Transition Planning for Youth with
Disabilities from the Child Welfare
and Juvenile Justice Systems
Jenny Pokempner
Juvenile Law Center
Goals of Today’s Webinar
Review laws and rules regulating provision of
treatment, services, and transition planning for youth in
the child welfare (CW) and juvenile justice (JJ) systems.
 Review strategies for improving treatment, services, and
planning for youth with disabilities while they are in the
system.
 Review action steps for ensuring a proper transition to
adult serving systems and services.
 Show how to use Juvenile Law Center tools.

Youth in Care have Many and Multiple
Health and Behavioral Health Care Needs
Of youth who enter the child welfare system:
 Almost 90% have some health problem or need
 55% have two or more chronic health care conditions
 Almost 25% have three or more chronic health care
conditions
 30-60% have developmental delays
 50-80% have mental and behavioral health problems
 30-40% are receiving special education services
Youth with Disabilities in Foster Care Have
Poorer Outcomes than their Non-Disabled Peers
They are:
 More likely to be maltreated while in the system
 More likely to have placement instability
 More likely to be institutionalized
 Lower rates of achievement of permanency and longer
stays in care.
 Poorer educational achievement
Barriers Faced to Successful
Transitions
Lack of appropriate placement settings and services in
the community as youth progress through the CW and
JJ systems.
 Lack of appropriate services for the transition-age
population.
 Lack of understanding of the adult-serving system.
 Lack of clarity about who is responsible for arranging
services and supports.

Good News: We Actually Have Some Good Laws
and Court Rules in Place
Currently we have federal and state laws that require that:
 Health care needs are met through MA and monitored by the
CW and JJ systems and courts
 Youth are in the least restrictive placement and treatment
setting (CW and ADA requirement)
 Services and treatment that meet the child’s needs can be
ordered by the court and provided by the child welfare agency
 An appropriate transition plan be created that includes health
care needs and insurance coverage before the case can be
closed.
Using Current Law
Many services, treatments, and placements that we want
for our clients to flourish can be supported by using
our current laws, regulations and court rules.
 For youth to benefit from these provisions, requesting
court orders, putting on hearings, appealing and
litigating issues may be necessary.

Relevant Laws: Monitoring of
Health and Disabilities Needs

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Federal child welfare law (Fostering Connections) requires that
states have a plan for the ongoing oversight and coordination of
health care services for any child in foster care placement,
including how needs will be met and continuity of care will be
provided following transition. 42 U.S.C.A. §622 (b)(15)(A).
Federal and state child welfare law requires monitoring health and
well-being related to case planning and court reviews. 42 U.S.C.A. §
675 (1) (C) & § 675 (5)(D).
Federal law requirement to update health and educational records in the case
file and providing youth who age out a copy of their records at no charge. 42
U.S.C.A. § 675 (5)(D).
Laws Related to Provision of
Services
Independent Living Services should be provided to
youth beginning at age 16
 Transition services and planning must be provided in
the IEP for youth beginning at age 14
 Medicaid’s EPSDT requirement for youth under 21
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Schedules re: screenings and access to treatment
Medically necessary services are provided
Denials of service can be appealed
Laws Relevant to Serving Youth
With Disabilities in Care


Beginning January 2014, youth will be categorically eligible for Medicaid until
age 26 regardless of income if:
 They were in foster care at age 18 and
 Enrolled in Medicaid
Action steps. Ask for the following language in the court order:
 For the purposes of establishing eligibility under 42 U.S.C.
§1396a(a)(10)(a)(i)(IX), this Court finds that (Name of Youth) was in
foster care at age 18 and was enrolled in the Medicaid Program at that
time.
Anti-Discrimination Laws
Americans with Disabilities Act and the Rehabilitation
Act:
 Prohibit disability discrimination in the provision of
services and
 Require that individuals be served in the most
integrative setting appropriate to their needs.
 Require that Protection and Advocacy Agencies exist in
each state to provide advocacy and representation for
individuals with disabilities. In PA, the P & A is DRN.
Child Welfare Transition Planning
Federal and state child welfare laws require that a
transition plan be developed with the youth at least 6
months prior to discharge from care that includes
specific plans in several areas, including health, health
insurance, housing, education, employment,
mentoring, and support services.
 The plan must also include information about health
care decision-making options.
42 U.S.C.A. §675 (5)(H)

Child Welfare Transition Planning
State Court Rules require that a transition plan be
developed that includes provision of health care,
insurance and addresses health care decision making
before a child welfare case can be discharged.
 The Rules require that the case cannot be closed until
the court is satisfied that an appropriate plan has been
presented.
Juvenile Court Rule 1613.

