DRAFT - Crisis Process

Crisis Process Bulletin

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.23.XXX DRAFT

Purpose:

The purpose of this Information Bulletin is to clarify the process for individuals who are believed to be in crisis and need services to resolve their crisis situation.

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 a 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. Homeless - includes but not limited to individuals who do not have a permanent residence or are staying at a shelter; 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.
    2. Abuse - includes harm done to the individual as well as the maladaptive/aggressive/abusive behaviors the individual is displaying towards others which result in the crisis. 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 of the alleged abuser to the individual, whether the abuse has been reported to or investigated by the appropriate authorities such as local police, OIG, IDPH, APS, etc. 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.
    3. Neglect - in determining neglectful situations, 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. 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, etc. and the outcome of the investigation, if one has occurred
      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 overturn clinical eligibility or crisis determinations made by an ISC agency.
  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 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. Either format must include a safety plan.
      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, home-based services and Support Services Team (SST) as needed.
      3. If an individual is in need of more immediate services, DDD may issue a Pre-Award Letter to allow the individual to enter into services immediately.
      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.
    2. Do not meet crisis but are financially and clinically eligible can choose ICF/DD services or choose to be placed on the PUNS list. Individuals can enter an ICF/DD and be on PUNS (to be selected for DD Waiver services). Individuals who are determined to not meet crisis 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
    3. 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

Upon Final Posting