Presentation By Diana Flores APD Luis Tomas Our

Presentation By: Diana Flores, APD & Luis Tomas, Our Kids, Inc. Rick Scott, Governor Barbara Palmer, Director

Intro In October 2004, the Agency for Persons with Disabilities (APD) became an agency separate from the Department of Children and Families, specifically tasked with serving the needs of Floridians with developmental disabilities. Prior to that time, it existed as the Developmental Disabilities Program. The agency is governed by Chapter 20, Chapter 393, and Chapter 916 of the Florida Statutes. Mission: The Agency Supports Persons with Developmental Disabilities in Living, Learning, and Working in their Communities.

Disabilities covered by APD Intellectual Disabilities Evidenced by the concurrent existence of significantly sub average general intellectual functioning by an IQ two or more standard deviations below the mean on an standardized intelligence test. Significant deficits in adaptive functioning in one or more of the following areas: Communication skills Self-care, home living Social and interpersonal skills Manifested prior to age 18 Phelan Mc. Dermid Syndrome Children born with a specific chromosomal abnormality. Although the range and severity of symptom may vary, PMS is generally characterized by low muscle tone, absent to severely delayed speech, moderate to profound intellectual disability, minor malformed or misshapen features, symptoms of autism spectrum disorder, motor delays, and epilepsy.

Disabilities covered by APD Cont…. Autism (severe) A neurological condition that causes severe learning, communication or behavioral disorder. It is pervasive, meaning always present and without interruption. It is a developmental disability with an age of onset during infancy or childhood. Cerebral Palsy A group of disabling symptoms of extended duration that can result from damage to the developing brain during the prenatal period and characterized by paralysis, spasticity, or abnormal control of movement or posture such as poor coordination or lack of balance, which is manifested prior to three years of age. It also means the presence of other significant motor dysfunctions appearing prior to age 18 due to perinatal, anoxia, oxygen deprivation or traumatic brain injury.

Disabilities covered by APD Cont. … Spina Bifida A condition of the spinal column and cord. Occurs when the cord fails to close. It is one of the most common developmental defects of the nervous system. Prader-Willi Syndrome A genetic disorder which is most often associated with a random deletion of chromosome 15. Some of the characteristics include insatiable appetite, chronic overeating, hypotonia, short stature, obesity and behaviors. Down Syndrome A condition caused by the presence of extra chromosomal material on chromosome 21. This disorder is often associated with impairment in cognitive ability, characteristic in physical growth and features, and congenital medical conditions.

Disabilities covered by APD Cont. … High risk of a developmental disability Children between the ages of 3 -5 are in this category with one or more of the following characteristics: A developmental delay in cognition, language, or physical development. A child surviving a catastrophic infectious or traumatic illness known to be associated with developmental delay. A child who has a physical or genetic anomaly associated with a developmental disability. Under this category the child must have a confirmed diagnosis of a developmental disability as defined in Florida Statutes 393. 063 by age five.

Waitlist Categories The APD wait list categories are listed from the highest priority to the lowest. Category 1 is the highest priority. Category 7 is the lowest priority. Category 1 includes clients deemed to be in crisis as described in rules 65 G-1. 046 and 65 G 1. 047. Crisis includes homelessness, danger to self or others and caregiver unable to give care. Documentation required for change: Documentation for this category requires the completion of a crisis application by the regional office. Category 2 includes children who are from the child welfare system with an open case in the Department of Children and Family Services' statewide automated child welfare information system. Documentation required for change: Only documentation from DCF that confirms the child is in the child welfare system will be accepted.

Waitlist Categories Cont…. Category 3 includes clients: Whose caregiver has a documented condition that is expected to render the caregiver unable to provide care within the next 12 months and for whom a caregiver is required but no alternate caregiver is available; Who are at substantial risk of incarceration or court commitment without supports; Documentation required for change: A summary of incidents in which the individual has engaged in dangerous or criminal charges; a summary of incidents in which the individual has engaged in dangerous behavior; a summary of past history of involvement with the court system or law enforcement, any current involvement with the court system or law enforcement; a summary of any past history of multiple arrests, incarceration in jail, prison, or admission to the mentally retarded defendant program. Whose documented behaviors or physical needs place them or their caregiver at risk of serious harm and other supports are not currently available to alleviate the situation; Documentation required for change: A description of the condition or circumstance that renders the caregiver unable to provide care. Documentation must explain the reason the current caregiver can no longer provide the individual’s care. If the condition or circumstance is due to a medical condition, a physician’s statement must be provided. Documentation required for change: Description of the behaviors or physical needs that are causing the risk or potential harm and the medical treatment provided to the individual or to others because of the individual’s behaviors or physical needs; and documentation of the frequency, intensity and duration of behavioral incidents with an explanation of behavioral intervention that have been used to address the behaviors. Who are identified as ready for discharge within the next year from a state mental health hospital or skilled nursing facility and who require a caregiver but for whom no caregiver is available. Documentation required for change: A discharge summary from the facility; a status of available caregivers for the individual and documentation that there are no other available resources or services other than waiver services to meet the individual’s needs.

