PFA Tips: You Finally Received the Autism Waiver: What Should You Expect?

You waited years on the Autism Waiver registry and you’ve just been told your child is receiving the Waiver! Now the questions are swimming around in your head as you wonder what your expectations should be as you begin.

Services Provided: Expectations vs Reality

What services will my child most likely be eligible to receive?
• Intensive Individual Support Services (IISS) – 1:1 goal oriented support in the home and community
• Respite Care (includes approved camps) – 1:1 support provided in home and community-based settings
• Family Consultation – Support provided to the caregiver, based on the family needs, that is provided during direct contact with the caregiver
• Adult Life Planning Services – Available for children 14 and older. The planner provides guidance about the transition to the adult system.
• Environmental Accessibility Adaptations – $5,000 over a 36-month period to improve safety in the home
• Therapeutic Integration Services – 1:3 supervision in an afterschool or weekend program
• Intensive Therapeutic Integration Services – 1:1 supervision in an afterschool or weekend program
• Residential Habilitation Services – group home or alternative living unit placement
*In order to maintain enrollment in the Autism Waiver, at least 5 hours of Waiver Services must be utilized per month.

How are a child’s hours determined for IISS and respite?
Service coordinators will consider the participant’s age, Level of Care assessment, parent feedback, and other services that are currently being accessed in order to determine an appropriate allotment of hours. As the Waiver Plans of Care are individualized, they should accurately reflect the amount of service hours that the participant will be able to handle in addition to their school day and any additional activities.

What should I not expect from Autism Waiver services?
• Onboarding in a flash (due to staffing issues, parent choice, and constant turnover)
o “Onboarding” is the process by which the new direct care worker is socialized into your family, in addition to being oriented to their specific job tasks and associated work expectations.
• An abundance of professionals to choose from (providers work very hard to attract and keep qualified direct support staff)
• Professionals with ABA experience or high levels of autism experience (highly qualified professionals have a wide array of choices including private pay, private insurance, other community-based programs, etc.)
• Backup staff to fill in when staff cancel (many parents do not want a substitute who is unfamiliar with their child and their treatment program)
• Funding for items and services outside of the waiver (e.g. therapeutic riding, summer camps, iPads)
• Staffing or funding for morning and afterschool care

Staff Involved in Your Autism Waiver Services

Who will be providing the services?
Providers are companies that complete an application process to implement the Waiver services, and both MSDE and MDH review the applications to ensure that they meet the designated criteria. There is an average of 45 providers serving Autism Waiver families. Autism Waiver regulations (COMAR) provides guidelines as to the types of individuals who can provide each Waiver service. In addition, providers are required to have a professional on-call at all times and must also assure supervision of direct care workers.

What is Supervision?
Autism Waiver regulations (COMAR) require that program supervisors:
• Train and provide ongoing supervision to IISS workers
• Supervise the IISS workers when crisis intervention services are necessary —evaluate the nature of the crisis and intervene as necessary
• Plan and regularly review the participant’s therapeutic activities and behavior plan
• Meet regularly with participant and family
• Observe participant in the home or community setting
• Develop individualized interventions and identify them on the Plan of Care
• Identify the tasks that the direct care worker is to implement on the Plan of Care

Program supervision must be provided by one of the following:
• Licensed psychologist
• Certified school psychologist
• Certified special/general educator
• Licensed certified social worker
• Licensed professional counselor
• Board-certified behavior analyst
• Licensed occupational therapists
• Licensed speech therapists
• Licensed physical therapists
• Individual with a masters or doctorate degree in special education or a related field and at least 3 years of experience in providing training or consultation in the area of ASD or DD
• Individual with a bachelor’s degree in special education or a related field and at least 5 years of experience in providing training or consultation in the area of ASD or DD

What is Family Consultation?
Family consultation is a separate service from supervision, though the family consultant may also function as the supervisor in some cases. Family consultation can only be billed to the Waiver if the consultant is directly meeting with the parent/caregiver. Families should expect a strong consultant to:
• return calls/emails within 24 hours
• address parents’ concerns
• regularly update parents on the plan’s progress

The family consultant’s role is to provide caregivers with training related to the participants’ needs in the following areas:
• daily life skills
• behavior management
• self-direction
• socialization
• mobility
• money management
• habilitation (e.g., communication, sensory integration)

Family Consultation must be provided by one of the following:
• Licensed psychologist
• Licensed marriage and family therapist
• Certified school psychologist
• Certified special/general educator
• Licensed certified social worker
• Licensed professional counselor
• Board-certified behavior analyst
• Licensed occupational therapists
• Licensed speech therapists
• Licensed physical therapists
• Individual with a masters or doctorate degree in special education or a related field and at least 3 years of experience in providing training or consultation in the area of ASD or DD
• Individual with a bachelor’s degree in special education or a related field and at least 5 years of experience in providing training or consultation in the area of ASD or DD

Who will be working directly with my child?
Direct Care Workers (a.k.a. IISS workers, instructors, therapists, caregivers, support staff) provide direct support to the participant. The qualifications for this entry-level position are:
• Individuals who are 16 years of age and older
• Adequate and appropriate training within 60 days of employment pertaining to care for children with ASD
• Supervised by qualified professional employee
• Approved by parents
• Experience as volunteer or employee with individuals with ASD or DD as a service provider or family member for a minimum of 100 hours

Who will help me manage our Waiver services?
A service coordinator provides the following case management services for Autism Waiver participants:
• Completes Risk Assessment with caregiver within 45 days of confirmation of participant’s enrollment in the Waiver
• Completes at least 4 quarterly visits, one of which must be in the participant’s home. Other visits may take place outside of the home, including school, Therapeutic Integration (TI) or Intensive Therapeutic Integration (ITI) program, or other afterschool program
• Contacts the caregiver on a monthly basis to obtain updates on Waiver services, school, and any other general updates
• Conducts annual reassessment meetings
• Prepares updates to the participant’s Plan of Care – adding and/or deleting services, increasing/decreasing service hours, adding/deleting providers
• Reviews monthly tracking logs for each Waiver participant
• Collaborates with other involved agencies
• Facilitates residential habilitation application process
• Connects families to available resources outside of the Autism Waiver

 

Thank you to the Members of the Autism Waiver Advisory Board Committee for their contributions to this article.

Additional Resources

PFA Tips: You Finally Received the Autism Waiver: Tips for Choosing a Provider

For more information regarding the Autism Waiver, contact the Maryland State Department of Education at 410-767-1446.

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