Week Thirteen

At the time of Terrance’s arrested, his mother, Vasha, was starting to get her life on track with help through Mental Health Support services.  Vasha’s "new lease on life” left her with a clearer mind and her counselor was able to provide her with great resources to help get Terrance the services he so desperately needed.  Terrance and Vasha meet with a case manager from the Community Services Board (CSB) who began the process to acquire a Mental Retardation/Intellectual Disabilities (MR/ID) Waiver for Terrance. 

In order to qualify for the MR/ID Waiver, Terrance must meet three categories of eligibility:  Diagnostic Eligibility (i.e. mental retardation diagnosis); Functional Eligibility (i.e. significant needs in at least two of the following categories of the Level of Functioning (LOF) survey: Health Status, Communication, Task Learning Skills, Personal/Self Care, Mobility, Behavior, or Community Living Skills); and Financial Eligibility (i.e. financially eligible for Medicaid).  The availability of waiver services or “slots” as they are more commonly known is very limited.  Even if Terrance was found eligible, he would need to go on one of three waiting lists:  the urgent, non-urgent or planning.  Terrance was found eligible for the MR/ID Waiver.  Since he met the following criteria:

§  has a diagnosis of mental retardation,

§  meets the ICF-MR criteria,

§  needs services within 30 days,

§  is considered to be at significant risk and

§  would accept services immediately if they are offered.

And additionally, even though Vasha was no longer living in the homeless shelter and was making progress with her own life, she was in no condition to care for Terrance.  Vasha, being Terrance’s primary caregiver, falls under the following criteria:  “one primary caregiver, or both caregivers, has a chronic or long-term physical or psychiatric condition or conditions which significantly limits the abilities of the primary caregiver or caregivers to care for the individual with mental retardation” (Office of Mental Retardation Services, 2008).  Due to this additional criterion, Terrance was placed on the Urgent Waiting List. 

It was not long after Terrance was placed on the waiting list that someone moved out of the area, freeing a spot for him.  Fortunately for Terrance, it was determined that he was the most in need and was consequently offered the waiver.  Accepting the waiver, he thereby “waived” his right to be placed into an institutional setting.  A Consumer Service Plan (CSP) which is “the document that addresses needs and desires in all life areas of individuals who receive Mental Retardation Waiver services.  It is comprised of Individual Service Plans, as dictated by the individual’s health care and support needs” (Office of Mental Retardation Services, 2008) was developed for Terrance.  He moved into a group home with 3 other individuals where he was able to live and work with the level of supports necessary to keep him on track and productive.

Vasha would visit Terrance periodically, however as the years when on the visits became fewer and far between.  After Vasha was assaulted and robbed she struggled with increasing depression. When Terrance was 32, Vasha swallowed a bottle of Tylenol with a bottle of her old favorite: Vodka, and was found dead in her apartment by maintenance personnel. It was her 52nd birthday.  Terrance could not fully comprehend exactly what it meant that Vasha was dead and essentially went on with his life like nothing had happened.

Every once in a while Terrance would have serious behavioral issues the exact cause of which eluded the staff at his group home.  On several occasions Terrance’s behavior escalated to the point in which he risked being removed from his group home.  In cases such as this Terrance was able to use the Crisis Stabilization service of his MR/ID waiver.  “Crisis Stabilization is a time-limited service designed to temporarily increase the level of supports to the individual at his time of need to prevent hospitalization or loss of community services. It can be approved in 15-day increments, up to a maximum of 60 days per CSP” (Office of Mental Retardation Services, 2008).

Terrance continues to do well for the most part.  He continues to receive residential support services to help him with daily living, financial issues, etc.  Due to the limitations of Terrance’s condition, he receives multiple federal aids and financial benefits. After contacting the Federal Rehabilitation Services Administration, Terrance was also assigned a local job coach. Terrance’s new coach helped him refine his interpersonal communication skills as well as his hands-on employment skills. After months of training, Terrance finally had the opportunity to employ his new skills at a local restaurant as a busboy. This job provided structure and routine. Although transitioning into the workforce was hard, Terrance found an “employer who was understanding of FASD, had reasonable expectations, and provided a supportive work environment” (Streissguth & Kanter, 1997). Although Terrance’s job does not provide him with the highest salary, he has received something more valuable in return. Terrance now has a supportive group of people surrounding him at all times, even though his peer and social interactions remained fairly poor even with the support that was offered.  He liked having people around but did not initiate the social interaction.