Navigating the Transition Years

Transcription

1 Navigatig the Trasitio Years A Publicatio of the Marylad Coalitio of Families for Childre s Metal Health Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years

2 Ackowledgemets Fudig to produce this hadbook was provided by: Substace Abuse ad Metal Health Services Admiistratio Ceter for Metal Health Services Marylad Departmet of Health ad Metal Hygiee Metal Hygiee Admiistratio Marylad State Departmet of Educatio Author A Geddes, PhD Trasitio Specialist Marylad Coalitio of Families for Childre s Metal Health Dedicatio This hadbook is dedicated to all families strugglig to help their child with metal health disabilities trasitio to adulthood. May you fid this hadbook a source of iformatio ad empowermet. The Coalitio hopes that this iformatio will be dissemiated widely. Whe copyig or quotig, please credit: Marylad Coalitio of Families for Childre s Metal Health September , Marylad Coalitio of Families for Childre s Metal Health. All rights reserved. Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

3 Missio The Marylad Coalitio of Families is the statewide voice for childre s metal health ad is dedicated to: Buildig a family-drive etwork of iformatio ad support ad Improvig services i all systems of care for childre, youth ad their families The Coalitio represets families across Marylad who are carig for a child with metal health eeds. May childre have bee i a psychiatric hospital, residetial treatmet ceter, juveile justice facility, or special educatio program. Families struggle to fid appropriate services for their child ad may families face staggerig costs for treatmet ad other special services their child may eed. Eve with the challeges of raisig a child with serious emotioal or behavioral eeds, families have stregths ad wat to be full parters with professioals i plaig for their child s treatmet ad care. We Believe Childre ad youth with metal health eeds are valued ad require idividualized services to achieve their full potetial. Families are a costat i a child s life ad are equal parters i plaig, implemetatio, moitorig ad evaluatio of services. Services for childre, youth ad their families are provided from a stregth-based approach ad are resposive to the eeds of the whole child ad etire family. Local ad state systems of care are family-drive ad culturally competet. For iformatio cotact: Marylad Coalitio of Families for Childre s Metal Health Little Patuxet Parkway, #119 Columbia, Marylad Toll Free [email protected] Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years

4 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

5 Navigatig the Trasitio Years Table of Cotets Chapter 1 Itroductio 7 Trasitio to adulthood Developmetal characteristics of youg adults with metal health eeds The chagig role of families Parterig with your child i the trasitio process Chapter 2 High School Trasitio Plaig 11 High school support staff High school trasitio plaig timelie Course of study optios Work-based Learig (also called work-study) For all studets Fiacial aid Chapter 3 Divisio of Rehabilitatio Services (DORS) 17 Referrals Eligibility Services Workforce Techology Ceter programs ad services Supported employmet Other employmet optios Chapter 4 Post-secodary Educatio 22 Post-secodary educatio optios The Americas with Disabilities Act ad Sectio 504 accommodatios Chapter 5 Supplemetal Security Icome (SSI) 25 About SSI A decisio Eligibility requiremets The applicatio process Maagig SSI beefits Employed Idividuals with Disabilities Program Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years

6 Chapter 6 Health Care 29 Health care reform The Metal Health Parity Act Patiet Protectio ad Affordable Care Act Medicaid The public metal health system Programs for youth of trasitio age Marylad Primary Adult Care Chapter 7 Housig Optios 34 Housig realities Subsidized housig Private-pay housig optios Chapter 8 Legal Matters 37 Age of majority Decisio makig spectrum of optios Estate plaig Chapter 9 Coclusio 41 Appedix 1 42 Office of Special Educatio ad Core Service Agecy Phoe Numbers, by Couty Appedix 2 43 Project Access Appedix 3 44 Routes to Supported Employmet Appedix 4 45 Programs for youth of trasitio age Notes 49 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

7 Trasitioig from havig my etire life revolve aroud metal health to havig my life revolve aroud me as a perso was oe of the most terrifyig processes I ve ever had to experiece. I made a lot of mistakes i the process, ad took a lot of risks that my family ad support team were t too fod of. I had so much support through it all, though. Ad ow I m a full-time college studet, I have a group of amazig frieds, my relatioship with my family has gotte so much better, ad for the first time i 10 years, I feel like my life is goig exactly the way it should. I truly am happy. --A 20-somethig youg adult who wet through it ad has come out o the other side Chapter 1 Itroductio I the sprig of 2006, the Marylad Coalitio of Families held focus groups i six locatios across the state. We asked youth of trasitio age (defied as years) with emotioal disabilities 1 ad their families to tell us about their experiece with the trasitio process that period of preparig ad movig from high school to the adult world. A umber of commo themes emerged: Both youg adults ad their families had expasive dreams for the youg adult s future. Families, who had bee lifelog advocates for their child, kew that it was time to let go but foud this prospect very frighteig. Families ad youth felt that existig trasitio services were ot well-tailored to youth with metal health eeds. Youg adults emphatically stated that they wated to trasitio to adulthood ot ito the adult metal health system. Overwhelmigly, participats were frustrated by the lack of coordiated iformatio about the may aspects of the trasitio process. Oe mother said, Everythig is so complicated, ad I do t kow where to go to get help. This hadbook is a outgrowth of the focus groups. It is a attempt to brig together i oe place iformatio ad tools to avigate the trasitio process. The hadbook is writte for families, but the itet is that with this iformatio, families ca support their youth i self-advocacy. 1 I this hadbook metal health eeds ad emotioal disabilities are used iterchageably. They deote: A DSM-IV diagosis that would qualify as a disablig coditio, or The desigatio by the school system of a coditio which etitles a child to IDEA or Sectio 504 accommodatios. These coditios iclude, but are ot limited to, ADHD, mood disorders, axiety disorders ad schizophreia. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 7

8 It is worth otig here that trasitio-age youth with emotioal disabilities are a richly diverse group. Some geeralizatios or topics will follow i this hadbook that may or may ot apply to your child. We hope that there will be some thigs i the followig pages that will be helpful to all. Trasitio to adulthood The trasitio to adulthood ca be legthy ad difficult for all youg adults ot just those with metal health disabilities. For example, the 2000 cesus foud that the average age at which childre permaetly move out of the family home is 30; the 2010 cesus will probably fid that the average age has icreased. As our society has become more complex, the adult milestoes of completig secodary educatio, fidig a job that pays a livig wage, ad leavig the family home ofte are ot achieved util age 30 or later. 2 For youg adults with metal health disabilities, the trasitio to adulthood ca be loger ad more difficult. The social ad emotioal delays experieced by youth with metal health eeds impede the skills ecessary to successfully trasitio to adulthood. 3 Developmetal characteristics of youg adults with metal health eeds Youth ad youg adults display developmetal characteristics that ca be tryig ad sometimes frighteig to their caregivers. Due to the social ad emotioal delays experieced by may youth with emotioal disabilities, some developmetal characteristics are more typical of youger adolescets. Others are commo to most youg adults. They iclude: Seekig differetiatio ad idepedece from their parets Possessig a overwhelmig desire to fit i with their peers, icludig havig a circle of frieds ad a girlfried or boyfried Cravig the outward displays of adult milestoes, which may iclude the use of alcohol ad/or drugs, ad sexual activity Not watig to self-idetify as someoe with a disability Ofte youg adults are ot iterested i participatig i aythig that looks like metal health services ; they wat spedig moey, a car, frieds, ad their ow place to live they share the goals of their odisabled peers. The dilemma for families is that while youth with metal health eeds wat the same thigs as other youth their age, they may lack the social skills, cofidece ad maturity eeded to achieve their dreams. To complicate matters, it is ot uusual for youth to refuse ay kid of metal health services that may help them reach their goals, icludig takig medicatio. 2 Marya Davis, The Path from Adolescece to Adulthood, NAMI Begiigs, Summer J. Heidi Graliski-Batker, Stuart T. Hauser, Rebecca L. Billigs, ad Joseph P. Alle, Risks Alog the Road to Adulthood: Challeges Faced by Youth with Serious Metal Disorders, O Your Ow Without a Net (2005). 8 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