Fostering Connections Extension of Care Options
Youth can remain in the child welfare system past 18 age
if they are engaging in at least one of the following:
Completing secondary education or an equivalent credential;
 Enrolled in an institution that provides post-secondary or
vocational education;
 Participating in a program actively designed to promote or
remove barriers to employment;
 Employed for at least 80 hours per month; or
 Have a behavioral health or medical impairment that prevents
them from engaging in the above activities.
42 Pa. C.S.A. 6302. (“Child”)

Relevant Laws: The Court’s Authority to
Address Health and Disability Needs
The court must make “any findings necessary to
identify, monitor, and address the child’s needs
concerning health care and disability…” Juvenile Court
Rule 1512 (D)(i).
 Orders can be made for evaluations and treatment. Id.

Relevant Laws: The Court’s Plenary
Jurisdiction to Address Treatment Needs
Under the Juvenile Act, the court has the authority to
order treatment, services, and placement that is “best
suited to the protection and physical, mental , and
moral welfare of the child.” 42 Pa. C.S.A. 6351.
 PA case law interpreting the Juvenile Act
demonstration that:

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The court’s plenary jurisdiction is limited only by what is
“best suited to the protection and physical, mental, and moral
welfare of the child.” 42 Pa. C.S.A. 6301 (b)(purpose).
Dispositions should be individualized.
Meeting Treatment, Service and
Placement Needs while in the System
Poll 1: Extension of Care and the Transition
In your experience, how can the extension of care past 18 help
ensure appropriate transitions for youth with disabilities?
 Allows for better health and educational outcomes
 Allows more time to plan and arrange services
 “Adult” services are hard to navigate for an 18-year-old
 Permanency services and court oversight remain
 All of the above
Strategies for Improving Treatment while in the System:
Is the setting the least restrictive?

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Is the placement should be in the least restrictive setting?
 Are the ADA and CW laws being followed?
What services or supports would be needed to reduce the level of restriction?
Strategies for Improving Treatment while in the System:
Is the youth getting all the services he is entitled to?

Is the youth getting all the services he or she is entitled to?
 All medically necessary treatment under the EPSDT requirement
 Permanency services
 Independent Living Services and Transition Services
 Education


Public school education until the year he turns age 21
An appropriate IEP, including transition services
Poll 2: What are special education
transition services?
Transition services in the IEP…
 Only relate to academic skills.
 Are exactly the same as IL services.
 Include an array of services and community experiences
that youth need to function as an adult.
 Are only what the school tells us they can provide.
 Can only be provided until the youth is age 18.
Transition Planning for Youth with
IEPs
Must begin at age 14 in PA
 Must be informed by age-appropriate transition
assessments
 Must have goals in the following areas:
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Post secondary education/training
Employment
Independent/community living
Community participation
Adult service connections
The Transition from High School to PostSecondary Ed/Training or Work: Tips


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Ensure that youth who have IEPs have an educational decision
maker.
 The school has a responsibility under the IDEA to appoint
one.
 The court may also be able appoint one if necessary.
Ensure that the required Summary of Academic Achievement
and Functional Performance has been completed.
Make sure the graduation requirement is meaningful—don’t let
the youth be pushed out of school before she is ready!
The Transition from High School to
Post-Secondary Ed/Training or Work
Consult with Office of Vocational Rehabilitation and
the special education team about post-school options.
 Ensure that the youth is connected with the disabilities
services office at any post secondary program so that
accommodations plans can be developed.

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There is no IEP in post-secondary education programs.
The ADA and Rehab Act apply
Strategies for Improving Treatment while in the System:
Is the youth receiving the right treatment?


Is the youth getting the right treatment?
 Have the needed assessments been completed?
 Are the multiple disabilities or ones that have not been formally identified that are
barriers to making progress
Do the placement and service providers understand the youth’s disability and are they
equipped to serve the youth.
 If they are not, services should be arranged for or a new provider is needed.
 Repeated reports of non-compliance may be a sign that
 the treatment is not the right fit,
 another service or provider must be added, or
 an assessment or evaluation must be done to determine the nature of the
barrier to progress
Easier said then done.

