WAC 388-825-256
Service need levels. (1) The department
shall use service need levels to determine periodic family
support service authorizations.
(2) The department shall determine service need levels in
order of priority for funding as follows:
(a) Service need level 1: Client is at immediate risk of
out-of-home placement without the provision of family support
services. The client needs intensive residential support to
assist the client's family to care for the family's child or
adult requiring nursing services, attendant care, or support due
to difficult behaviors. A client shall:
(i) Have received, over the past three months, at least ten
days or eighty hours of service; or
(ii) Requires at least ten days or eighty hours per month of
service to prevent immediate out-of-home placement, based upon an
assessment conducted by the department;
(b) Service need level 2: Client is at high risk of
out-of-home placement without the provision of family support
services and has one or more of the following documented in
writing:
(i) The client:
(A) Currently receives adult protective services or division
of children and family services as an active:
(I) Child protective service client;
(II) Child welfare service client; or
(III) Family reconciliation service client.
(B) Has returned home from foster care or group care
placement within the last six months;
(C) Has a serious medical problem requiring close and
ongoing monitoring and/or specialized treatment, such as:
(I) Apnea monitor;
(II) Tracheotomy;
(III) Heart monitor;
(IV) Ventilator;
(V) Constant monitoring due to continuous seizures;
(VI) Immediate life-saving intervention due to life
threatening seizures;
(VII) Short bowel syndrome; or
(VIII) Brittle bone syndrome.
(D) Has a dual diagnosis based on current mental health DSM
Axis I diagnosis;
(E) Has an extreme behavioral challenge resulting in health
and safety issues for self and/or others which:
(I) Resulted in serious physical injury to self or others
within the last year;
(II) For a client who is two years of age or older, requires
constant monitoring when awake for personal safety reasons; or
(III) Is of imminent danger to self or others as determined
by a psychiatrist, psychologist, or other qualified professional.
(F) Is ten years of age or older or weighs forty pounds or
more, requires lifting, and needs direct physical assistance in
three or more of the following areas:
(I) Bathing;
(II) Toileting;
(III) Feeding;
(IV) Mobility; or
(V) Dressing.
(ii) The caregiver:
(A) Is a division of developmental disabilities client;
(B) Has a physical or medical problem that interferes with
providing care; or
(C) Has serious mental health or substance abuse problems
and:
(I) Is receiving counseling for these problems; or
(II) Has received or applied for counseling within the past
six months.
(c) Service need level 3: The family is at risk of
significant deterioration which could result in an out-of-home
placement of the client without provision of family support
services due to the following:
(i) The client requires direct physical assistance, above
what is typical for such client's age, in three or more of the
following areas:
(A) Bathing;
(B) Toileting;
(C) Feeding;
(D) Mobility; or
(E) Dressing.
(ii) The client has current behavioral episodes resulting
in:
(A) Physical injury to the client or others;
(B) Substantial damage to property; and/or
(C) Chronic sleep pattern disturbances or chronic continuous
screaming behavior.
(iii) The client has medical problems requiring substantial
extra care; and/or
(iv) The family is:
(A) Experiencing acute and/or chronic stress;
(B) Has acute or chronic physical limitations; or
(C) Has acute or chronic mental or emotional limitations.
(d) Service need level 4: Family needs temporary or ongoing
services in order to:
(i) Receive support to relieve and/or prevent stress of
caregiver/family; or
(ii) Enhance the current functioning of the family.
(3) The department, through regional review committees,
shall determine service need level of the client's service
request by reviewing information received from the client,
family, and other sources about:
(a) Whether client is an active recipient of services from
the division of children and family services or adult protective
services;
(b) Whether indicators of risk of out-of-home placement
exist, and the imminence of such an event. The department's
assessment of such risk may include:
(i) Review of family's requests for placement;
(ii) History of family's involvement with children's
protective services or adult protective services;
(iii) Client's current adjustment;
(iv) Parental history of psychiatric hospitalization;
(v) Clinical assessment of family's condition; and
(vi) Statements from other professionals.
(c) Caregiver conditions, such as acute and/or chronic:
(i) Stress;
(ii) Physical limitations; and
(iii) Mental and/or emotional impairments.
(d) Client's need for intense medical, physical, or
behavioral support;
(e) Family's ability to use typical community resources;
(f) Availability of private, local, state, or federal
resources to help meet the need for family support;
(g) Severity and chronicity of family or client problems;
and
(h) Degree to which family support services will:
(i) Ameliorate or alleviate such problems; and
(ii) Reduce the risk of out-of-home placement.
[99-19-104, recodified as § 388-825-256, filed 9/20/99, effective
9/20/99. Statutory Authority: RCW 71A.12.030, 71A.12.040 and
Title 71A RCW. 97-13-051, § 275-27-223, filed 6/13/97, effective
7/14/97. Statutory Authority: RCW 71A.12.040 and 43.43.745. 94-04-092 (Order 3702), § 275-27-223, filed 2/1/94, effective
3/4/94. Statutory Authority: RCW 71A.12.040. 92-09-114 (Order
3372), § 275-27-223, filed 4/21/92, effective 5/22/92. Statutory
Authority: RCW 71.20.070. 88-05-004 (Order 2596), § 275-27-223,
filed 2/5/88.]