9 The chagig role of families Parets ad caregivers of childre with metal health eeds are accustomed to advocatig for their child. Typically, they are ivolved i every aspect of their mior child s life from educatio ad social activities to medical care ad metal health treatmet. Yet the roles ad resposibilities of parets ad caregivers chage dramatically whe a child turs 18, regardless of how prepared ad capable a child is at that poit. Ofte, this places families i a difficult positio. Families feel resposible for their child, but have little or o cotrol or access to iformatio. They may feel helpless ad frustrated if their child loses groud or refuses/ fails to receive appropriate support. Through this time of trasitio, the task of the family is to take o a ew role, oe that tries to support rather tha cotrol their youg adult. To help youth successfully trasitio to the adult world, families eed to stad back ad let go, while providig a safety et of support. The passage from childhood to adulthood for all of us ivolves the digity of risk; the right to make mistakes ad lear from them. --From Growig Up Without Growig Apart Utah Support Network Above all, it is critical for families to recogize that youg adults seek idepedece from their families ad eed to pursue this process. Therefore, trasitio plas must be developed ad drive by the youg adult. While this prospect makes may parets ueasy, it ca be dowright scary for families of youth with emotioal disabilities. They fid it extremely difficult to step back while their youg adult meets the complex ad critical challeges of the trasitio stage. But steppig back does ot mea removig yourself etirely from the process. Youg adults still eed the guidace of their families. Ad for that reaso, the more effective trasitio plas are youth-drive ad family-guided. Plas ad goals must be defied by the youth with families providig critical guidace, especially whe their youth ecouters barriers or perhaps stumbles alog the way. Here are some possible suggestios for adoptig a youth-drive, family-guided approach: Your youg adult s prefereces are critical. You may ot like them or agree with them, but do t dismiss them. Liste with a ope mid. Support your youg adult s career goals. Be o-judgmetal the ultimate goal must be the youg adult s. Help your child to break dow a major goal ito smaller more maageable compoets, ad ecourage back-up plas. Braistorm with them. Recogize that the boudaries have shifted, ad that your youg adult must ow take resposibility for themselves. Stad back ad sometimes let them stumble. Allow youth to experiece atural cosequeces wheever possible. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 9

10 Parterig with your child i the trasitio process To develop a trasitio pla that is youth-drive ad family-guided, you may fid it helpful to complete this exercise. Aswer the followig questios. Thik about how your child might aswer the questios, or see if you ca get them to respod. Where are there similarities? What are the differeces? How ca you move toward supportig your child s visio of their future? Whe might you eed to allow them to experiece atural cosequeces? Questios What are your dreams about your child s future? What short-term goals do you have for your child? What careers would you like your child to pursue? What further educatio do you imagie your child attaiig? What barriers might get i the way of your child accomplishig their goals? What idepedet livig skills do you feel your child has acquired (bakig, budgetig, cookig, shoppig)? What do you thik is lackig? How do you aticipate your child will meet their trasportatio eeds? How do you perceive your child s social life? 10 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

11 Chapter 2 High School Trasitio Plaig High school support staff If your child has a Idividualized Educatio Pla (IEP), a team of staff members is resposible for helpig them with their trasitio plaig ad the implemetatio of their pla. If your child is o a 504 pla, they still have access to the services of a guidace couselor, trasitio coordiator, ad Divisio of Rehabilitatio Services (DORS) couselor, but you ad your child may be resposible for iitiatig cotact to access their support. The Marylad Trasitioig Youth website is a valuable resource for youth ad families, coverig a wide array of topics. Go to The major players i a studet s trasitio pla are: IEP case maager Esures that age-appropriate career iterest assessmets are completed (or, i some schools, this may be the duty of the trasitio or vocatioal persoel) Helps to develop a trasitio pla IEP that is drive by the studet Guidace couselor Assists with the developmet of a course schedule that meets trasitio objectives Esures that a studet registers for ad takes admissio tests (such as the PSAT ad SAT), if appropriate Provides iformatio o colleges ad other istitutios of cotiuig educatio Provides guidace o applyig for fiacial aid Trasitio coordiator 4 Atteds IEP meetigs 4 Sometimes trasitio coordiators do ot make cotact with trasitioig youth o IEPs or 504 plas. To get the ame ad cotact iformatio of the trasitio coordiator for your child s school, cotact the Office of Special Educatio for your couty (see appedix 1). Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 11

12 Develops the trasitio pla withi the IEP for those studets age 14 or older i cojuctio with the studet May help develop a work-based learig or other employmet experiece Assists the family ad studet i makig agecy likages (DORS, MHA, etc.) May fuctio as a guidace couselor i some schools Divisio of Rehabilitatio Services (DORS) couselor (See chapter 3 o DORS) Atteds IEP meetigs begiig i a studet s secod to last year of school Refers the studet for vocatioal assessmets Makes referrals to outside agecies as eeded High school trasitio plaig timelie The Idividuals with Disabilities Educatio Act (IDEA) 2004 ad the Marylad State Departmet of Educatio have both set out guidelies o the activities ad timelies that IEP teams should follow to develop trasitio plas that help studets meet their educatio ad employmet goals. Age 14 Youth atteds IEP meetigs. The IEP should iclude the studet s trasitio goals 9th grade (4 years prior to exit) Review graduatio requiremets ad complete career iterest assessmets; revise IEP as eeded Work with the trasitio coordiator to update the trasitio pla ad work o trasitio activities Esure that the IEP addresses the acquisitio of ecessary life skills, especially whe the high school offers appropriate courses such as budgetig ad moey maagemet, techical educatio, or cookig 10th grade (3 years prior to exit) Review graduatio requiremets ad update career iterest ivetories; revise IEP as eeded Work closely with the trasitio coordiator to update the trasitio pla ad work o trasitio activities Esure that the IEP addresses the acquisitio of ecessary life skills 11th grade (2 years prior to exit) Review graduatio requiremets ad update career iterest ivetories; revise the IEP as eeded Cosider placemet i a work-based learig program (see below) The IEP team or family should make a referral to DORS, ad a DORS couselor should atted the IEP meetig 12 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

13 Esure that the IEP icludes aticipated trasitio services, icludig Supplemetal Security Icome (SSI) beefits, higher educatio or career school support services, ad Metal Hygiee Admiistratio (MHA) services, such as supported employmet, psychiatric rehabilitatio programs ad residetial rehabilitatio programs Cosider applyig for Project Access if you live i cetral Marylad (see appedix 2) Visit ay cotiuig educatio facility the studet is cosiderig attedig, ad talk to staff i the Disability Support Services office If a studet is ot o track to receive a learer s permit from the Motor Vehicle Admiistratio, they should apply to the MVA for a Idetificatio Card: 12th Grade (year of exit) Maitai regular cotact with the DORS couselor DORS should have examied documetatio, performed assessmets ad determied eligibility status Make sure the DORS couselor is ivited to atted the IEP meetig Review the Exit Documet 5 Esure that the IEP icludes aticipated trasitio services DORS couselor should make the outside referral to a supported employmet provider ad to the MHA as eeded Visit ay cotiuig educatio facility that the studet is cosiderig attedig, ad talk to staff i the Disability Support Services office Visit the DORS Workforce Techology Ceter if the studet is cosiderig receivig ay services there Families should fill out the FAFSA (Free Applicatio for Federal Studet Aid) Marylad Seamless Trasitio Collaborative (STC) I certai jurisdictios, the Divisio of Rehabilitatio Services has itroduced the Seamless Trasitio Collaborative for youth with disabilities who have IEPs. Some of the STC sites serve youth idetified with emotioal disabilities. Seamless Trasitio provides ehaced services to youth, icludig a variety of paid employmet optios, ehaced family supports, ad likages to adult systems. Cotact your school district s Office of Special Educatio (Appedix 1) to see if this program is available for studets with emotioal disabilities i your school. 5 The Marylad Exit Documet provides graduatig studets with IEPs importat iformatio that they may use as they trasitio from school to post secodary activities. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 13

14 High school course of study optios Youth should work with their guidace couselor/trasitio coordiator to develop their plas. Preparatory classes for post-secodary educatio Eve if a studet is plaig o pursuig post-secodary higher educatio, it ca be beeficial for them to iclude a high school work-based learig experiece i their schedule (see below). Also, they should cosider takig oe or more courses at the local commuity college, if this is a workable optio. Career ad Techology Educatio (CTE) (formerly Vocatioal Educatio) CTE programs are for both career ad college boud studets. Career ad Techology Educatio (CTE) programs iclude a sequece of four or five high school courses take i additio to the academic core classes Courses are offered withi a comprehesive high school, a techical high school, or a CTE ceter Course of study icludes a itership or work-related experiece Studets have the opportuity to ear career liceses (such as cosmetology) or college credits 10 career clusters are offered. 6 Each cluster, however, is ot ecessarily available i all areas GED For a variety of reasos, a traditioal high school educatio is ot feasible for some youth. While droppig out of school ad pursuig a GED is ot the ideal choice, it is a appropriate choice for some studets. Work-based Learig (also called work-study) Studies idicate that youg adults who have had a paid work experiece durig their high school years are far more likely to be employed i the years followig graduatio tha those who have ot. Moreover, a successful work experiece ca profoudly ifluece a youg adult s self-esteem ad sese of idepedece. For some youth, a work-study program is a excellet way to get that paid work experiece i high school. Work-based learig is a supported program where studets work i a idepedet placemet i the 6 They are: Arts, Media ad Commuicatio Busiess Maagemet ad Fiace Costructio ad Developmet Cosumer Services, Hospitality ad Tourism Evirometal, Agriculture ad Natural Resources Health ad Bioscieces Huma Resource Services Iformatio Techology Maufacturig, Egieerig ad Techology Trasportatio Techologies 14 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

