Systems of Care Regional Regional Systems of Care Center and - PDF document

Systems of Care – – Regional Regional Systems of Care Center and IEP Center and IEP Josh Mandelberg, M.D., Josh Mandelberg, M.D., F.A.A.P. F.A.A.P. Fellow, Developmental- Fellow, Developmental - Behavioral Pediatrics, 2009 Behavioral Pediatrics, 2009 Systems Systems ������������ ������������� ��������������� ����� ������ ��� ������������� 1

Ages Ages 0 0- -3 years old 3 years old - - Regional Center Regional Center 3 3- -5 years old 5 years old – – IEP preschool IEP preschool – Child Find = must evaluate if parents, teacher, – Child Find = must evaluate if parents, teacher, other express concern other express concern 5 5- -22 years old 22 years old – – IEP IEP Regional Center System Regional Center System Developmental Quotient (DQ) Developmental Quotient (DQ) DQ = Developmental Age / Chronological DQ = Developmental Age / Chronological Age Age Areas: cognitive, motor, communication, Areas: cognitive, motor, communication, social, adaptive social, adaptive 2

Regional Center Services Regional Center Services Physical Therapy Physical Therapy Occupational Therapy (including feeding therapy) Occupational Therapy (including feeding therapy) Speech Therapy (after 18 months old) Speech Therapy (after 18 months old) Behavior Therapy (ABA - - applied behavior analysis, applied behavior analysis, Behavior Therapy (ABA discrete trials. Includes educational orientation and discrete trials. Includes educational orientation and parenting course) parenting course) Infant Stimulation (developmental therapist for infant) Infant Stimulation (developmental therapist for infant) Infant Toddler Program (center based Early Infant Toddler Program (center based Early Intervention Program) Intervention Program) Respite Care (child care) – Respite Care (child care) – offered in certain situations offered in certain situations Family Resource Center Family Resource Center Regional Center System Regional Center System Non- Non -profit corporations profit corporations Contracted with Dept of Developmental Contracted with Dept of Developmental Services Services Private agencies, all independent of each other Private agencies, all independent of each other 3 Major Programs 3 Major Programs 1. Prevention of disabilities 1. Prevention of disabilities 2. Early Start Program 2. Early Start Program 3. Lanterman 3. Lanterman Act Act 3

Regional Center System - - Regional Center System Programs Programs 1. Prevention of Disabilities Prevention of Disabilities 1. – Covers persons at risk for parenting a – Covers persons at risk for parenting a developmentally disabled child (i.e. covers developmentally disabled child (i.e. covers genetic tests on uninsured parents) genetic tests on uninsured parents) Regional Center System - - Regional Center System Programs Programs 2. Early Start Program Early Start Program 2. – 0- -36 months old 36 months old – 0 – – Federal Program Federal Program – – Cover kids who meet criteria for: Cover kids who meet criteria for: Established risk Established risk High risk High risk Developmental Delay Developmental Delay 4

Regional Center System – – Early Early Regional Center System Start, Established Risk Start, Established Risk At risk used to include both High and At risk used to include both High and Established Risk Established Risk Established risk includes conditions such as: Established risk includes conditions such as: – Congenital / genetic syndromes (Down, Congenital / genetic syndromes (Down, Prader Prader Willi Willi, , – Williams, Fragile X, Fetal Alcohol syndrome, Williams, Fragile X, Fetal Alcohol syndrome, Tuberous Sclerosis, congenital rubella) Tuberous Sclerosis, congenital rubella) – Extreme prematurity (23 Extreme prematurity (23- -25 weeks EGA) 25 weeks EGA) – – Grade IV IVH Grade IV IVH – – Multiple non – Multiple non- -febrile seizures febrile seizures – Brain malformation ( – Brain malformation (holoprosencephally holoprosencephally, , schizencephaly) ) schizencephaly – Kernicterus – Kernicterus Regional Center System – – Early Early Regional Center System Start, High Risk Start, High Risk High risk includes conditions such as: High risk includes conditions such as: – Prenatal: Developmentally disabled parent, prenatal exposure to Prenatal: Developmentally disabled parent, prenatal exposure to – drug or teratogen teratogen drug or – Neonatal: <32w EGA or <1500g birth weight, Ventilation x48hrs Neonatal: <32w EGA or <1500g birth weight, Ventilation x48hrs – in 1st 28days, SGA (<=3%ile), IUGR, Severe, persistent in 1st 28days, SGA (<=3%ile), IUGR, Severe, persistent metabolic abnormality, Neonatal asphyxia (5min apgar metabolic abnormality, Neonatal asphyxia (5min apgar <6) <6) – Non Non- -febrile seizures in 1st 3yrs of life, CNS infection, lesion or febrile seizures in 1st 3yrs of life, CNS infection, lesion or – abnormality (microcephaly) abnormality (microcephaly) – Biomedical insult (injury, accident, illness) which could Biomedical insult (injury, accident, illness) which could – POSSIBLY permanently affect developmental outcome (UCLA POSSIBLY permanently affect developmental outcome ( UCLA patients) patients ) – Multiple congenital anomalies or genetic – Multiple congenital anomalies or genetic d/o d/o that could that could POSSIBLY affect developmental outcome POSSIBLY affect developmental outcome – – Clinically significant failure to thrive (<3%ile) Clinically significant failure to thrive (<3%ile) – Persistent hypotonia or Persistent hypotonia or hypertonia hypertonia (i.e. risk for CP) (i.e. risk for CP) – – Brain or spinal cord infection (meningitis, encephalitis, etc.) Brain or spinal cord infection (meningitis, encephalitis, etc.) – 5

Regional Center System – – Early Early Regional Center System Start At Risk – – Proposed Changes Proposed Changes Start At Risk High risk - - Instead of Early Start Services will get Instead of Early Start Services will get High risk “ “At Risk Follow At Risk Follow- -Along Program Along Program” ” * * – Case Management – Case Management – Developmental Monitoring (?every 6 months) Developmental Monitoring (?every 6 months) – – Westside & North LA Regional Centers trying to turn – Westside & North LA Regional Centers trying to turn parent education into group therapy (i.e. PT, OT) parent education into group therapy (i.e. PT, OT) – If develop significant delays then get services – If develop significant delays then get services – May only cover up to 24 months – May only cover up to 24 months Established risk Established risk – Condition of known etiology with high probability of Condition of known etiology with high probability of – leading to developmental delays leading to developmental delays – Need medical record documentation – Need medical record documentation – Example Example – – Down syndrome, cleft palate, PVL Down syndrome, cleft palate, PVL – Regional Center System – – Early Early Regional Center System Start – – Proposed Changes Proposed Changes Start Developmental Delay Developmental Delay – Birth – – 24 months 24 months – – 33% delay in one or more 33% delay in one or more – Birth developmental domains developmental domains – 24 – – 35 months* 35 months* – 24 33% delay in 2 or more developmental domains 33% delay in 2 or more developmental domains 50% delay in 1 or more developmental domains 50% delay in 1 or more developmental domains Trying to discourage referral for isolated speech delay Trying to discourage referral for isolated speech delay Patients with insurance coverage may have to Patients with insurance coverage may have to use their covered benefits and show denial use their covered benefits and show denial before getting services* before getting services* 6