Frequently Asked Questions

Below are assembled lists of many frequently asked questions (FAQs) and their answers. FAQs are available on the following topics:

Child and Family Services

Printable FAQ - Intensive Care Coordination

INTENSIVE CARE COORDINATION (ICC)

QUESTION : Our locality already has Utilization Management (UM) staff, so do I have to terminate this staff person and have the Intensive Care Coordinator perform the utilization management duties?

ANSWER : No, as long as the UM function is completed in some way for these cases, it does not matter who performs it. The position description provided with the Intensive Care Coordination Guidelines is one example that localities may use.

QUESTION : Our locality has someone that works out of our CSA office that performs the duties described in the Intensive Care Coordination Guidelines. Can she continue as the Intensive Care Coordinator or will this person need to work at the CSB? We still plan to provide supervision for the ICC at the CSB.

ANSWER : Yes, the person at the CSA office can still provide the service but a contract will have to be worked out with the CSB as they will be responsible for oversight of the position. In order for the service to be considered ICC, the caseload must not exceed 12 at any time.

QUESTION : Does the CSB have the power to make the final determination regarding placement and treatment for the ICC cases?

ANSWER : No, the Intensive Care Coordinator makes recommendations to the FAPT, and then the FAPT decides as a team regarding the services to put in place.

QUESTION : Do the services recommended by the Intensive Care Coordinator have to be provided by the CSB?

ANSWER : No, these services can be provided by any provider the FAPT feels is qualified to perform the services which could be the CSB but could be any other private or public provider. In fact, it is not the intent that the Intensive Care Coordinator provide the services, rather they would assess service needs and locate and arrange for all of the services necessary to assure community tenure for the child.

QUESTION : Is there a deadline for implementation of Intensive Care Coordination?

ANSWER : The Guidelines became effective July 1, 2008 so it is expected that communities begin the implementation process now if they have not done so already. Many communities already provide Intensive Care Coordination. There is no established deadline for completion, as we realize this will be an evolving process, requiring more time in some communities than others.

QUESTION : Is ICC mandated and required to be provided in each community, or is it an option based on local factors?

ANSWER : The guidelines are flexible to allow for the diversity in localities. Due to resource allocation or other considerations, it is not mandated that every local government have their own ICC. However, it is expected that the service will be offered. This could mean that some localities could work together to offer the service. It is expected that every CSB will either provide intensive care coordination or contract with another entity to provide it.

QUESTION : Is there a statewide rate for billing Intensive Care Coordination to CSA?

ANSWER : No. The state does not plan to set one rate for Intensive Care Coordination services. Some communities have already established a rate that works for them. Currently, the Intensive Care Coordination Implementation Workgroup is looking at coming up with some examples of rate methodologies that could be used, or are currently being used. The work of this group is scheduled to be completed December 1, 2008 and information developed by the workgroup, such as examples of rates, will be made available to all communities.

QUESTION : Is Intensive Care Coordination the same as Targeted Case Management that is provided by CSBs and is reimbursable to the CSB by Medicaid?

ANSWER : No, although there may be some overlapping duties. Some major differences between the two roles are that the ICC caseload is small (no more than 12 cases) which allows for a more intensive, thorough, and holistic clinical assessment. Also, the ICC role is time-limited and is for the purpose of transitioning a youth from residential care or preventing a youth from going in to care. The ICC will be involved with ensuring that the family’s needs are being considered in the development of services and will include the creation of services through informal or natural supports. The ICC is also responsible for the development of a 24 hour crisis plan, brokering of services with providers, and may be involved with the CPMT in identifying and forming needed services within the community.

The agency case manager whom is responsible for targeted case management duties may remain involved in the case but to a lesser degree while ICC is being implemented. However, because the functions of the ICC duplicate some of the roles of the targeted case manager, federal law prohibits Medicaid reimbursement of targeted case management that is provided concurrently with ICC. The functions include, assessment, planning, linking to resources, and monitoring. Therefore, Intensive Care Coordination can be billed to Medicaid as targeted case management but never when the CSB is also billing for other targeted case management services at the same time. Once the ICC completes their time-limited service, the targeted case management provider may resume billing Medicaid for targeted case management services.

Questions that come up frequently will continue to be posted to this site. We have been answering individual questions on a regular basis since July 1 and will continue to do so. If you have a question, or just need assistance in getting started with ICC, please contact Pam Fisher, DBHDS, by phone at 804-786-0158 or by e-mail at pamela.fisher@dbhds.virginia.gov.

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INTELLECTUAL DISABILITIES

THE AAIDD DEFINITION

QUESTION : What is the official American Association on Intellectual and Developmental Disabilities (AAIDD) definition of intellectual disability?

ANSWER : Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before the age of 18.

QUESTION : Where can I find the updated AAIDD definition of intellectual disability?