15 commuity. The placemet may provide traiig or be a paid positio. School staff members provide dropi support ad services. Work-based learig is available to all special educatio studets 16 ad over who are o a IEP. The optio to do a work-based learig program is a decisio of the IEP team, who will look at: -- Behavior ad attedace -- Availability i a studet s schedule -- Number of credits still eeded for graduatio -- HSA progress Trasportatio for a work-based learig program may be provided by school Because of the may beefits a work experiece provides, a studet s trasitio coordiator should work to arrage a work-based learig experiece for the youth wheever possible. For all studets The high school guidace couselor should help all studets with: Registerig for academic testig. Providig iformatio o colleges ad vocatioal programs. Compilig applicatio packets. Providig iformatio o applyig for fiacial aid. Voluteer ad work experieces are as helpful for studets o IEPs as they are for studets who are ot. Guidace couselors have iformatio about a wide variety of voluteer opportuities i the local commuity. While the work-based learig program is ot a optio for studets who do ot have a IEP, the Career Techology Educatio program is a optio, ad CTE programs iclude either a itership or a paid work experiece. Studets who are cosiderig attedig a istitutio of cotiuig educatio should check with their guidace couselor about admissio testig requiremets. There is a cost for most admissio tests, ad also for applicatios, although they may be waived sometimes owig to fiacial eed. Fiacial aid Studets who are cosiderig pursuig cotiuig educatio after high school should have their families complete the FAFSA (Free Applicatio for Federal Studet Aid). A FAFSA is required for almost all forms of fiacial aid such as grats, loas ad scholarships (some scholarships, however, do ot require a FAFSA). A FAFSA is also required to be eligible for fiacial aid through DORS (see chapter 3). Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 15

16 Most studets will ot be eligible for idepedet studet status (i.e., idepedet of their family s icome). Studets are eligible if they are: 24 or older, or Married, or A graduate studet (havig completed a bachelor s degree), or Have a depedet other tha a spouse (e.g., a child), or A vetera, or A orpha, or be a ward of the court at age 18 Marylad law provides that youth, who are i foster care at the time they graduate or complete their GED, receive free tuitio at all Marylad state colleges ad uiversities. 16 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

17 Chapter 3 Divisio of Rehabilitatio Services Oce studets i special educatio leave high school, they move from the world of etitlemet to eligibility. A youg adult must be eligible to receive services, ad eve if eligible, some programs or services may have waitig lists ad/or fees. Eligibility determiatios are made o the basis of the severity of the disability. DORS is Marylad s Vocatioal Rehabilitatio Agecy. Federal law requires that every state have a vocatioal rehabilitatio agecy, with the missio to promote the employmet, idepedece ad selfsufficiecy of idividuals with sigificat disabilities. DORS is uder the Marylad State Departmet of Educatio ad serves idividuals ages DORS serves all disability groups. Referrals Studets with emotioal disabilities should be referred to DORS for services if they: Have a IEP. Have a 504 pla. Have a sigificat metal health disability. Have a goal of employmet. Timeframe ad meas of referral IEP teams should coordiate the referral of studets to DORS. This typically occurs at the begiig of a studet s ext to last year of high school. Studets with 504 plas will ot automatically be referred, so families should cotact DORS directly. I additio, ayoe ca make a referral to DORS at ay time after a idividual turs 16 years. Go to or call Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 17

18 Whe cotactig DORS, families should compile all relevat iformatio such as: Educatioal assessmets icludig cogitive tests or achievemet tests. Psychological or psychiatric evaluatios. Speech ad laguage assessmets. IEPs. 504 plas. Exit Documets. This iformatio facilitates the determiatio of eligibility ad the developmet of the Idividualized Pla for Employmet (IPE). Eligibility Cosistet with federal law, a idividual is eligible for DORS services if they: Have a physical or metal impairmet which costitutes or results i a substatial impedimet to employmet. Ca beefit from services i terms of a employmet outcome. Require vocatioal rehabilitatio services to achieve employmet. Oce a referral is made, DORS will determie a youth s eligibility status by goig over existig documetatio ad perhaps performig some of their ow assessmets. DORS uses three eligibility categories: most sigificat, sigificat, ad o-severe disabilities. Due to resource limitatios, DORS provides services oly to idividuals who are determied to have most sigificat ad sigificat disabilities. Youth who have most sigificat ad sigificat disabilities are defied as those who: Will require multiple services over a exteded period of time. Have impairmets that seriously limit oe or more fuctioal capacities such as: -- self directio -- iterpersoal skills -- work tolerace -- work skills Your right to appeal: If your child is determied to have a o-severe disability, you may appeal the decisio through the Cliet Assistace Program. DORS provides iformatio about this program, or call Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

19 Eve if a youth is determied eligible for services, they may be placed o a waitig list. DORS may provide some limited services, such as career assessmets ad couselig, to studets o the waitig list. DORS has trasitio couselors who are assiged to each high school i Marylad. The trasitio couselor usually starts iteractig with studets at the begiig of the studet s ext to last year of school. If the studet is foud to be most sigificatly or sigificatly disabled, they develop a pla for employmet services, some of which may be provided while the studet is still i school. Services DORS provides a rage of services depedig o the eeds of the youth. These may iclude: career assessmet career decisio-makig couselig ad referral vocatioal traiig Services are provided by DORS couselors i the local offices or by commuity providers. DORS also operates the Workforce ad Techology Ceter i Baltimore. May DORS offices are co-located with the Oe-stop Job Ceter. The Oe-stop Ceters are operated by the Departmet of Labor, Licesig ad Regulatio, ad are located i each jurisdictio. The Oestop Ceters serve all idividuals who are searchig for jobs. They provide access to various resources, icludig computers, copiers ad fax machies, a library of relevat books, ad semiars o diverse job seekig topics. DORS couselors facilitate the coectio with the Oe-stop Ceters, which also provide iformatio o topics such as how to: use the computers o-site to research job opeigs fill out job applicatios produce a good résumé develop etworkig skills DORS couselors discuss with the youg adult their optio of whether or ot to disclose their disability to a employer. DORS couselors explai the youg adult s rights uder the Americas with Disabilities Act (ADA), ad ca help to evaluate potetial accommodatios that might be available to them if they choose to disclose. 7 Paymet for services DORS pays oly for services that have bee pre-approved ad authorized i writig by a DORS official. DORS has a slidig scale for paymet of may services, based o the icome of the family. Youg adults who receive SSI are ot required to cotribute to the cost of services. DORS provides a umber of services for free, icludig assessmet, couselig/guidace/referral, ad supported employmet. 7 Some typical job accommodatios are: Modified work schedule Modified examiatios, traiig, or other programs Adjustmets to leave policy Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 19

20 DORS is ot a primary fuder for post-secodary educatio. Youth who eed post-secodary educatio to reach a approved employmet goal are required to apply aually for grats ad scholarships. Fiacial eed ad other coditios apply i order to become eligible for fiacial aid through DORS. Workforce ad Techology Ceter (WTC) programs ad services The Workforce ad Techology Ceter i Baltimore is the mai campus of DORS. It offers a diverse variety of services ad programs for idividuals with disabilities, icludig itesive career ad ability assessmets, life-skills classes, driver s educatio courses, classes o usig assistive techology, classes o readig Braille, ad a variety of vocatioal traiig programs. Dormitory services are available Suday ight Thursday ight. It is importat to ote that the WTC serves idividuals of all ages ad all disabilities. Two programs that might be of iterest to youth of trasitio age with metal health eeds are Prevocatioal Services ad Occupatioal Traiig. Pre-vocatioal services focus o developig work readiess, household skills, ad persoal orgaizatio. Occupatioal traiig is offered i ie program areas for idividuals who have a determied career goal. 8 It is highly recommeded that iterested idividuals ad their families arrage for a tour of the WTC. For more iformatio o DORS, icludig the phoe umbers ad locatios of the local DORS offices, see the DORS website or cotact the DORS Trasitio Specialist at (toll free: ). Supported Employmet a partership betwee DORS ad the Metal Hygiee Admiistratio Supported Employmet provides a job coach to help people with disabilities fid ad keep competitive employmet i their commuities. It has bee foud to be a successful program for youth with metal health disabilities. The goals of Supported Employmet are to help idividuals secure: 8 They are: Automotive detailig Automotive mechaics Tire, oil ad lube services Computer-aided draftig ad desig Evirometal services Food service Office techology customer service Office techology admiistrative professioal Security guard 20 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