Waitlist Categories Cont…. Category 4 includes clients whose caregivers are 70 years of age or older, and for whom a caregiver is required but no alternate caregiver is available, willing or able to provide support, and other government or community resources are not available to provide assistance for the caregiver. Documentation required for change: Date of birth of the primary caregiver must be provided as well as documentation that the individual needs a caregiver and no other caregiver is available. Information regarding the health of the caregiver and availability of other caregivers must be included. Acceptable proofs of date of birth include, but are not limited to, birth certificates and state-issued identifications. Category 5 includes clients who are expected to graduate within the next 12 months from secondary school and need support to obtain or maintain competitive employment, or to pursue an accredited program of postsecondary education to which they have been accepted. Documentation required for change: School documentation of the individual’s graduation date and documentation there are no other resources other than waiver funded services to provide the individual with support to obtain or maintain a job or pursue post-secondary education.

Waitlist Categories Cont…. Category 6 includes clients 21 years of age or older who do not meet the criteria for category 1, category 2, category 3, category 4, or category 5. Documentation required for change: Individual’s date of birth and that no other category criteria apply. Acceptable proofs of date of birth include, but are not limited to, birth certificates and state-issued identifications. Category 7 includes clients younger than 21 years of age who do not meet the criteria for category 1, category 2, category 3, or category 4. Documentation required for change: Individual’s date of birth and that no other category criteria apply. Acceptable proofs of date of birth include, but are not limited to, birth certificates and state-issued identifications.

CBC Intake Community Based Care (CBC) cases are where abuse (physical/sexual), exploitation, neglect, and abandonment are reported and Department of Children & Family (DCF) get involved and investigate. Structure: DCF Our Kids Inc. CBC Contacted Agencies APD Our Kids of Miami-Dade and Monroe, Inc. communicate client statuses to APD via quarterly scheduled calls , APD check in every 6 months, daily emails). If child is identified with a Developmental Disability, DCF/Our Kids/CBC Agencies or court makes referral directly to Lakeview Center. Lakeview is the APD Court Liaison Office that handles all Juvenile/Delinquency Cases (minors), Criminal Cases (adults) & Dependency Cases (CBC). Lakeview Center: 1330 Coral Way Miami, FL 33145; Office: 305 -860 -6042.

Intake Cont. . Once Lakeview receives referral Lakeview set up intake appointment. Lakeview staffs the case with APD eligibility committee to determine eligibility for services. 30 Ineligible FWD days for doctors to give back evaluations. Cases to APD office to complete process of application = APD prepares Due Process Letter. Applicant has option of appealing decision by requesting administrative hearing with APD HR Liaison. Eligible FWD Cases to APD office to complete process of application = APD prepares Due Process Letter. Transfers to GR Unit = GR processes case and assigns to worker.

Wavier Enrollment Reunification, Permanent Guardianship, & Adoption Our Kids contact advises APD Waitlist worker that child is achieving permanency through reunification, permanent guardianship or adoption two months before case closes. Thus the process of enrollment into Waiver starts: APD sends enrollment to Tallahassee All CBC cases have correct Medicaid for waiver. Permanency Options Reunification- the child is reunified with the parent removed from upon completion of case plan tasks and court approval. Permanent Guardianship- the child is left in the full custody or a relative or non-relative and the case is closed by the courts. Adoption- the parents rights are terminated by the courts (TPR) and the child is placed with an adoptive family. APPLA: Another Planned Permanent Living Arrangement Goal given to children that no other permanency option was available and will be turning 18 while in foster care. Contact between Our Kids and APD occurs to avoid this population from being homeless. This is coordinated with APD at the age of 17. APD prepares Crisis Tool as child ages out of foster care and ready for waive reenrollment.

List of General Services Our Kids for children 18+ Extended Foster Care Stipend Housing assistance (rent; utility setup, room and board) Educational services (DCF tuition waiver enrollment) Case management services Nurse case management services APD Adult Dental Behavior Analysis Behavior Assistant Life Skills Development 1 Companion Life Skills Development 2 – Supported Employment Life Skills Development 3 – Adult Day Training Therapies: Dietician, Occupational, Speech, Physical, Respiratory, Specialized Mental Health Counseling Nursing Residential Habilitation Respite Special Medical Home Care In-Home Subsidies Family Care Recreation Assessments and Medical Evaluations Environmental Accessibility Adaptations Support Planning Durable Medical Equipment Psychological Evaluations Consumable Medical Supplies Interpreter Services Personal Supports Parent Training Supported Living Coaching Competency Training Support Coordination Transportation Personal Emergency Response Systems

Contracted agencies that work with Our Kids and Lakeview for referral of client to APD Agencies for case management services Wesley House family Services (WHFS) for Monroe County Children’s Home Society (CHS) for Miami-Dade County (South) Family Resource Center (FRC) for Miami-Dad County (Central) Center for Family and Child Enrichment (CFCE) for Miami-Dad (North)

In Home care- the term used when there is court involvement with the family but remain living with the parent(s) due to low danger risk factors. Out of Home care- the term used when children are removed from their parents or caregivers due to abuse or neglect. 2 options Non-licensed care- relative or nonrelative placement Licensed care- foster home, group home, shelter, institutional placement (mental health facility, hospital, and prison)

APD Group Home (GH) Design Most of APD GH are designed for adults (18+ years old) A few Children GH, however, not ideal. Types of Group homes ICF – medically needy (18+ years old) Behavior focused (18+ years old) Standard (18+ years old) Few child GH (17 - years old) Capacity 95% of APD GH are designed to hold 6 beds. VS Large GH hold between 7 -15 beds.

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