ANSWER : The new 10th edition of Intellectual Disability: Definition, Classification, and Systems of Supports discusses the updated AAIDD definition and classification system in detail. It presents the latest thinking on intellectual disability and proposes tools and strategies to determine if an individual has intellectual disability. Further, the book suggests what supports can be used to optimize functioning of persons with intellectual disability.

QUESTION : What factors must be considered in determining if a person has intellectual disability and consequently, developing a support plan for the individual?

ANSWER : When using the AAIDD definition, classification, and systems of supports, professionals and other team members must:

Evaluate limitations in present functioning within the context of the individual's age, peers, and culture;
Take into account the individual's cultural and linguistic differences as well as communication, sensory, motor, and behavioral factors;
Recognize that limitations often coexist with strengths within an individual;
Describe limitations so that an individualized plan of needed supports can be developed; and
Provide appropriate, personalized supports to improve the functioning of a person with intellectual disability.

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KEY CONCEPTS IN THE AAIDD DEFINITION

QUESTION : What is a disability?

ANSWER : A disability refers to personal limitations that are of substantial disadvantage to the individual when attempting to function in society. A disability should be considered within the context of the individual’s environmental and personal factors, and the need for individualized supports.

QUESTION : What is intelligence?

ANSWER : Intelligence refers to a general mental capability. It involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly, and learn from experience. Although not perfect, intelligence is represented by Intelligent Quotient (IQ) scores obtained from standardized tests given by a trained professional.

With regards to the intellectual criterion for the diagnosis of intellectual disability, intellectual disability is generally thought to be present if an individual has an IQ test score of approximately 70 or below. IQ scores must always be considered in light of the standard error of measurement, appropriateness, and consistency with administration guidelines. Since the standard error of measurement for most IQ tests is approximately 5, the ceiling may go up to 75. This represents a score approximately 2 standard deviations below the mean, considering the standard error of measurement. It is important to remember, however, that an IQ score is only one aspect in determining if a person has intellectual disability. Significant limitations in adaptive behavior skills and evidence that the disability was present before age 18 are two additional elements that are critical in determining if a person has intellectual disability.

QUESTION : What is Adaptive Behavior?

ANSWER : Adaptive behavior represents the conceptual, social, and practical skills that people have learned to be able to function in their everyday lives. Significant limitations in adaptive behavior impact a person's daily life and affect the ability to respond to a particular situation or to the environment.

Limitations in adaptive behavior can be determined by using standardized tests. On these standardized measures, significant limitations in adaptive behavior are operationally defined as performance that is at least 2 standard deviations below the mean of either (a) one of the following three types of adaptive behavior: conceptual, social, or practical, or (b) an overall score on a standardized measure of conceptual, social, and practical skills.

QUESTION : What are some examples of Adaptive Behavior Skills?

ANSWER :

Conceptual Skills
- Receptive and expressive language
- Reading and writing
- Money concepts
- Self-directions
Social Skills
- Interpersonal
- Self-esteem
- Responsibility
- Gullibility (likelihood of being tricked or manipulated)
- Naiveté
- Follows rules
- Obeys laws
- Avoids victimization
Practical Skills
- Personal activities of daily living such as eating, dressing, mobility and toileting. Instrumental activities of daily living such as preparing meals, taking medication, using the telephone, managing money, using transportation, and doing housekeeping activities.
- Occupational skills
- Maintaining a safe environment

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SUPPORTS AND INTELLECTUAL DISABILITY

QUESTION : What are supports?

ANSWER : Supports are resources and individual strategies necessary to promote the development, education, interests, and personal well being of a person with intellectual disability. Supports can be provided by a parent, friend, teacher, psychologist, doctor, or by any appropriate person or agency. the way habilitation and education services are provided to persons with intellectual disability. Rather than mold individuals into pre-existing diagnostic categories and force them into existing models of service, the supports approach evaluates the specific needs of the individual and then suggests strategies and services to optimize individual functioning. The supports approach also recognizes that individual needs and circumstances will change over time.

Supports were an innovative aspect of the 1992 AAIDD manual and they remain critical in the 2002 system. In 2002, they have been dramatically expanded and improved to reflect significant progress over the last decade.

QUESTION : Why are supports important?

ANSWER : Providing individualized supports can improve personal functioning, promote self-determination, and enhance the well being of a person with intellectual disability. Supports also leads to community inclusion of persons with intellectual disabilities. Focusing on supports as the way to improve education, employment, recreation, and living environments is an important part of a person-centered approach to providing care to people with intellectual disability.

QUESTION : How do you determine what supports are needed?

ANSWER : AAIDD recommends that an individual's need for supports be analyzed in at least nine key areas such as human development, teaching and education, home living, community living, employment, health and safety, behavior, social, and protection and advocacy.

QUESTION : What are some examples of support areas and support activities?