21 A maistream job i the commuity that pays at least miimum wage A work settig that icludes people who are ot disabled A job coach who provides ogoig, proactive support The approach is based o the priciples that: A idividual s prefereces are importat A perso should choose as much or as little support as they wat from their job coach A idividual should make the decisio o whether or ot to disclose their disability to employers Follow-alog supports must be cotiuous Supportive Employmet is resposive to the fact that may youg adults with metal health eeds wat to both work ad atted school. If that is a youth s preferece, their job coach will work to help them search for a part-time job that will fit i with their school schedule. Although a fudametal pricipal of Supported Employmet is to achieve a job that pays at least miimum wage, if paid employmet is ot possible, job-shadowig or upaid iterships i the area of iterest to the youth may be a possible optio. Supported Employmet specialists will work with the youg adult i whatever their job iterest may be, ad will cotiue workig with the youg adult as log as they wat the help. Trasitio-age youth who are foud to be most sigificatly or sigificatly disabled meet the criteria for receivig Supported Employmet services through the Metal Hygiee Admiistratio. To access Supported Employmet, it is importat that all of the referrals are made to the appropriate agecies. The chart i Appedix 3 shows the various paths for accessig Supported Employmet services for youth of trasitio age. Other employmet optios I the curret ecoomic climate, there are o guaratees of ladig a job. Families ad youth should always try to develop their ow opportuities. Parets ad studets should explore the etwork of adults they kow to fid out if they are aware of ay job opeigs, or if they have other coectios that might be helpful i locatig a job. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 21

22 Chapter 4 Post-secodary Educatio Post-secodary educatio optios Studets have a broad rage of optios for cotiuig educatio. College 4-year selective-admissio colleges seek studets who have: Good grade poit averages College preparatory courses i high school Good scores o stadardized college admissios tests (e.g., SATs) Extra-curricular activities 2-year ope-admissio commuity colleges admit all applicats that meet the requiremets for a specific program. Commuity Colleges optios iclude: -- Takig a few selected courses i a area of iterest -- Takig vocatioal courses to trai for specific jobs or certificatios -- Pursuig a Associate Degree -- Preparig for a four-year college Stadardized college admissio testig (e.g., SATs) ad specific high school courses are ot required. High school grades are ot relevat to admissio. Schools usually require placemet tests i readig, writig ad math to determie the level at which to begi course work. If studets do ot meet the miimum proficiecy levels, they are required to take remedial courses. Credits eared i Marylad commuity colleges usually trasfer to Marylad four-year colleges, if the credits are for college-level courses 22 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

23 Vocatioal ad techical schools Vocatioal schools are may ad varied. They teach job-specific skills ad are devoted to practical traiig rather tha academics. Examples iclude: Techical Istitutes Barteder School School of Dog Groomig Barber School Weldig School Travel Academy School of Cookig Academy of Hair Desig Let the buyer beware. Try to get refereces about vocatioal schools of iterest from the high school guidace couselor, alumi, frieds, or career resource ceters. Appreticeships The Marylad Appreticeship ad Traiig Program oversees state-approved appreticeship programs ad provides iformatio o the umerous appreticeship programs i Marylad. Some of the more commo appreticeship programs are: Automobile Mechaic Bricklayer Cabiet Maker Carpeter Electricia HVAC/R Techicia Plumber Sheet Metal Worker Tool ad Die Maker Welder Appretices work full time, ad are paid depedig o level of teure. Most programs take three to six years to complete, ad lead to a atioally recogized certificate of completio. May appreticeships are very competitive. A studet s guidace couselor or trasitio coordiator ca explai the appreticeship applicatio process ad make the appropriate referrals. Also, you ca go to for more iformatio. The Americas with Disabilities Act (ADA) ad Sectio 504 accommodatios If a studet has a IEP i High School, it will ot carry over to a program of cotiuig educatio. Istead, studets must prove with supportig documetatio that they have a disability that etitles them to accommodatios uder ADA ad Sectio 504. The Americas with Disabilities Act (ADA) The America with Disabilities Act is a federal law that guaratees equal opportuity for people with disabilities i public accommodatios, employmet, ad other areas. Ulike the Idividuals with Disabilities Educatioal Act (IDEA), persos with disabilities are ot etitled to services but ca request reasoable accommodatios. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 23

24 Sectio 504 of the Federal Rehabilitatio Act Sectio 504 of the Federal Rehabilitatio Act prohibits discrimiatio o the basis of a disability i programs coducted or fuded by federal agecies. Ulike IEP accommodatios, which are iteded to make available to studets with disabilities a free appropriate public educatio that emphasizes special educatio ad related services desiged to meet their uique eeds, 9 Sectio 504 requires that reasoable accommodatios be provided to studets with disabilities. Typical cotiuig educatio accommodatios for youth with metal health disabilities iclude: Allowace for excused abseces Tutorig Exteded time o tests Freedom from distractios whe testig Schools will ot provide accommodatios that require a fudametal alteratio of the coursework. Schools ad professors vary tremedously i their willigess to develop ad implemet ADA ad Sectio 504 accommodatios. For this reaso, it is very importat for studets to visit the Disability Support Services Office before decidig to atted a particular istitutio. Ask questios ad you will get a sese of how willig they will be to work with you. Accessig accommodatios At least oe moth before startig classes, a studet (ot the paret) should register with the Disability Support Services office. The ame of this office varies by istitutio. The studet will meet with a DSS couselor ad should brig supportig documetatio of their disability, as well as suggestios for accommodatios that may be helpful. A studet must meet with a couselor before receivig accommodatios. Accommodatios will ot be provided retroactively for a studet who is doig poorly. Supportig documetatio The documetatio required to be eligible for accommodatios differs from oe school to aother. As a rule, however, schools require documetatio prepared by a qualified professioal that icludes: Diagosis Methodology used to determie diagosis Fuctioal limitatios A medical history, icludig past treatmets ad medicatios Other documetatio might iclude a letter from a doctor, documetatio from high school, or testig results from a professioal. I additio, it ca be useful if a professioal recommeds specific accommodatios that might be helpful to the studet. 9 Peter W. D. Wright, Pamela Darr Wright, Wrightslaw: IDEA 2004 (2005). 24 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

25 Chapter 5 Supplemetal Security Icome About SSI Supplemetal Security Icome (SSI) is a federal program that provides a mothly paymet to qualifyig idividuals with disabilities ad limited icome ad resources. Beefits are based o fiacial eed ad adjusted to the idividual s icome ad livig situatio. Curretly, the maximum mothly paymet is $674. I additio to a mothly paymet, the beefits of SSI eligibility iclude: Automatic eligibility for Medicaid a comprehesive public health care pla. Automatic DORS eligibility ad all of DORS services free of charge. Tuitio waivers at may Marylad Commuity Colleges. SSI should ot be cofused with SSDI (Social Security Disability Icome); they are differet programs. People who have worked a certai amout of time ad paid ito Social Security, who the become disabled, are eligible for SSDI. SSI is for people with disabilities who either have ot worked or have ot worked log eough to qualify for SSDI. What follows is a discussio about SSI sice, i most circumstaces, it is the program that youth of trasitio age might qualify for. 10 A Decisio May families struggle with the decisio of whether or ot to have their child apply for SSI. While the advatages of a secure icome are clear, there may be disadvatages as well. Studies show that oly 1 out of 1,000 people who go oto SSI ever come off of SSI. Thus, there is a fear that beig o SSI might promote depedece. Also, some families believe there is a stigma associated with receivig public beefits. Ultimately, the decisio to apply for SSI should be your youg adult s, with you providig the best iformatio ad support that you ca. Eligibility Requiremets A idividual age 18 ad older is cosidered disabled if he/she: Has a medically determiable physical or metal impairmet which: -- Results i the iability to do ay substatial gaiful activity -- Has lasted or ca be expected to last for a cotiuous period of ot less tha 12 moths 10 If your youg adult has a substatial work history, they may qualify for SSDI rather tha SSI. The applicatio process for the two programs is idetical. The Social Security Admiistratio will make the determiatio o whether your applicatio is for SSI or SSDI. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 25

