsel.org/home#panel-2 • 8 of the 11 RCs with higher-than average percentages of Hispanic and Black/African-American consumers had lower-than-average per capita authorizations. • DDS’ current method of allocating funding among the RCs perpetuates funding disparities. • The data is not being compiled and reported in a uniform manner and many of the RCs’ data reports are incomplete, inaccurate, and inaccessible to the public.

29. Public Counsel Disparity Report • Significant disparities across RCs for minority children. (e.g., for Spanish–speaking children living in their homes ages 3-21 in 2015-2016, highest per capita authorizations were at Redwood Coast Regional Center ($16,801), while lowest per capita authorizations were at Central Valley Regional Center, ($2,690). • Significant disparities between children of different ethnicities and languages within individual RCs. (e.g., at North Bay Regional Center in Fiscal Year 2015-2016, Black/African American children 0-2 living at home had per capita authorizations of $4,165; White children 0-2 living at home had $7,999 in per capita authorizations.

30. AB 1089 (2014): RC Transition Procedures for Foster Children • Transfers of court-involved children between RCs • Once RC is notified of child’s move to another RC catchment area by child welfare agency or attorney, the sending RC must get services in place in new location within 30 days of notification • The sending RC must report to the court if services not in place within 30 days, and continue to report every 30 days until all services are secured • Case management transfers from sending RC to receiving RC after services are secured

31. SB 1048 (2012): Joinder • Authorizes the court, at any time after a petition has been filed, to: • Join in a juvenile court proceeding any agency that the court determines has failed to meet a legal obligation to provide services to a child who is the subject of a dependency proceeding, a minor who is the subject of a delinquency proceeding, a nonminor person over whom the juvenile court has retained dependency or delinquency jurisdiction, or a nonminor dependent, as defined. • Definition of “Agency” • Any governmental agency or any private service provider or individual that receives federal, state, or local governmental funding or reimbursement for providing services.

32. Common misconception that Non-Minor Dependents (NMDs) receiving Regional Center services or SSI are NOT eligible for extended foster care (EFC) after age 18. • They are! EFC intended to be as inclusive as possible. • Statutory guidance: • WIC 11403(b) Participation Criteria #5 for eligibility: medical exception (state policy specifies RC & SSI). • WIC 303: NMD who is incapable of making an informed agreement does not need to sign the mutual agreement. • WIC 13754: NMD right to receive SSI and be their own rep payee, if appropriate. • Los Angeles County MOU between DCFS & RCs Remaining In Foster Care

33. Emerging Issues Involving Youth with Disabilities In Extended Foster Care • Capacity Issues • Supported Decisionmaking vs. Conservatorships • Placement Issues • Resources: e.g., SCI Rates, ILP, RC, Special Ed., Dept. of Rehab., SSI, DAC, CAPI, IHSS, CCS, Katie A., etc. • Ethics

34. I.T. v. Los Angeles County, et al.Highlights of Settlement • 2010 Settlement: Our investigation showed that youth with DD are often in danger in juvenile hall and are detained 6 to18 months longer than others because of the lack of available community placements. WHO? • Youth with or suspected of having a DD • Btw May 2012-June 2014, there were 270 unique youth • Approx. 30-50 youth at any given time in Juvenile Hall) • Approx. 50-75 youth at any given time in Juvenile Field or Placement

35. I.T. v. Los Angeles County, et al.Highlights of Settlement (continued) WHAT? • L.A. County Department of Probation Directives No. 1379 and 1382: set policy and expectations for Detention, Field, and Placement staff for all probationers with an identified DD or suspected of having a DD. WHERE/WHEN? • Minors under Probation’s jurisdiction (e.g. detained in juvenile hall, in suitable placement, or in home of parent or relative). WHY? • To ensure that youth with or suspected of having DD have adequate care, protection from harm, and reasonable modifications to their treatment under federal and state law.

36. I.T. v. Los Angeles County, et al.Highlights of Settlement (continued) HOW? • While detained: • Identification/screening; referral to regional center (if not yet a client) • Providing information to caregivers re: RCs and appeals process • Referral for special education services (if not yet participating) • Monitoring by Developmentally Disabled Minors Coordinator (DDMC) • Special Housing; Integrated Habilitative Treatment Plan (IHTP); Social, Recreational, Pre-Vocational/Vocational Skills; Discharge Planning • In Suitable Placement and Field: • Monitoring by Developmentally Disabled Placement Coordinator (DDPC)or Developmentally Disabled Field Services Coordinator (DDFSC), • Referral to RC (if not yet a client); request IPP meeting for current consumers; provide info to caregivers; attend IHTP meetings; review and implement Discharge Plan, provide Transitioning services.

