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Eligibility for Community Living Supports Policy

Policy Issue

Eligibility criteria established by government opens the door to services for children and youth with special needs, adults with developmental disabilities and their families. Restrictive eligibility criteria results in people living a marginalized existence without the supports and services they require.

Presently, government has different definitions for children and youth who have special needs and adults who have developmental disabilities. These definitions form the basis for determining eligibility for and access to supports and services.

The BC Ministry of Children and Family Development defines children and youth with special needs as:

"Those children and youth up to 19 years of age who require significant additional educational, medical/health and social/environmental support — beyond that required by children in general — to enhance or improve their health, development, learning, quality of life, participation and community inclusion" (MCFD website, 2013).

Families who have children and youth with special needs often find themselves on lengthy waitlists for the type of assessments required to determine eligibility, or are falling outside the eligibility criteria for specific programs.

Community Living BC (the crown agency responsible for providing services to adults with developmental disabilities) eligibility criteria for community living services include:

  • significantly impaired adaptive functioning
  • ƒsignificantly impaired intellectual functioning
  • these limitations must have started before age 18

To meet the assesment criteria for adult services, CLBC requires documentation from a professional that states they meet the “Diagnostic Criteria for Mental Retardation” cited in the DSM-IV-TR.

According to the DSM-IV, three criteria must be met:

  1. an IQ below 70,
  2. "significant limitations in two or more areas ofadaptive behavior (as measured by an adaptive behavior rating scale, i.e. communication, self-help skills, interpersonal skills, and more)", and
  3. "evidence that the limitations became apparent before the age of 18."

Because of different definitions and eligibility criteria, children and youth with special needs who receive supports and services, are not always deemed eligible for adult supports and services when they turn 19 years of age.

Purpose

To ensure that fair eligibility criteria are established for children and youth with special needs and adults with developmental disabilities to facilitate timely access to needed supports and services.

Guiding Principles

1. Eligibility criteria should ensure that children and adults who require services and supports receive the help they need when they need it.

2. Eligibility is multi-faceted and should not be based on single determinants like IQ or adaptive behaviour assessments.

Background

In recent years, government directives have resulted in a narrowed interpretation of the eligibility criteria being implemented and fewer adults requiring support being accepted into service. In 1999, a government communication regarding the management of the budget resulted in an over emphasis on IQ in determining eligibility for community living services for adults.

Data obtained from instruments measuring intellectual function and adaptive skills are intended as only one part of the overall eligibility assessment. Conclusions and recommendations should be made on the basis of all information including interviews with people acquainted with the person and observations of the person’s behaviour.

Although government has relaxed its use of IQ as a sole criteria, it still exists as part of the eligibility policy. Inclusion BC believes that as long as a quantitative measurement exists, it can be used to exclude people who are in need of supports and services. For example, if an adult who has measured significant limitations in two or more adaptive skill areas, experienced this onset before the age of 18 years but has a determined I.Q. of 76, they will be deemed ineligible. An IQ of 76 falls one point above the pre-determined range of approximately 70 (plus or minus 3 - 5 points).

While the government has reduced the emphasis on IQ as criteria in favour of using adaptive skill assessments, which assess limitations in the major areas of life activity, ( e.g., expressive or receptive language, learning, mobility, capacity for independent living, economic self-sufficiency or self-direction) in 2001, government service plans announced plans to introduce more "restricted eligibility criteria" for children and adults.

In February, 2010, Community Living BC introduced the Personalized Supports Initiative to provide supports to people who do not qualify under current eligibility criteria, such as persons diagnosed with Fetal Alcohol Syndrome Disorder or Autism Spectrum Disorder.

While this is a positive step forward, the new intiative is reaching a relatively small number of people.

Policy Statements

1.  Inclusion BC adopts the following definitions which should be used in determining eligibility for supports and services:

Adults with Developmental Disabilities

A developmental disability:

  • is manifested before the person reaches 18 years of age,
  • reflects the need for specialized lifelong individualized services and supports,
  • results in substantial functional limitations in major life activities that could include expressive or receptive language; learning; mobility, economic self-sufficiency or self-direction.

Children and Youth with Special Needs

Children and youth with special needs are children and youth who require extra support for their physical, intellectual, emotional, communicative, behavioral or social development.

2.  When required, eligibility assessments should be free, easily accessible and provided in a timely manner.

3.  Once eligibility is established, supports and services should be immediately available to meet the needs of the child, adult and family.

4.  Once eligibility is determined for adults, the designation that they have a developmental disability should remain with them for life, and should not be subject to  re-assessment.