26 To be eligible for SSI, a idividual must have limited icome ad resources. Curretly, the icome limit is $980/moth ad the resource limit is $2,000. Not all sources of icome or resources are couted towards the limits. O the SSI web-site there are lists of icome ad resource exemptios. The Applicatio process The applicatio process for SSI ca be difficult, i terms of both paperwork ad emotioal impact. You ad your child will have to documet all of their past illess, which ca be rather traumatic. I additio, you will be tryig to show why your child s illess will prevet them from egagig i ay gaiful activity. This experiece ca be demoralizig for your child. The potetial beefit of beig determied eligible, however, for SSI may outweigh these drawbacks. A youth may apply for adult SSI after they tur 18. At age 18, the youth will be evaluated o their ow icome ad assets, ot the family s. For a child uder age 18 to be eligible for Medicaid, there is a very low family icome limit. While ideally your child should do as much of the applicatio as they ca, realistically you will be much better able to tackle the fairly dautig applicatio process. To apply for SSI, call Represetatives are available Moday through Friday from 7 a.m. to 7 p.m. For shorter call-waitig times, it is best to call at the ed of the moth, at the ed of the week, ad early i the morig. You will evetually speak with a represetative who will gather some basic iformatio about your child. The represetative will also set up a appoitmet for you at your local Social Security Office. A face-to-face meetig with a represetative of the Social Security Admiistratio at your local SSA office is a required part of the applicatio process. Your child must be preset at the meetig. Before the meetig, you must complete a Adult Disability Report. You ca either fill it out o-lie (go to click o Supplemetal Security Icome, click o How do I apply for SSI? the click o Adult Disability Report ) or have a packet set to you. Either way, you must have the Adult Disability Report forms completed before your appoitmet with the Social Security Office. You ca ot apply for SSI o-lie. 11 Fillig out the Adult Disability Report potetially ca be a overwhelmig process. It helps if you are well prepared before you start to fill out the forms. I order to fill out the report, you will eed to gather a list of all services provided to your child, icludig: Emergecy Room visits Hospitalizatios Day hospitalizatios Treatig psychiatrists Treatig therapists ad/or couselors School services IEPs or 504 plas Neuropsychological or other testig Medicatios Start with the most recet services ad providers ad go back i time for the history. 11 If you go to the Social Security website, it will appear as if you ca apply o-lie. 26 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

27 The you will eed to locate: The ame, address ad phoe umber of each provider/hospital that provided the service. The dates that your child received services from the provider/hospital. The secod part of the Adult Disability Report is employmet history. To complete this report, you will eed to provide a list of all the jobs your child has held alog with the ames, addresses ad phoe umbers of their employers, alog with the dates that they worked. Oce you have gathered this iformatio, you will be able to fill out the report. If you did ot file the Adult Disability Report o-lie, you will eed to brig a copy of it to your appoitmet. I additio, everyoe must brig: Social Security Card or umber Origial birth certificate Copies of bak statemets for checkig ad savigs accouts Copies of other assets such as savigs bods W-2 form from last year (if your child worked) If your child is livig with you, you will eed a writte agreemet from your child to pay fair market value for housig ad food (i the amout of at least $250 per moth). 12 If you do ot have a lease agreemet with your child, the free room ad board that you are providig to them will be couted as a source of icome. You do ot eed to brig medical records. The Disability Determiatio Service will sed letters to your child s medical providers (icludig hospitals) to request medical records. The Disability Determiatio Service may also require that your child has a psychiatric evaluatio with their ow psychiatrist, at o cost to you. SSI determiatios usually take about six moths. It is ot uusual for youg adults with metal health eeds to be tured dow o the first applicatio. Therefore, pla to appeal ay deial. May applicats who are tured dow iitially are determied eligible o appeal. I a deial letter, Social Security provides detailed iformatio about how to file a appeal. Follow this process. Oce Social Security makes a favorable disability determiatio, the claimat is eligible for SSI beefits goig back to the date o which they iitially applied for the beefits. Sice six moths or more may have passed, this usually meas that a large back paymet is owed to the idividual by SSA, which SSA will pay i three istallmets. 12 It should say, I am receivig food ad shelter from (caregivers ames) i the amout of $250 ad I agree to repay them. Siged by (child s sigature) ad date Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 27

28 Maagig SSI beefits Mothly SSI checks may be set directly to your child or, if Social Security determies that your child will ot be able to maage their mothly checks, they may require a Desigated Payee for the youth. You ca apply to be amed your child s desigated payee (see chapter 9). If you wish to esure that your child receive the full SSI beefit ($674/moth), ad if your child is livig with you, you must draw up a retal agreemet chargig your child a miimum of $250 for room ad board ad cotiue to charge them that amout. All icome the youth ears must be reported to SSA. As a SSI recipiet ears wages, the beefit check is reduced accordig to a formula that provides cotiued icetives to work. SSI recipiets will always make more moey by workig tha by ot workig. If your child is uder the age of 22 ad regularly attedig school, they may ear up to $1,640/moth (up to $6,600/year) ad ot have it affect the amout of their SSI beefit. Certai stipulatios apply. Cotact SSA for more iformatio ( or ). Employed Idividuals with Disabilities Program The Employed Idividuals with Disabilities Program (EID) allows idividuals with disabilities who lose SSI due to their icome to retai full Medicaid coverage. The impetus for the EID program is to ecourage SSI recipiets to work, ad work at higher salaried positios, without havig to worry about losig their Medicaid. The EID program is for Maryladers who: Have disabilities that meet Social Security s medical criteria Work for pay Are years old Meet the icome limit (as high as $66,000/year for idividuals ad $88,440/year for married couples Meet the resource limit ($10,000, which does ot cout the home i which the applicat lives, ay vehicles, ad may types of retiremet accouts) EID erollees pay a mothly premium based o their level of coutable icome. The mothly premium may be $0, $25, $40, or $55. EID beeficiaries receive the full Medicaid package of coverage, ad ca also have private isurace. Cotact: Marylad Departmet of Disabilities Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

29 Chapter 6 Health Care Health care reform This is a time of rapid chages i health care law. O July 1, 2010, the Metal Health Parity Act wet ito place, requirig that health care isurers provide the same coverage for metal health care as they pay for somatic (physical) care. At the same time, ew federal health care legislatio is i the process of radically alterig both private health isurace ad Medicaid, with chages scheduled to go ito effect betwee ow ad Metal Health Parity Act While the full ramificatios of the Metal Health Parity Act are still ukow, certai poits are clear. As of July 1, 2010: Isurers may ot charge separate deductibles for metal health care ad somatic health care. Isurers may ot impose differet limits o the umber of visits allowed for metal health care ad the umber of visits allowed for somatic health care. Isurers may ot charge greater co-paymets for metal health care tha for somatic health care. Some of the fier poits of these chages will be complicated, ad some may eed to be challeged through appeals. I geeral, if your isurer treats your metal health coverage differetly that your somatic health coverage, complai to the isurace compay ad complai to the Marylad Isurace Admiistratio. To file a complait with the Marylad Isurace Admiistratio, go o-lie ad click o file a complait, or call Patiet Protectio ad Affordable Care Act The Patiet Protectio ad Affordable Care Act is the ladmark chage i health care i the Uited States that was eacted i Some provisios of the legislatio have already take effect; others will ot take effect util The two provisios that will have the greatest impact o youth of trasitio age ad their families are the age extesio for health care coverage for depedets, ad the expasio of Medicaid to childless adults. New federal health isurace law Begiig September 23, 2010, federal law requires health isurers to allow families to maitai depedet childre o their health isurace policy util a youg adult s 26th birthday, regardless of the youth s studet status. This law will take effect durig a employer s first ope erollmet period after September 23, At that time, a family will be able to re-eroll ay depedet child uder the age of 26 who previously had lost coverage because of age ad/or studet status. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 29

