Supplemental One-to-One Support Services Funding Guidelines

Supplemental 1:1 support services are designed for individual circumstances in which the service may be temporarily required to address specific and documented behaviors and or adjustment issues. Supplemental 1:1 support services may be provided in the residential facility or day program. The intervention must be time limited and specific to those behaviors that are jeopardizing the client's placement, or are presenting a danger to the health and safety of the client or others. In purchasing such services, it is expected that all other resources, programming, and types of intervention have been fully explored and utilized prior to a request for 1:1 support services. Day program or other services specifically designed to serve clients on an ongoing 1:1 staff to client ratio are not intended to be included as a part of this policy.

Supplemental 1:1 services are time limited and will be authorized for a period not longer than three months.

Supplemental 1:1 services may be purchased when ALL of the following criteria are met:

• (1a) The client presents significant and serious behavioral challenges which jeopardize placement in the most appropriate and least restrictive environment. Examples of such behaviors include severe self-abuse, aggression, property destruction, maladaptive sexual acting out, and AWOL.
  
• (1b) The provider has submitted a behavioral plan specifically describing and documenting the type, severity, and frequency of the target behaviors, as well as identifying why the current program design and intervention has been unsuccessful. Additionally, this plan must specify the intervention being considered, including but not limited to, the duration, number of hours requested, and the purpose and role of the 1:1 support services in implementing the plan. This plan must be measurable and also include a process to fade out the 1:1 services. The expected outcome must be clearly identified and the means by which to measure progress toward the outcome delineated.
  
  In situations where there is an immediate danger to the health and safety of the client, emergency 1:1 support services can be considered on a provisional short term basis pending the receipt of the behavioral plan. Generally, emergency 1:1 support services will be authorized for a period of up to two weeks.
  
• (1c) The ID team, including the regional center contracted psychologist, has reviewed and approved the behavioral plan and recommends 1:1 services with a specified number of hours on a time limited basis appropriate to the circumstances. The following items will be considered when determining the number of hours and duration of service to be provided:

  The staffing level of the current facility or program design.
  
  The hours spent in school or day program, and/or on home visits (for 1:1 support services in residential placement).
  
  The behavioral plan as delineated in section 1b.
  
  The cost effectiveness of 1:1 services in the current environment as compared with a more restrictive environment without the 1:1 services.

Re-authorization/extension of 1:1 services may be considered for up to a three month period if the proper conditions are met. If 1:1 services continue to be provided for an extended period of time without any significant progress, the current residential or day program environment will need to be re-evaluated for its appropriateness and an alternative environment may be considered. The following are the conditions that need to be met for re-authorization of 1:1 services:

• (2a) Progress reports have been submitted monthly, with the latest report also indicating the need of the extension of services, the amount of hours and duration requested.
  
• (2b) The ID Team, including the regional center contracted psychologist, has reviewed the consumer's situation, the justification for the extension of service (including progress reports) to determine if:

  1. The 1:1 is still needed,
  
  2. The 1:1 is more appropriate than moving the individual to a more restrictive setting, and
  
  3. The service is producing expected outcomes consistent with the IPP.

• (2c) There is no other appropriate program identified which can deliver similar services without the utilization of 1:1 services.

ADOPTED BY BOARD OF DIRECTORS: FEBRUARY, 1998