Who can help determine what treatments, services or settings
may be possible for youth I work with?
Enlist help of DRN and Health Law Project to appeal denials of
services from MA.
 Enlist the help of the Special Needs Units at the MCO.
 Enlist help of DRN, ELC, and JLC when educational issues arise.
 Enlist help of agencies like DRN, ARC, Mental Health
Association, Centers for Independent Living and Liberty Resources
to come up services and supports that would allow a less restrictive
setting or suggesting evidence based and promising treatments.
***Pages 4 and 30 of Professional’s Guide for contact info for
resources.

Planning for the Transition
Poll 3: Who is responsible?
In my county, the following is the main entity responsible
for making sure youth who have special health or
behavioral health needs are planned for:
 The CW or JJ agency
 The attorney for the child
 The health care or behavioral health care provider or
system
 It is not always clear to me
Some Differences Between Child
and Adult Serving Systems
Child Welfare/Child Serving
Systems

Many services are mandated
or considered entitlements
(EPSDT, IDEA, CW Sytem).


Child welfare services usually
include placement and
services.
Juvenile court oversees
service provision and can
order appropriate services
and placement.
Adult Serving Systems/Programs



Few services are mandated or
are entitlements.
Placement may not be part of
the service array.
No court oversight or
entitlement to a lawyer or
advocate to ensure provision
of services.
A snap shot of the child to adult cliff: Medicaid
pre and post age 21
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The Early and Periodic Screening, Diagnostic, and
Treatment is Medicaid's comprehensive and preventive
child health program for individuals under the age of 21.
It includes periodic medical screening, vision, dental, and
hearing services.
It requires that any medically necessary health care service
be provided to eligible youth (w/a few exceptions).
Medicaid Coverage After Reaching Age 21

After age 21 the EPSDT requirement no longer applies.

The types and amounts of treatment and services an
adult can receive are much more limited.
Examples of Changes in Coverage At Age 21
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Hearing aids are not covered.
You can only get 1 wheelchair every 3 years.
Stays at psychiatric hospitals are limited to a certain number
of days a year.
Home health services, including nurses aids, physical,
occupational, and speech therapists are limited by per
month caps.
Strategies for Meeting A Youth’s
Needs When they Transition
Accessing Medical Assistance Home and Community
Based Waivers
 Accessing SSI

Poll 4: Special Issues for Youth With Intellectual
Disabilities
At what age should a youth with intellectual disabilities be
registered with their county ID Agency?
 Six months before they “age out” of care.
 At age 18.
 As early as they are identified as having an intellectual
disability.
Tips for Transitioning Youth with
Intellectual Disabilities

Register youth with your county IDS as soon as
possible. DO NOT WAIT UNTIL CLOSE TO
DISCHARGE.
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Consider assigning a point person at your private or county
agency to register youth and update information if youth
move, etc.
Registration is what triggers and allows access to all services
and supports through the IDS system, including HCBS
waivers.
Tips for Transitioning Youth w/ID

IQ scores and testing of adaptive functioning must be
submitted for registration.

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Make sure updated IQ testing is available (get it court ordered
if facing challenges)
Provider and school should assist with providing
documentation of adaptive functioning
There is an appeals process if you disagree with the
determination.
 Requesting an independent evaluation may be
appropriate when testing in the borderline range (70-75)

Home and Community Based
Medicaid Waivers (HCBS)
Treatment and services for individuals with significant
cognitive, developmental, and/or physical disabilities
so that they can remain in the community.
 Services can be paid for that may be limited under MA
coverage.
 Some waivers provide services and placement while
others just provide services.
 Many waivers have waiting lists. They are not
entitlements. Eligible individuals do not automatically
receive services.