30 No chage It was true ad remais true that a paret ca maitai a depedet child o their health isurace policy idefiitely if the youth: Is depedet for support o the paret/guardia. Is umarried. Is icapable of self-support because of metal or physical icapacity (i this evet, a youth may also be eligible for SSI/Medicaid). A idividual may have both private health isurace coverage ad Medicaid. Medicaid Medicaid (also called Medical Assistace) is a joit federal-state program that pays for the health care of people with disabilities ad of certai people who have low icome. 13 Medicaid is ot the same as Medicare they are differet public health isurace programs. Medicaid eligibility requiremets Curretly, youth of trasitio age are eligible for Medicaid uder the followig coditios: If they are erolled i the Marylad Childre s Health Isurace Program (MCHIP), they are Medicaid eligible util age 19. If they were i foster care whe they tured 18, they are Medicaid eligible util age 21; i 2014 the age will be raised to 26. If they receive a disability determiatio ad are eligible for SSI, they are automatically Medicaid eligible. If they have a depedet child ad have a low icome ($21,200 for a family of three), they are Medicaid eligible. If they fall uder oe of Medicaid s other categories (such as low-icome pregat wome), they are Medicaid eligible. To fid out if you are eligible for Medicaid, you must file a applicatio with the Local Departmet of Social Services (LDSS) i the city or couty where you live. Go to or call for a list of offices. New federal Medicaid eligibility expasio Federal law requires that by 2014, all idividuals, icludig childless adults, with limited assets ad a icome at or below the Federal Poverty Level (curretly $10,825 for a idividual) will qualify for Medicaid. 13 Low icome is defied differetly for differet categories of eligibility. Some Medicaid eligibility criteria have asset limits, some do ot. 30 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

31 The expasio of Medicaid will help may youg adults. Marylad may phase i Medicaid eligibility expasio before If the State s fiscal coditio improves, watch for earlier chages to Medicaid expasio. The public metal health system If your youg adult qualifies for SSI, they will receive Medicaid. If they receive Medicaid, they will be eligible to obtai metal health services through the public metal health system (PMHS). I Marylad, the PMHS is maaged by the Metal Hygiee Admiistratio (a state agecy) through local metal health authorities the Core Service Agecies (for a list of Core Service Agecies ad their cotact iformatio see appedix 1). The PMHS provides metal health services to those idividuals who are o Medicaid or, i very specific cases, to those who are foud exceptioally eedy. The PMHS offers a spectrum of metal health services, a umber of which are ot available through private isurace. For those who are eligible, most services are low-cost or o-cost. PMHS eligibility criteria Must be eligible for Medicaid OR Must meet the strict eligibility criteria for exceptioal circumstaces The criteria for exceptioal circumstaces are very arrow, applyig to such cases as homeless idividuals, youth comig out of residetial treatmet ceters, or idividuals comig out of jail. A umber of coditios apply i these circumstaces. 14 Cotact the local Core Service Agecy for help determiig a idividual s eligibility for services i the PMHS. Services provided i the Public Metal Health System The followig list is ot exhaustive, but icludes the more commoly utilized services: Psychiatric ipatiet care (hospitalizatio) 14 The criteria to receive services from the PMHS for those who are ot o Medicaid are: Must eed treatmet for a covered metal health diagosis Must have a verifiable Social Security Number Must have applied for Medicaid, SSI or SSDI Must meet citizeship requiremets Must meet Marylad residecy requiremets Must meet the fiacial criteria established by the MHA I additio, a idividual must meet oe of the followig requiremets: Received services from the PMHS withi the past two years Received SSDI for metal health reasos Is homeless Has bee released from priso, jail or a correctioal facility with a metal health diagosis i the last three moths Has bee discharged from a Marylad psychiatric hospital withi the last three moths Metal health services are required as part of a coditioal release Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 31

32 Psychiatric day treatmet (partial hospitalizatio) Residetial Treatmet Respite Idividual metal health practitioer services (sessios with couselors, psychologists ad psychiatrists) Medicatios Psychiatric Rehabilitatio Programs (a day program, for 5-6 hours/day, 5 days a week; usually more appropriate for older adults who have a severe metal illess) Residetial Rehabilitatio Programs (RRP) - the most itesive level of housig service provided Supported Livig Services (provides less itesive services tha a RRP) Supported Employmet ad vocatioal services Case Maagemet Services (A case maager is assiged to coordiate care across all providers ad agecies ad to help with beefits.) PMHS programs for youth of trasitio age The Metal Hygiee Admiistratio has itroduced several pilot programs geared toward servig oly youth of trasitio-age. These programs are desiged to move youth ito adulthood ot ito the adultservig metal health system. The uderlyig philosophy of trasitio-age programs is that with the proper supports i place, ad give time to mature, may of these youth will ot require log-term services i the adult system. Appedix 4 provides brief descriptios of the Metal Hygiee Admiistratio s programs for youth of trasitio age. The programs are widely diverse from a summer camp to Residetial Rehabilitatio Programs (RRP). Typically, a youth must be a residet of the couty i which the program is located i order to receive services, but exceptios may be made i certai circumstaces. Appedix 4 also lists a program for trasitio-age youth for which youth do ot eed to be eligible for the PMHS i order to receive services the St. Luke s program i Motgomery Couty. Marylad Primary Adult Care (MPAC) Marylad Primary Adult Care was itroduced i 2006 to provide health care services to people with limited icomes aged 19 ad over. It does ot offer the broad array of services that Medicaid provides, but it has much less striget eligibility requiremets. MPAC eligibility requiremets Be age 19 or older Not be eligible for Medicare 32 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

33 As a idividual, have a icome uder $12,550 a year ad assets less tha $4,000. Certai types of icome ad resources are ot couted; for example, icome from supported employmet programs. Check the MPAC web site for iformatio o exemptios. Childre who live with their parets are eligible for the program. Their paret s icome is ot icluded i eligibility calculatios, provided that their family does ot claim them as a exemptio for icome tax purposes. MPAC provides: Free visits to a Primary Care Provider Free outpatiet visits to a psychiatrist Free outpatiet visits to metal health professioals, icludig occupatioal therapists, social workers, psychologists, ad professioal couselors Substace abuse treatmet Mobile treatmet services Psychiatric rehabilitatio programs Low-priced prescriptio drugs Metal health related medical laboratory services PAC does ot pay for hospital stays or emergecy room visits. Desigated providers serve PAC cliets. For more iformatio, a applicatio, or a list of participatig providers, go or call toll-free at Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 33

34 Chapter 7 Housig Optios Housig realities Most families of youg adults will fid their youth cotiuig to live with them, if ot o a permaet basis, the o a revolvig door trajectory movig out for a time ad the movig back i. Youth with metal health disabilities may well eed to live i the family home loger tha average, sice it ca be more difficult for them to attai a well-payig job. I some cases, however, the severity of a youg adult s emotioal disability makes it difficult for them to live at home. I other cases, eve though it may be a fiacial strai, it is desirable for youth to get the experiece of havig some idepedece from their family. Outside of the major optio of livig i the family home, there are both subsidized ad private-pay housig possibilities. Subsidized housig The Metal Hygiee Admiistratio operates a umber of Residetial Rehabilitatio Programs. RRPs provide the most itesive level of housig service. Typically two to three adults live i a furished apartmet or towhouse, with varyig level of staff support as eeded per uit. Trasitio-age youth (TAY) Residetial Rehabilitatio Programs Must be eligible for the Public Metal Health System For youth of trasitio age oly Very limited umber of beds Waitig lists usually exist but ca fluctuate rapidly Couty residets have priority Itesity of eed takes priority If a youg adult is homeless or comig out of a RTC, they will go to the top of a waitig list. For iformatio about the TAY residetial programs, see Appedix 3. For iformatio about a particular program, cotact the CSA i that couty (see Appedix 1). Adult Residetial Rehabilitatio Programs are for adults with metal health disabilities. Must be Public Metal Health System eligible May be appropriate for youg adults who will eed RRP services beyod 24 years of age Limited umber of beds 34 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

35 Waitig lists exist Couty residets have priority Itesity of eed takes priority For iformatio, cotact the local CSA (see Appedix 1) Other subsidized housig programs Departmet of Huma Resources Supported Housig Programs For youg adults who are comig out of foster care For iformatio, cotact your local Departmet of Social Services, which ca be foud at or call Mai Street Housig Mai Street Housig is a o-profit orgaizatio that offers quality affordable retal housig to idividuals with metal health disabilities. The orgaizatio ows 17 properties throughout Marylad ad is cotiually expadig its umber of retal uits. Two or three teats per house Ret set at affordable levels For iformatio: or call Sectio 811 Sectio 811 is a federal program that provides affordable retal housig for people with disabilities ad low icomes. Ret set at affordable levels Not available i all jurisdictios Waitig lists exist For iformatio: local Public Housig Authority office (see Appedix 5) Sectio 8 housig Sectio 8 is a federal program that provides ret subsidies to families ad idividuals with low icomes. Sectio 8 voucher recipiets typically pay about 30% of their icome toward ret. Waitig lists vary by jurisdictio, but typically are very log ad sometimes are closed. For iformatio, cotact your local Public Housig Authority office (see Appedix 5). Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 35