ANSWER :

Human Development Activities
- Providing physical development opportunities that include eye-hand coordination, fine motor skills, and gross motor activities
- Providing cognitive development opportunities such as using words and images to represent the world and reasoning logically about concrete events
- Providing social and emotional developmental activities to foster trust, autonomy, and initiative
Teaching and Education Activities
- Interacting with trainers and teachers and fellow trainees and students
- Participating in making decisions on training and educational activities
- Learning and using problem-solving strategies
- Using technology for learning
- Learning and using functional academics (reading signs, counting change, etc.)
- Learning and using self-determination skills
Home Living Activities
- Using the restroom/toilet
- Laundering and taking care of clothes
- Preparing and eating food
- Housekeeping and cleaning
- Dressing
- Bathing and taking care of personal hygiene and grooming needs
- Operating home appliances and technology
- Participating in leisure activities within the home
Community Living Activities
- Using transportation
- Participating in recreation and leisure activities
- Going to visit friends and family
- Shopping and purchasing goods
- Interacting with community members
- Using public buildings and settings
Employment Activities
- Learning and using specific job skills
- Interacting with co-workers
- Interacting with supervisors
- Completing work-related tasks with speed and quality
- Changing job assignments
- Accessing and obtaining crisis intervention and assistance
Health and Safety Activities
- Accessing and obtaining therapy services
- Taking medication
- Avoiding health and safety hazards
- Communicating with health care providers
- Accessing emergency services
- Maintaining a nutritious diet
- Maintaining physical health
- Maintaining mental health/emotional well-being
Behavioral Activities
- Learning specific skills or behaviors
- Learning and making appropriate decisions
- Accessing and obtaining mental health treatments
- Accessing and obtaining substance abuse treatments
- Incorporating personal preferences into daily activities
- Maintaining socially appropriate behavior in public
- Controlling anger and aggression
Social Activities
- Socializing within the family
- Participating in recreation and leisure activities
- Making appropriate sexual decisions
- Socializing outside the family
- Making and keeping friends
- Communicating with others about personal needs
- Engaging in loving and intimate relationships
- Offering assistance and assisting others
Protection and Advocacy Activities
- Advocating for self and others
- Managing money and personal finances
- Protecting self from exploitation
- Exercising legal rights and responsibilities
- Belonging to and participating in self-advocacy/support organizations
- Obtaining legal services
- Using banks and cashing checks

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CAUSES OF INTELLECTUAL DISABILITY

QUESTION : What are the causes of Intellectual Disability?

ANSWER : The causes of intellectual disability can be divided into biomedical, social, behavioral, and educational risk factors that interact during the life of an individual and/or across generations from parent to child. Biomedical factors are related to biologic processes, such as genetic disorders or nutrition. Social factors are related to social and family interaction, such as child stimulation and adult responsiveness. Behavioral factors are related to harmful behaviors, such as maternal substance abuse. Educational factors are related to the availability of family and educational supports that promote mental development and increases in adaptive skills. Also, factors present during one generation can influence the outcomes of the next generation. By understanding inter-generational causes, appropriate supports can be used to prevent and reverse the effects of risk factors.

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INSIDE AAIDD

QUESTION : What is AAIDD?

ANSWER : Founded in 1876, AAIDD is the world's oldest and largest interdisciplinary organization of professionals concerned about intellectual disability and related developmental disabilities. With headquarters in Washington, DC, AAIDD has a constituency of more than 50,000 people and an active core membership of 7,500 in the United States and in 55 other countries. The mission of AAIDD is to promote progressive policies, sound research, effective practices, and universal rights for people with intellectual disabilities.

QUESTION : Has AAIDD always had the same definition of intellectual disability?

ANSWER : No. AAIDD has updated the definition of intellectual disability ten times since 1908, based on new information, changes in clinical practice, or breakthroughs in scientific research. The 10th edition of Intellectual Disability: Definition, Classification, and Systems of Supports contains a comprehensive update to the landmark 1992 definition and provides important new information, tools, and strategies for the field and for anyone concerned about people with intellectual disability.

QUESTION : What is the reaction of AAIDD to the U.S. Supreme Court decision to ban execution of persons with intellectual disability?

ANSWER : AAIDD applauds and fully supports the U.S. Supreme Court decision to stop executing persons with intellectual disability. AAIDD has always advocated against the death penalty and has long served as amicus curiae in Supreme Court cases. In 2001, AAIDD and eight other disability organizations presented an amicus brief to the U.S. Supreme Court advocating against the death penalty in the Atkins case. James W. Ellis, past president of AAIDD, who also argued the case for Atkins says, “The Court has recognized the consensus among the American people, even those who support the death penalty. They are deeply disturbed by the prospect that people with intellectual disability could face execution.”

Visit http://www.aaidd.org/ to learn more about AAIDD.

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