Intensive In-Home Services
October 12, 2016
Intensive In-Home Services (IIH) for children with autism are available through the New Jersey Department of Children and Families’ Children’s System of Care (CSOC). They are designed to assist children and their families when intensive behavioral intervention is needed in the home.
When Would a Child Qualify for Intensive In-Home Services?
A child with autism may be eligible for services if it is determined that they meet the clinical criteria for IIH. Broadly, these criteria are one or more of the following:
- When behaviors may threatens the health or safety of the child or others; when the behavior is having a significant impact on the child’s ability to participate in daily activities
- When behavior may be a barrier to the child remaining in the least restrictive setting or prevents the child from participating in family and community life
- When the child lacks developmentally appropriate adaptive, social or functional skills
What Kinds of In-Home Services does CSOC Provide?
There are three categories of Intensive In-Home Supports:
- Clinical and Therapeutic services are intended to be rehabilitative, and to restore a child to a level of functioning after an acute episode or a decline in functioning related to a mental health diagnosis. Services are usually completed within 12 months and range from 1-4 hours a week. Treatment typically consists of cognitive and behavioral strategies and other psychotherapeutic approaches.
- Behavioral services utilize Applied Behavior Analysis (ABA) as the intervention and are designed to decrease dangerous or maladaptive behavior and/or help develop or improve self-help, communication and adaptive skills. Services are related to address behaviors resulting from a developmental disability, are typically provided for 12 – 18 months duration and range from 10-17 hours per week (plus 3 hours of supervision by BCBA or BCaBA).
- Individual Support Services assist individuals with developmental disabilities with adaptive behavior and skill development. Activities of daily living are addressed. Services range from 2 to 12 months and are provided up to 10 hours a week, utilizing positive behavior supports and an instructional approach.
Behavioral or ABA services are the most intensive and long term. Because they are not intended to replace ABA services that would be offered in a school setting, the clinical criteria have a higher threshold and are designed to ensure that children with moderate-to-high need for intervention are able to access the services.
What are the Steps to Becoming Eligible for IIH
Before a child can be provided IIH services, they must have been determined eligible for developmental disability services through the CSOC. To apply for eligibility, families can call PerformCare (the single access point into CSOC) at 877.652.7624, download the application from the website, or fill out the application on the web-based portal.
In addition, a child must be eligible for Care Management Organization (CMO) services by meeting the clinical criteria for moderate or high need. CMOs are partners within the Children’s System of Care and operate at the county level to assist children and families in need of behavioral and other supports.
If a child is experiencing any of the behaviors described above, and the family believes they may meet the clinical criteria for services, they will need their CMO to initiate a referral for an assessment. The CMO will conduct an initial assessment of the strengths and needs of the child and family and develop an Individual Support Plan (ISP). For a child who may meet the clinical criteria for IIH Behavioral Services, the CMO will request a Functional Behavior Assessment (FBA) and an initial Behavior Support Plan (BSP).
When a Child is Approved to Receive Behavioral Services, How Much Therapy Will They Receive?
It depends on the child’s assessed level of need, which would be categorized as either moderate or high level. Examples of behavior that demonstrate a moderate level of need and have potential for self-harm are:
- Noncompliance to verbal/written directions
- Property destruction
Examples of behavior that demonstrate a high level of need and that are likely to result in harm to self or others include:
- Sexual aggression
For children with moderate needs, families can expect to receive 10 to 12 hours per week, while children with high needs receive 15-17 hours per week. Generally, services are authorized for a 90-day period, after which the CMO can request additional services.
What if a Child is Determined Ineligible for IIH Behavioral Services?
Because eligibility is dependent on a child having a moderate to high level of need, not all children who can benefit from ABA will meet the clinical criteria established by the Children’s System of Care. In addition, families need to exhaust other resources before a child can receive services, including benefits through private health coverage (some, but not all plans include ABA as a covered service).
Currently, ABA services through CSOC are funded through a Medicaid Waiver (commonly referred to as the ASD Pilot) and funding is limited. Therefore, criteria for eligibility may be higher than medical necessity criteria for private insurance. Although the federal EPSDT (Early Periodic Screening Diagnosis and Treatment) benefit under Medicaid allows some treatment for autism to be covered (for example, speech therapy), the state Medicaid program (NJ FamilyCare) does not currently include ABA as a covered benefit. Autism New Jersey continues to advocate for ABA to be a covered benefit under NJ FamilyCare and made available to all children with autism for whom ABA has been determined medically necessary.
School is another resource for children who require ABA in order to benefit from their educational program. Families can advocate on their child’s behalf for him/her to receive ABA services in school, and if needed, in a home program as well. Home programs can help children generalize skills across environments, and in some cases, to prevent regression of skills.