This article was written for our sponsor, Alliance Health.
The Centers for Disease Control and Prevention report that 26.8 percent of adults in North Carolina have some type of intellectual or developmental disability. There are various types of disabilities, and individuals and loved ones dealing with these behavioral health issues represent a vulnerable population that requires unique resources and specialized services.
An intellectual disability is a disability that is characterized by significant limitations in both intellectual functioning and adaptive behavior, as defined by the American Association on Intellectual and Developmental Disabilities.
A developmental disability adversely affects an individual's daily life and ability to function as defined by the N.C. Department of Health and Human Services. A developmental disability can be caused by either a mental or physical impairment, or a combination of both.
Intellectual and developmental disabilities are often referred to in unison as I/DD.
"An intellectual disability is measured through psychological evaluations that look into a person's ability to learn and apply information, and also translate that information into social behavior," explained Jeff Payne, senior director of Care Coordination at Alliance Health, a managed care organization for public behavioral health that serves citizens in Durham, Wake, Cumberland and Johnston counties. "It can be that a person isn't reaching the same benchmarks in school at the same pace as others or something as serious as the inability to physically care for oneself — the scope is vast and wide."
Alliance Health provides help to individuals and families with I/DD based on eligibility, preferences and availability of resources that include:
- Evaluations related to disability
- Access to health care and services
- Independent living programs
- Behavioral health treatment and therapy
Alliance Health also provides help to those with traumatic brain injuries. A TBI, according to the Mayo Clinic, "usually results from a violent blow or jolt to the head or body. An object that penetrates brain tissue, such as a bullet or shattered piece of skull, also can cause traumatic brain injury. Mild TBI may affect your brain cells temporarily."
More serious TBI can result in physical damage to the brain, long-term physical, sensory and cognitive symptoms, or even death.
"TBI can cause serious impairments in areas of cognitive functioning, processing and remembering information, impulse control, and more," Payne added.
"The common thread between intellectual and developmental disabilities and traumatic brain injury is that people who experience these conditions are likely to have need of long-term help or care," Payne continued. "So many of these children or adults require intensive support needs — if they don't have family support, the bigger health system would have to potentially serve them through an institutional setting.
"There are two important Medicaid-funded waivers that we administer for these population groups. The purpose of these waivers is to refrain from sending people to institutional care when it's not necessary, or when their needs can be met in the community safely and well."
The North Carolina Traumatic Brain Injury Waiver is a pilot program at Alliance designed to provide a variety of services for adults with TBI in the home and the community as an alternative to a long-term facility. Services include in-home support, arranging for resources and many more.
When people can afford to, they may pay for the services themselves, however, federal, state and local funds are provided to each county to help pay for services. In order to apply and be eligible for TBI waiver services, individuals must apply for Medicaid.
Additionally, to be eligible for TBI waiver services an individual must:
- Be a resident of Durham, Wake, Cumberland or Johnston counties
- Experience the TBI on or after the age of 22
- Experience effects that are likely to occur for a long time
- Experience effects that resulted in significant challenges completing daily activities
- Need more than one type of rehabilitative service or support
There is also a similar Medicaid-funded waiver program called N.C. Innovations that offers a community-based option for people whose support needs might otherwise require an intensive institutional care setting. A key difference is that children as young as 3 years old who experience a severe, lifelong disability are eligible. Additionally, services tend to be more behaviorally functioned-based rather than rehabilitative.
"It could be anything from a caregiver coming into a family's home and helping teach a skill, like how to make a meal or do laundry, to more functional community-inclusive activities, like how to use the bus system or how to manage personal financial transactions," Payne said. "More sophisticated services for those that are interested include things like supporting people in identifying a job of interest and maintaining it."
Payne emphasized these waivers are designed for people with intensive support needs that will likely require care for a long time.
"There are people who have mild intellectual disabilities, or high-level or high-functioning autism for example, that may not meet the level of care needs that require constant support," he said. "For those with less intensive needs, there are also resources out there for them, which we can help facilitate."
"The Innovations and TBI waivers offer a community-based support option to institutional care," added Doug Fuller, director of communications for Alliance Health. "People living with I/DD and TBI have much to contribute to their communities, and these programs provide some critical resources to families and caregivers to help make this possible."
For more information on the Innovations or TBI waivers, eligibility or how to apply, reach out to the Alliance Access and Information Center at (800) 510-9132 and ask to speak with an I/DD specialist.
This article was written for our sponsor, Alliance Health.