36 Private-pay housig optios College/uiversity dormitories: the room part of tuitio, room ad board College ad Commuity College message boards seekig roommates Craig s List a popular computer message board - be savvy about meetig up with stragers Private trasitio-age youth/adult programs: out-of-state group homes exist for TAY, but are very expesive. 36 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

37 Chapter 8 Legal Matters This iformatio is meat as a guide. I all legal decisios, it is importat to cosult with a lawyer who is kowledgeable about issues pertaiig to idividuals with disabilities. Age of Majority Whe your child turs 18, they become a legal adult, regardless of whether or ot you feel they are ready for this status. Me must register for the selective service. Your youg adult must act for themselves i all legal matters. They have the right to exclude you from receivig medical or fiacial iformatio about them, ad the right to exclude you from participatig i ay decisio-makig process. 15 This ca be a scary prospect for parets of youg adults with a metal health disability. Their youg adult may seem especially vulerable. There are may ways for youg adults to coset to the disclosure of cofidetial iformatio ad iclude parets i decisio makig. Some are volutary at the discretio of your child; others are ivolutary. As your youth trasitios to adulthood, it is importat to always begi with choosig the least restrictive optio i matters of decisio makig. The ultimate goal is for your youth to feel as empowered as possible. Coset to share iformatio If your child agrees to allow their doctor or therapist to share iformatio with you, your child ca simply write a statemet to this effect. They may revoke the statemet at ay time. Decisio-Makig Spectrum of Optios Beyod sharig iformatio, there is a spectrum of optios for sharig decisio makig with your child. Medical decisio-makig Advace directives A advace directive allows a perso to decide who they wat to make health care decisios for them, especially i the evet that they are uable to do so themselves. It ca also be used to state what kids of treatmet a perso wats or does ot wat. A advace directive ca either ame a health care aget, or provide health care istructios, or do both. It is volutary ad empowerig to the idividual. 15 Educatio is a exceptio. As log as your child is i high school, you are etitled to receive iformatio about their educatioal progress ad to participate i ay plaig process. Oce your child advaces to post-secodary educatio, however, you lose these etitlemets. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 37

38 Health care aget A health care aget is someoe amed to make decisios about aother s health care. (This sometimes is also called a durable power of attorey for health care, but, ulike other powers of attorey, this is ot about moey.) A health care aget has the authority to see that doctors ad other health care providers give a perso the type of care they wat, ad that they do ot give a idividual treatmet agaist their wishes. This perso has full power to receive ad provide iformatio about the idividual. Health care istructios for treatmet A idividual ca let providers kow what treatmets they wat or do ot wat, i the evet that they are uable to make their wishes kow themselves. Preparig a advace directive Advace directives do ot eed to be draw up by a attorey. You ca get sample forms from the web site of the Marylad Attorey Geeral, which also cotais liks to other sample forms. There is o oe form that must be used. To make the advace directive valid, it must be siged i the presece of two witesses, who will also sig. If a health care aget is amed, they may ot be a witess. Marylad law does ot require the documet to be otarized. Copies of the advace directive should be give to doctors ad hospitals. If a health care aget is amed, that perso should also be give a copy of the advace directive. For a sample advace directive form ad istructios, go to: Implemetatio of a advace directive If a idividual ames a health care aget, he/she should make clear i the advace directive whe he/she wats the aget to be able to act for you. This ca be at ay time (icludig the preset). A advace directive typically takes effect, however, whe a doctor certifies i writig that a perso is ot capable of makig a decisio about their care. A idividual ca chage or rescid his/her advace directive at ay time Advace directives for metal health treatmets Advace directives for metal health treatmet are idetical to medical advace directives, except they are used for psychiatric decisio makig. A advace directive for metal health treatmet is a empowerig ad proactive step for a perso with a metal health disability, for they retai the say of their prefereces. All of the regulatios that apply to advace directives, icludig their preparatio ad implemetatio, apply to advace directives for metal health treatmet. For a sample advace directive for metal health treatmet, go to ad click o Advace Directive for Metal health Treatmet. As i medical advace directives, a perso may do oe or both of the followig i a advace directive for metal health treatmet. Health care aget A idividual ca appoit a health care aget to receive ad share medical iformatio about them, ad/or to make treatmet decisios for them. It ca go ito effect wheever the idividual chooses either immediately after beig witessed, or whe the perso is declared medically icompetet by a treatig physicia. 38 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

39 Treatmet directive I a treatmet directive, a idividual states their wishes regardig treatmets or medicatios they do or do ot wat, providers they do or do ot wat, visitors they do or do ot wat, ad who providers have permissio to speak with. A treatmet directive goes ito effect whe a treatig physicia determies that the idividual is metally icompetet. You should kow, however, that a idividual may revoke their psychiatric advace directive at ay time eve i the evet that they are foud icompetet to make decisios. Also, Marylad law does ot allow a perso to sig aother adult ito a psychiatric hospital. This power ca ot be exercised by a health care aget. If your child fids it difficult to complete a formal advace directive, they ca simply write dow their ow wishes i their ow had. Fiacial decisio-makig Fiacial power of attorey There are differet kids of fiacial powers of attorey: geeral ad limited. Like advace directives, fiacial powers of attorey are volutary. A geeral power of attorey coveys to a aget full power ad authority to act o behalf of the gratee i busiess ad persoal situatios ivolvig bak accouts, real estate, stocks, cotracts, ad aythig else that may arise. A limited power of attorey is used for a limited duratio or circumstace, to give the aget the authority to perform a specific actio or trasactio, or series of trasactios, o behalf of the gratee. This actio is clearly stated i the documet (such as sellig a car). Fiacial powers of attorey do ot eed to be drafted by a attorey. There are sample forms o websites that ca be used as guides. Some fiacial istitutios have their ow forms that they require be used. Power of Attorey documets should be siged ad otarized. Represetative Payee Whe the Social Security Admiistratio (SSA) makes a disability determiatio, it may also determie that the beeficiary caot maage their ow moey. I this evet they will seek to appoit a represetative payee preferably someoe who lives with the beeficiary ad has their best iterest i mid. Parets are frequetly amed the represetative payee for their child. A represetative payee must see to it that the payee s beefit checks are used for the beeficiary s eeds. They must file a aual report that states how the beeficiary s moey was spet. If the SSA did ot fid that your child eeds a represetative payee, but you have come to believe that your child is uable to maage their ow moey for their care, you ca apply to become their represetative payee. Cotact the SSA office earest you to apply (to locate the earest office, go to You must submit: A applicatio form. SSA requires that you complete the form i a face-to-face iterview with a represetative. Documets to prove your idetity Your social security umber Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 39

40 After you apply to be your child s payee, SSI will ivestigate ad make a determiatio as to whether or ot your child is capable of maagig their moey. If you are desigated your child s represetative payee, you ca use this as a opportuity to empower your child by havig them decide how ad whe moey realistically should be spet. Guardiaship Guardiaship is the most restrictive way to assist a perso with decisio makig. It is a drastic measure, ad the law requires that it oly be cosidered whe less restrictive alteratives have failed. Guardiaship: Deprives the perso of the right to make virtually all persoal ad/or fiacial decisios. Must be determied i a court by a judge. Laws differ by state ad Marylad has very restrictive laws; it is quite difficult to be grated guardiaship. Is costly ad time cosumig. Potetially sets up a adversarial relatioship with your child, who will have a court-appoited attorey represet them. There are three types of guardiaship: Guardiaship of Perso: makes decisios about the perso s medical care, residece, food, clothig, shelter, etc. Guardiaship off Property: makes decisios oly about the perso s moey, icome, property, ad other assets Guardiaship of both If less restrictive measures have failed, it is preferable to have limited guardiaship, such as just guardiaship of property, rather tha full guardiaship. This limitatio allows your child to maitai some cotrol of their ow life. It is importat to cosult a lawyer if you are cosiderig guardiaship. Estate Plaig Families have importat issues to cosider whe plaig how to leave moey or assets to a child with metal health disabilities. First, a iheritace over $2000 will cause their child to lose their SSI ad possibly their Medicaid. Secod, the family must cosider whether the child is mature eough to maage a bequest resposibly, ad how will the child support themselves i their later years. Due to the complexities that these questios ivolve, it is wise to hire a attorey who specializes i disability estate plaig. A attorey who is kowledgeable about govermet beefits ad sesitive to the eeds of people with disabilities ca guide you through the issues ad help you cosider alteratives o how best to structure your estate. It may also be appropriate to discuss potetial iheritaces with gradparets or ayoe else that might leave a bequest to your child. Agai, a attorey with expertise i special-eeds estate plaig ca recommed optios that will preserve your child s eligibility for public beefits. 40 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

