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Intellectual & Developmental Disabilities Services

Community Access Services

Pathways Center Community Access Services has two distinct categories: Community Access Group and Community Access Individual. Community Access services are individually planned to meet the participant’s needs and preferences for active community participation. Community Access services are provided outside the participant’s place of residences. Services include design of activities and environments for the participant to learn and/or use adaptive skills required for active community participation and independent functioning. These activities include training in socialization skills as well as personal assistance as indicated in the Individual Service Plan (ISP). Community Access services cannot be provided in the participant’s home or family home, personal care home, community living arrangement, or group home.

Community Access Individual (CAI) services are provided to an individual participant, with a one-to-one staff to participant ratio. CAI services are directly linked to goals and expectations of improvement in skills. The intended outcome of CAI services is to improve the participant’s access to the community through increased skills, increased natural support, and/or less paid supports. CAI services are designed to be teaching and coaching in nature. These services assist the participant in acquiring, retaining, or improving socialization and networking, independent use of community resources, and adaptive skills required for active community resources, and adaptive skills required for active community participation outside the participant’s place of residence. CAI services may include programming to reduce inappropriate and/or maladaptive behaviors. CAI services are not facility-based.

Community Access Group (CAG) services are provided to groups of individuals, with a staff to individual ratio of one to two or more. CAG services are designed to provide oversight, assist with daily living, socialization, communication, and mobility skills building and supports in a group. CAG services may include programming to reduce inappropriate and/or maladaptive behaviors. CAG services may be provided in a facility or a community as appropriate for the skill being taught or specific activity supported.

Community Living Support Services

Community Living Support (CLS) Services are individually designed to support the acquisition, retention, or improvement of life skills to facilitate residence in a waiver participant’s own or family home. Personal care/assistance may be a component part of CLS services, but the focus of personal assistance should be teaching the skills related to activities of daily living and instrumental activities of daily living. CLS services are offered to participants who live in their own or family homes.

CLS Services may include any of the following:
* Training and assistance with activities of daily living (ADLs), such as bathing, dressing, toileting, and transferring
* Teaching and assistance in performance of instrumental activities of daily living (IADLs), such as personal hygiene, light housework, laundry, meal preparation, grocery and other shopping, using the telephone, and medication and money management.
* Oversight and supervision of individuals unable to be left alone as assessed by DBHDD staff and under available funding.

CLS services include any transportation delivered to facilitate the individual’s participation in grocery or personal shopping, banking and other community activities that support the goals of the waiver participant and/or family. CLS services may include health-related activities such as basic first aid, arranging and/or transporting waiver participants to medical appointments, accompanying participants on medical appointments, tracking and documenting health- related daily activities such as intake and output, reminding participants to take medication, assisting with or supervising self administration of medication and other tasks that do not require the skill level of a licensed professional. Other task may be assigned by a licensed professional under the Proxy Caregiver Rule: Chapter 111-8-100 Rules and Regulations for Proxy Caregivers Used in Licensed Healthcare Facilities.

Direct personal care/assistance may be a component part of CLS services but should not be the only service provided to a participant. Rather, teaching skills that promote self-performance of the activities is the focus in all instances feasible. The frequency and duration of CLS services is designed to address specific needs determined by the Supports Intensity Scale, the Health Risk Screening Tool, and other participant-centered assessment information. The service need responsive to personal goals is specified in the Individual Service Plan.

Outpatient Treatment programs are available to all eligible individuals in our community that meet core customer criteria. We offer Outpatient Treatment programs in each of our counties.

Community Residential Alternative Services

Community Residential Alternative (CRA) services are targeted for participants who require formal support 24 hours/day, 7 days/week. CRA services provide a range of interventions with a particular focus on training and support in one or more of the following areas: eating and drinking, toileting, personal grooming and health care, dressing, communication, interpersonal relationships, mobility, home management, and use of leisure time. CRA services are individually planned and tailored to meet the specific needs of the participant and to accommodate fluctuations in his or her needs for various supports in the areas of functional, healthcare or behavioral services. CRA services are delivered according to level of need which correspond to rate categories which reflect the fact that individuals with more significant needs require more intensive supports.