37. Resolving Disputes With the Regional Center • Options include: • Filing for Fair Hearing • Claimant can participate in an Informal Meeting with the RC first to try to resolve • Parties may also participate in Mediation to try to resolve • Filing a Complaint • 4731 Complaints & Early Start Complaints

38. Important Timelines • RC has 15 calendar days to decide to whether to include a service in the IPP after the request has been made. • If the RC decides to deny, it has 5 working days to send a NOA advising the consumer of its decision. • The regional center must give you notice at least 30 days beforeit changes the services in your IPP. • Unless change is necessary to protect health and safety—in which case, NOA must be sent no later than 10 days afterthe change was made.

39. What can you do if the regional center denies eligibility or services? • Right to the Fair Hearing process, but the request must be made within 30 calendar days of receiving the Notice of Action (NOA). • “Aid Paid Pending” • For reduction or cancellation of services, you must appeal within 10 calendar days of receiving the NOA for services to continue during the appeal. • The right to Aid Paid Pending is automatic in Early Start.

40. What is the Dual Agency Rate? • Enhanced rate for a dual agency child (certain children in foster care, KinGAP, or adoptive placement who are also eligible for regional center services). • Children with “inactive” RC cases are still eligible – ACL 16-54

41. Dual Agency Rate • Dual Agency children under 3 in Early Start receive $1,041 – COLA effective 7/1/17 will raise • Dual Agency children under 3 with a developmental disability receive $2,328 - COLA effective 7/1/17 will raise • Dual Agency children over 3 w/o extraordinary needs receive $2,328 - COLA effective 7/1/17 will raise • Dual agency children over 3 may also be eligible for a Supplement to the Dual Agency Rate

42. Supplement to the Dual Agency Rate • Supplement of up to $1000 for Dual Agency children over age 3 w/ extraordinary needs • Available in increments of $250, $500, $750, or $1,000 • Available if there is there is a severe deficit in self-care, severe impairment in physical coordination or mobility, a severe medical condition, and/or severely disruptive or self-injurious behavior • Based on severity of condition and combination of multiple conditions

43. How to Request the Supplement • Caregiver can make a verbal and/or written request to the social worker • Referral can also be made by regional center • Social worker can and should identify children on their caseload who may qualify for the supplement • The county has an ongoing duty to inform caregivers of the Dual Agency Rate andSupplement and how to request the Supplement • CASA can request the Supplement on behalf of the family. Make sure to request any applicable retroactive payments of the Supplement in your request.

44. County Process to Determine Eligibility for Dual Agency Rate & Supplement • DCFS has 90 days from the date of the request or referral from regional center. • Info & verification from RC preferred not essential – ACL 17-67 • The caregiver must be informed through a Notice of Action if Supplement is denied or dissatisfied with the amount of the Supplement if approved. Must file for Fair Hearing within 90 days of the Notice of Action. • DCFS policy on Dual Agency Rates: • http://file.lacounty.gov/dcfs/cms1_172272.pdf

45. DCFS Regional Center Support • RC Contact, Services, Case Management, Referral, Consent, Eligibility, etc. • Payment Issues • Dual Agency/Supplement • Special Payment/Placement and SSI • Placement Assistance • Transition Age Planning • RC Case Transfers • Send an E-Mail to: • regionalcentersupport@dcfs.lacounty.gov

46. DISABILITY RIGHTS CALIFORNIA 350 South Bixel Street, Suite 290 Los Angeles, CA 90017 Ph: (213) 213 - 8000 Fax: (213) 213 - 8001 OFFICE OF CLIENTS’ RIGHTS ADVOCACY East LA Regional Center – Jackie Dai and Lucy Garcia: (626) 576-4437 Harbor Regional Center – Marsha Johnson and Cynthia Salomon: (562) 623-9911 Lanterman Regional Center – Hannah Liddell and Ada Hamer: (213) 213-8180 North LA County Regional Center – Bebo Saab San Gab/Pomona Regional Center - Aimee Delgado South Central Los Angeles Regional Center – PerlaMuizar and Carlos Mora (323) 292-9907 Westside Regional Center – Debra Marcia and Luisa Delgadillo: (310) 846-4949 Advocacy Resources

47. Advocacy Resources (continued) • For dependency- & delinquency-linked children (including out of home or adoptive) ages 0-21 years: Public Counsel at (213) 385-2977. • For dependency-linked children, including out of home, ages 0-3 (Early Start cases): The Alliance for Children’s Rights at (213) 368-6010. • State Council on Developmental Disabilities, Los Angeles Office (formerly Area Board 10), (818) 543-4631

48. Thank you! Brian Capra Public Counsel (213) 385-2977 bcapra@publiccounsel.org Lisa Winebarger Alliance for Children’s Rights (213) 368-6010, ext. 126 l.winebarger@kids-alliance.org