41 Chapter 9 Coclusio While avigatig the trasitio years ca feel like travellig through treacherous waters at times, there is ample reaso for hope. Studies have show that cotiued family support ad commitmet to a youg adult vastly improves the odds of achievig a successful outcome. Your very act of readig this hadbook shows that you possess this commitmet to helpig your youg adult. We hope that it will provide you with some iformatio ad tools to assist your youg adult to achieve their dreams. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 41

42 Appedix 1 Departmet of Special Educatio, Core Service Agecy Phoe Numbers Jurisdictio Allegay Couty Ae Arudel Couty Baltimore City Baltimore Couty Calvert Couty Carolie Couty Carroll Couty Cecil Couty Charles Couty Dorchester Couty Frederick Couty Garrett Couty Harford Couty Howard Couty Ket Couty Motgomery Couty Price George s Couty Quee Ae s Couty St. Mary s Couty Somerset Couty Talbot Couty Washigto Couty Wicomico Couty Worcester Couty office of special educatio x x x core service agecy Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

43 Appedix 2 Project Access What: The Project Access Summer Istitute is a trasitio program located o the Howard Commuity College campus i Columbia, Marylad. Its goal is to help high school studets with disabilities get ito college ad succeed there. The four-week program offers istructio i readig, writig, math, study skills, college survival skills ad drama. Career couselors with backgrouds i special educatio will be available to help studets idetify appropriate career goals ad lear strategies to achieve them. Successful college studets with disabilities will help as tutors, metors, ad role models to show the studets ways to achieve success. Who: Project Access accepts studets comig out of 10th, 11th, ad 12th grades. Studets must be o a diploma track ad recogized by their high schools as havig the ability to do college level work. The Istitute serves studets i the followig couties: -- Ae Arudel -- Baltimore -- Carroll -- Howard -- Motgomery -- Price George s Trasportatio is provided for studets i Howard Couty, ad the college helps studets i other couties arrage car pools. Whe: Cost: The Istitute typically is held for four weeks i July from 9:00 a.m. 3:00 p.m. The applicatio process begis i early Jauary ad cotiues util the middle of April. The cost for the 2010 Summer Istitute was $550 for Howard Couty residets ad $560 for out-ofcouty residets. Fiacial aid is available. If iterested, call Dr. Lida Schapp at or at [email protected] ad your ame will be added to the mailig list. Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 43

44 Appedix 3 Process for Referrals to Supported Employmet Trasitioig Youth with a Metal Health Disability IEP Team makes referral to DORS Family makes referral to DORS DORS Departmet of Vocatioal Rehabilitatio makes referral to Core Service Agecy CSA Core Service Agecy makes referral to supported employmet provider Supported employmet provider 44 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

45 Appedix 4 Metal Hygiee Admiistratio Trasitio-age Youth Programs The Metal Hygiee Admiistratio made available grat moey for Core Service Agecies throughout the state, to provide services for trasitio-age youth with sigificat metal health eeds. The followig Core Service Agecies received grat fudig to provide specified services: Area Served: Ages Served: # of Youth: 11 TAY Services: Cotact: Ae Arudel Couty Itesive educatioal, case-maagemet, ad vocatioal supports. Cocetratio o skill developmet ad activities related to employmet, recreatio ad leisure. Provide fuds for health, vocatioal, educatioal, recreatioal, ad other services. Ae Arudel Metal Health Authority, Ic. Area Served: Ages Served: Baltimore City # of Youth: 26 TAY 14 i Residetial Rehabilitatio Program Services: Cotact: Residetial Rehabilitatio Program, itesive case maagemet, ad wrap-aroud supports. Services iclude coordiatio ad likages to housig, vocatioal traiig, social ad recreatioal activities, trasportatio, ad i-home ad school supports. Baltimore Metal Health Systems, Ic. Area Served: Ages Served: Baltimore Couty # of Youth 10 TAY 6 i Residetial Rehabilitatio Program Services: Cotact: Residetial Rehabilitatio Program. Idividuals are coached o idepedet livig skills ad provided with case maagemet. Cliets participate i commuity-based school, traiig, or employmet. Case maagemet is provided for o-residetial cliets. Baltimore Couty Bureau of Metal Health Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 45

46 Area Served: Ages Served: # of Youth TAY Services: Cotact: Charles, Calvert, ad St. Mary s Couties Assistace with supported housig, obtaiig a high school diploma or GED, participatio i support groups, employmet, ad establishig savigs accouts. Provides housig ad idepedet livig supports to youth who are steppig dow from RTCs, therapeutic group homes, or other itesive placemets. Services iclude outpatiet psychiatric treatmet, Psychiatric Rehabilitatio Services, special educatio, case maagemet, ad residetial support. Charles Couty Core Services Agecy Area Served: Ages Served: # of Youth 12 TAY Services: Cotact: Howard Couty Provides Residetial Rehabilitatio Program, supported employmet, ad supported livig to eable idividuals to achieve idepedet livig. Fuds detal services, tuitio ad traiig, trasportatio, ad retal deposits. Howard Couty Metal Health Authority Area Served: Ages Served: # of Youth 3 TAY Services: Cotact: Ket, Quee Ae s, Talbot, Carolie, ad Dorchester Couties Provide fuds for trasportatio, utility paymets, grocery assistace, ad educatioal expeses such as tuitio ad books. Provide 40 hours of psychological cosultatio ad travel expeses. Mid-Shore Metal Health Systems 46 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

47 Area Served: Ages Served: Motgomery Couty Udefied # of Youth 117 TAY Services: Cotact: Offers 3 programs TAY: Itesive Residetial Rehabilitatio Program ad supported employmet. Icludes 24/7 o-site awake staff coverage. Also provides stipeds for medicie, food, ad social ad recreatioal activities TAY: Provides ogoig support services to youth placed i jobs, icludig job coachig ad trasportatio TAY: Provides supported educatio services. Motgomery Couty Core Service Agecy Area Served: Ages Served: # of Youth 6 TAY Services: Cotact: Price George s Couty Ages who are parets Provide housig, vocatioal traiig, career developmet, ad GED or college-level educatio assistace to trasitio-age youth that have childre. Services iclude paretig ad family supports, trasportatio, childcare, ad metorig. Price George s Couty Metal Health Authority Area Served: Ages Served: # of Youth 12 TAY Services: Washigto Couty Provides assistace with housig, educatio ad employmet. Provides discretioary fuds to pay for tuitio, vocatioal traiig, trasportatio, educatioal ad vocatioal supplies, ad retal deposits Area Served: Ages Served: # of Youth 15 TAY Services: Cotact: Worcester, Wicomico, ad Somerset Couties Assistace with educatioal activities, vocatioal traiig, voluteer activities, ad employmet. Provides trasportatio, detal services, tuitio, recreatioal activities, ad retal deposits. Worcester Couty Core Service Agecy Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 47

48 Other trasitio-age youth programs Healthy Trasitios Iitiative Frederick ad Washigto Couties I additio to the above programs, the MHA received a grat i 2009 to expad programmig for trasitio-age youth. The MHA is implemetig two programs oe i Washigto ad oe i Frederick couties. These programs provide trasitio facilitators to work with youth aged who have a serious metal health disability. The program offers a itesive form of trasitio facilitatio, providig access to supported employmet, commuity treatmet, ad other idividualized supports exitig withi the commuities. For more iformatio, cotact the Frederick or Washigto Couty Core Service Agecies (see Appedix 3). St. Luke s Career Trasitio Program (CTP) Motgomery Couty The St. Luke s Career Trasitio Program helps high school juiors ad seiors with metal health eeds make a successful trasitio to college, vocatioal traiig, the workforce, or other post-secodary goals. It offers a uique combiatio of metal health ad career/vocatioal resources to assist studets ad their families i idetifyig ad obtaiig ecessary resources to achieve a successful trasitio. Services iclude: Fidig a job that matches skills ad iterests Defiig career ad educatioal goals Applyig for college or further traiig Learig about public beefits for which a youth may be eligible to receive Coectig with support services i the commuity St. Luke s House has a history of successfully egagig youth with metal health eeds, providig sigificat support ad resources, ad eablig them to experiece a successful trasitio to adulthood. For more iformatio, call ext Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

49 Notes Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 49

50 Notes 50 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health

51 Notes Marylad Coalitio of Familes for Childre s Metal Health Navigatig the Trasitio Years 51

52 Navigatig the Trasitio Years Marylad Coalitio of Familes for Childre s Metal Health