Consolidated Waiver For Individuals Diagnosed with Mental
Retardation (Age 3 and Over)
Examples of Services
 Nursing
 Assistive tech.
 Behavioral supports
 Companion services
 Educ. Support services
 Supported employment
 Family living/life share
 Community living arrangement
(CLA)
 Home finding
 Day & residential habilitation
 Homemaker/chore services
 Specialized supplies
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Transportation
Respite
Supports coordination
Considerations
 Can cover a place to live as well as
services
 Waiting lists exist
 Waivers distributed based on need
Autism Waiver (Age 21 and Older)
Examples of Services
 Assistive tech.
 Behavioral specialist
 Community inclusion
 Residential habilitation
 Respite
 Family training
 Supported employment
Considerations
 Waiting list exists
 Some individuals w/autism may
be served through the OBRA
waiver
Attendant Care Waiver for Individuals with
Physical Disabilities (Ages 18-59)
Examples of Services
 In-home personal
assistance
 Community transition
services
 Personal response services
Considerations
 Consumer has right to
supervise, hire and fire
attendant
 Individuals w/lower level
of need should consider
Act 150 Attendant Care
Program
Independence Waiver for Individuals with
Physical Disabilities (Ages 18-59)
Examples of Services
 Assistive tech/specialized
equipment
 Community integration services
 Education services
 Environmental adaption
 Nursing services
 Respite
Considerations
 Consumer has right to
supervise, hire and fire
attendant
OBRA Waiver (Ages 18-59)
Examples of Services
 Same services as
Independence Waiver
 Prevocational services
 Supportive employment
services
Considerations
 Consumer has right to
supervise, hire and fire
attendant
What is SSI

Cash Entitlement (approx. $710 a months)

Guarantees Medical Assistance
Who is Eligible?
An individual who:

Has very little income and assets, and

Has a disability

Criteria for children (under 18) is related to disabilities that
interfere with daily functioning


Medical criteria for the evaluation of children under 18 can be found here:
http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm
Criteria for adults is related to the degree to which the disability
interferes with the ability to work
Can a Youth in Care Receive SSI?
Yes, BUT the cost of care is counted as income for the
youth and is deducted dollar for dollar from the SSI
benefit.
 For many youth, especially those in more expensive
placements, receipt of SSI may not make sense while in
care, especially for IV-E eligible youth.
 Applying for SSI in anticipation of discharge for youth
with disabilities, however, is essential!

How can SSI help a youth transitioning out of
foster care?

It can help prevent homelessness:

The benefit level is more than other cash assistance programs (TANF, General
Assistance) and may cover the cost of room and board.

Paired with other services, it may facilitate a solid transition plan.

SSI eligibility may be a gateway to other programs and benefits, such as
permanent affordable housing or other specialized programs.

Young adults receiving SSI have access to several programs that
incentivize work and education:

Youth can work part-time and still receive SSI

Social Security has programs to help recipients pursue education or attempt work
without losing eligibility.

Youth can receive school scholarships and receive SSI simultaneously
Poll 5: SSI and Transition
A youth cannot apply for SSI until they are discharged
from the CW or JJ system.
T
F
SSI Basics as a Youth Transitions


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Who can apply for a youth in care?
 If 18, the youth, but professionals working with the youth should
facilitate filing.
 If under 18, the parent or guardian, but a caseworker or foster parent can
start the application.
When can you submit an application for a youth in care?
 3 months before discharge date.
When can you start preparing the documents to submit?
 As early as possible!
SSI Basics

What documentation do you need to apply?

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Records of diagnoses, treatment, and how the disability
impacts on the youth’s functioning in the areas of daily living
and work.
Important to have “adult” diagnoses.
Important to show capacity or lack of capacity related to
work—vocational eval/assessment, work experience in
school/IEP.
Important to show level of adaptive functioning.

Providers and IL programs can assist with documenting adaptive
functioning.
Lunch Webinars for 2014
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Effectively Accessing the IDS System
Effectively Using SSI for Youth In Care and Upon Transition
Addressing Special Transition Issues for Youth with Behavioral Health Needs
Educational Transition Planning: High School and College
Developing Enhanced Transition Services and Supports in your Community
or County
Legal Strategies for Promoting Positive Transitions
Legal Decision-making Issues for Transitioning Adults with Disabilities
What the Protection and Advocacy System Can Do for You and Your
Clients: DRN, CAP and More!
Housing Issues for Youth and Young Adults with Disabilities
Understanding Home and Community Based Medical Assistance Waivers
For More Information
Jenny Pokempner
jpokempner@jlc.org
215-625-0551 x 111
Webinar Next Monday!
Education for Kids in Care: What Judges and Attorneys Need to Know

Learn how to protect and advance the education rights of clients
through effective courtroom practices in this webinar copresented with Education Law Center-PA.

When: Monday, December 16, from 12 PM to 1 PM EST

Topics include:
 Juvenile court rules focused on education
 The role of educational decisionmakers
 Model orders and sample findings regarding education
Register now >>