Service Coordination

Customer Value: Coordination of Services. Allservices and supports necessary for anindividual to achieve his or her desiredoutcomes are provided in a manner that isperson-centered, integrated and coordinatedwith one another.

Service coordination consists of a unique set of services and supports assigned to regional centers by the Lanterman Act. It is the cornerstone service provided by the regional center. It is the universal service received by every client and is central to ensuring that the service system meets every client’s needs.

The Lanterman Regional Center employs over 90 professionals who help plan and coordinate services for 6,000 children and adults living at home, in the community, and in developmental centers. These service coordination activities occur in face-to-face meetings as well as via periodic telephone communications. Service coordinators (SCs) work with clients and families on the development of person-centered plans, called Individual Program Plans, or IPPs. SCs also conduct annual reviews of these plans, and for clients living in licensed residential homes or supported living they conduct quarterly face-to- face reviews at the home. In 2003, SCs will conduct approximately 1,700 IPPs, 3,500 annual reviews, and almost 3,000 additional quarterly face-to-face visits to clients’ homes.

As part of each annual review, the SC also completes an annual health status evaluation, intended to ensure that the client is receiving the recommended medical, mental health, and dental care, and an annual assessment of client adaptive behavior (the Client Development and Evaluation Record, or CDER). SCs whose clients live in a licensed residential home also participate with staff of the Center’s Community Services Department in monitoring the quality of services in those settings.

For our Early Start clients (age birth-to-three), SCs coordinate development of an Individual and Family Service Plan (IFSP) every year and review that plan after six months. In 2003, they will complete almost 800 IFSPs and approximately the same number of six-month reviews. Early Start SCs also provide outreach and case finding through activities such as
participation in monthly discharge planning meetings at six neonatal intensive care units serving the Lanterman area. Early Start SCs have been very successful in helping toddlers gain entry to typical (integrated) preschools. In 2002, nearly 120 of our children were accepted into community-based preschools. Finally, Early Start SCs work with families to ease the transition of these children into the public schools at age three.

SCs are the primary contact linking clients and families with services and supports needed to implement Individual Program Plans. They must ensure cooperation and collaboration across agencies and service providers in the interest of clients. This linkage may be to public and community resources such as the schools, the Department of Rehabilitation, and Social Security, or it may be to Regional Center authorized service providers. When necessary, SCs facilitate the purchase of services by the Regional Center from community service providers. On average over 800 new funding authorizations or changes to existing authorizations are processed each week, totalling over 40,000 in a year, and valued at $62.9 million. SCs monitor the service relationships to ensure that they are effective in helping clients achieve their desired outcomes, and they promptly intervene when problems or questions arise. These responsibilities require SCs to maintain intensive communications, both verbal and written, with agencies, direct service providers, clients, and their families. The SC is also the primary keeper of information about the client. They receive, review, act on, file and send hundreds of pieces of information on each client in a year. On average, each SC has a caseload of about 62 clients. At Lanterman, service coordinators do virtually all of their own secretarial activities themselves.

Emergency response. The Regional Center provides services during regular working hours and also responds to urgent situations and emergencies after hours and on weekends. Clients and families can contact an on-call staff manager 24 hours a day, 7 days a week through the Center’s emergency line.

Special Incidents. Service coordinators, in coordination with staff of the Center’s departments of Community Services and
Clinical Services, have the primary responsibility for investigating Special Incidents. Special Incidents are occurrences that potentially threaten the health and welfare of clients. They include things such as unexpected hospitalizations, physical injury, lost or missing clients, and suspected abuse. The aim of a Special Incident investigation is to intervene and resolve a problem, to determine whether the occurrence was preventable, and if it was, to develop strategies or interventions to prevent a recurrence. In 2002, Lanterman staff members investigated and resolved 1,192 special incidents. Many of
these investigations required the service coordinator to intervene on behalf of the client with a community agency such as a hospital, the Department of Children and Family Services, the Department of Mental Health, a law enforcement agency or court, Adult Protective Services, or the county’s Public Guardian Office. The Center’s Risk Mitigation Committee
monitors Special Incidents at the aggregate level to determine if there are any systemic issues warranting action by the Regional Center — for example, implementation of training initiatives, changes to policies or procedures, or the
development of new services and supports.

Targeted Case Management (TCM) Program. As a condition of the state obtaining federal financial participation in the funding of regional centers, service coordinators are required to document all of their direct service activities in the interdisciplinary (ID) notes of their clients’ records. The federal government has imposed strict requirements on this documentation — for example, services must be described precisely and in a by the regional center to bill the Department of Developmental Services (DDS) on a monthly basis. DDS, in turn, bills the federal government for these services. The TCM program brings approximately $100 million in federal funding into the state each year.