Crisis Process

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.24.003

Purpose:

The purpose of this Information Bulletin is to clarify the process for children and adults who are believed to be in crisis and need entrance into DDD funded waiver services to resolve their crisis situation and (replaces portions of DD.21.005).

Crisis Process
Ensuring safety and providing services to individuals who are in crisis are priorities for the Division of Developmental Disabilities (DDD). Individuals, guardians, if applicable, or families who believe an individual is in crisis should contact their local Independent Service Coordination (ISC) agency for assistance. Referrals can also be made from other entities such as the Office of Inspector General (OIG), Adult Protective Services (APS) and/or the judicial system.

1. In all cases, the ISC agency will review the individual's current circumstance based on the descriptions below.
   1. For individuals who are experiencing or at imminent risk of experiencing:

Homeless
This includes, but not limited to, individuals who do not have a permanent residence or are staying at a shelter; death of a caregiver, individual/caregiver has received an official eviction notice; situations where the authorities, such as the OIG, APS, the Department of Children and Family Services (DCFS) or the Illinois Department of Public Health (IDPH) is currently involved due to abandonment and/or lock out; and loss of home due to the primary caregiver's death or caregiver's admission into a long term care facility (i.e. intermediate care facility for the developmentally disabled, hospice, nursing facility, assisted living, senior living, etc.). The ISC agency will also consider who is supporting or caring for the individual now and what caused the homeless situation described above.

Abuse
This includes harm done to the individual, as well as the maladaptive/aggressive/abusive behaviors demonstrated by the individual applying for services that result in a report to APS or DCSF. Without intervention, the behaviors would likely result in severe injury to someone who resides in the individual's home. The ISC agency will inquire as to the frequency, intensity, duration, and severity of the aggressive behavior(s). The ISC agency will also consider the circumstances surrounding the abuse, the relationship between the alleged abuser to the victim, whether the abuse has been reported to or investigated by the appropriate authorities such as local police, OIG, IDPH, APS, DCFS, etc. The ISCs will consider any non-waiver interventions that might mitigate the potential harm such as community-based behavioral services, respite providers, or private pay supports.

Other considerations include recent changes in the individual's life that may have increased or caused the abusive behaviors, hospitalizations, Emergency Room visits, involvement by medical care, mental health, and/or behavior therapy professionals as related to the current crisis situation. And finally, the ISC agency must assess whether the proposed service will resolve the current crisis situation.

Neglect
In determining neglectful situations, the person or caregiver must be unable to complete tasks necessary for living. For example, securing food or water, taking medications, turning on heat if it is the winter, and ensuring one's safety if being left alone. The ISC agency will consider what the individual cannot do for himself/herself that is causing the crisis situation and/or how the family/caregiver is unable to meet the individual's needs (i.e., ADLs, medical, physical, psychiatric, adequate food, water, heat, electricity, functional bathrooms, and adequate sleep arrangements in the home, etc.). The ISC agency will also look at the adverse outcomes of these unmet needs and recent changes in the individual/family household that are prompting the crisis. Also, ISCs will consider if needs arise from a lack of ability to complete tasks or a lack of desire to complete tasks.

Additional factors to be considered in determining neglect are the availability of others who can meet the identified needs of the individual, services the individual is currently receiving, if the individual has a legal guardian, the type of guardianship and what the guardian is unable to do for the individual. It is also important to determine if the neglect has been reported to the appropriate investigative authorities such as local police, OIG, IDPH, APS, DCFS, etc. and the outcome of the investigation, if one has concluded.

NOTE: As a mandated reporter (definitions found in the Adult Protective Services Act [320 ILCS 20/], Inspector General [20 ILCS 1305/1-17], Abused and Neglected Long Term Care Facility Residents Reporting Act [210 ILCS 30/]), any/all suspected abuse and/or neglect must be reported to the proper investigative authority.

2. After careful consideration of an individual's situation, if the ISC believes the individual meets the crisis criteria, the ISC agency will check to ensure the individual is both financially eligible (Medicaid benefits for medical, cash and SNAP) and clinically eligible (as determined through a Pre-Admission Screening).

Note: DDD reserves the right to make the final determination on clinical eligibility or crisis determinations made by the ISC. There is an appeal process outlined at the end of this information bulletin.

3. Individuals who:
   1. Are in a crisis and found eligible for DD waiver services must be offered the choice of DD Waiver services or an Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD) services. The ISC agency will assist with making referrals to DD Waiver service providers and/or ICF/DD providers. Approved services must have the potential to alleviate the presenting crisis.
      1. For individuals who are in crisis and choose DD Waiver services, the ISC agency must submit the Crisis Transition Plan and Funding Request [IL462-0140] PDF form and upload it to Birdseye or complete the Crisis Request form contained within Birdseye. The form also has a space to explain the safety plan and date it was implemented.
      2. The ISC must ensure a safety plan is in place to keep the individual safe from the crisis situation until services begin working with the individual and the family to offer supports such as respite services, and Support Services Team (SST) as needed.
      3. If an individual chooses Community Integrated Living Arrangement (CILA) waiver services, DDD may issue a Pre-Award Letter.
      4. If DD Waiver services are not identified quickly, an individual can accept non-waiver services such as ICF/DD services on an interim basis. The ISC agency will record the choice of interim services on the Choice of Support Services [IL462-1238] PDF form and continue to work with the individual to identify permanent DD Waiver services.

Note: If the individual is awarded waiver-funded services, they must begin services within 72 hours of DDD producing a funding award notice. After the individual enters DD Waiver services, the ISC agency in the geographic area where the individual will reside will then provide case management or Individual Service and Support Advocacy (ISSA) to the individual. This includes facilitation of the Person-Centered Plan process, monitoring visits, assistance with rights and conflict resolution.

c. Do not meet the crisis criteria and/or are not clinically eligible also have the right to appeal these determinations as outlined in the Notice of Individual's Right to Appeal Medicaid Waiver Determinations form [IL462-1202] PDF.

Effective Date

This Information Bulletin is effective January 29, 2024