CRA services include assistance with and/or training in activities of daily living, such as bathing, dressing, grooming, other personal hygiene, feeding, toileting, transferring, and other similar tasks. CRA services may also include training and/or assistance in household care, such as meal preparation, clothes laundering, bed-making, housecleaning, simple home repair, yard care, and other similar tasks designed to increase waiver participants’ independence in self-care skills.

CRA services consist of medically related services that are not required to be provided by a licensed professional under State laws, rules, and regulations. Examples include basic first aid, arranging and transporting participants to medical appointments, assisting with therapeutic exercises, and assisting with or supervising self-administration of medication. Medically related services do not include direct nursing services, if required to treat, evaluate, or monitor specific conditions. CRA activities may also include implementing positive behavioral support plans individually designed to reduce inappropriate and/or maladaptive behaviors and to acquire alternative adaptive skills and behaviors.

CRA services include transportation to all other waiver services specified in the Individual Service Plan and as needed to facilitate the individual’s participation in personal shopping, recreation and other community activities.

CRA services may not be provided to persons living in their own or family homes.

Prevocational Services

Prevocational Services prepare a participant for paid or unpaid employment. These services are for the participant not expected to be able to join the general work force within one year as documented in the Individual Service Plan (ISP). If compensated, individuals are paid in accordance with the requirements of Part 525 of the Fair Labor Standard Act. Prevocational Services occur in facility-based settings or at community sites outside the facility for small groups of participants, called mobile crews, who travel from the facility to these community sites. Mobile Crews receive Prevocational Services by performing tasks, such as cleaning or landscaping, at community sites other than the participant’s home or family home or any residential setting. The emphasis of Prevocational Services is directed to habilitate rather than explicit employment objectives. These services include teaching participants individual concepts necessary to perform effectively in a job in the community. Activities included in these services are directed at teaching concepts such as rule compliance, attendance, task completion, problem solving, endurance, work speed, work accuracy, increased attention span, motor skills, safety, and appropriate social skills.

Supported Employment

Supported Employment services are ongoing supports that enables participants, for whom competitive employment as or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports, to perform in a regular work setting. Supported Employment services are conducted in a variety of settings, particularly work sites where persons without disabilities are employed. Participants who receive Supported Employment services must require long-term, direct or indirect job behaviors, transportation assistance, peer support, and/or personal care assistance during the workday. Supported Employment services consist of activities needed to obtain and sustain paid work by participants, including job location, job development, supervision, training, and services and supports that assist participants in achieving self-employment through the operation of a business, including helping the participant identify potential business opportunities, assisting in the development of a business plan, identifying the supports that are necessary for the participant to operate a business, and ongoing assistance, counseling and guidance once the business has been launched. These services do not include the supervisory activities rendered as a normal part of the business setting.

Intensive Crisis Supports

Intensive Crisis Supports are specialized services that provide a time-limited care and intervention to an individual due to his or her need for support and protection of others living with him or her. These supports provide specific intervention and case management strategies directed toward enabling the recipient to remain in the community. The outcomes of these services are designed to enhance the current family member’s or provider’s ability to meet the needs of the recipient. Intensive Out-of-Home Supports is intended to stabilize the individual through nursing and behavioral supports, on a time-limited basis and is provided by the Crisis Support Home. The Crisis Support Home will serve no more than four individuals simultaneously. Individuals under the age of 18 will not be served in the Crisis Support Home. Transportation is provided for individuals in need of transport to the crisis home, emergency facility or back to their place of residence once discharged from the Crisis Services.


The Crisis Support Home will provide meals, room and crisis services on a 24/7 basis, not to exceed 7 calendar days unless approved by the Regional Services Administrator.

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