Residential Services

Certified Residential Services are offered in integrated settings and support personal power, choice, and full access to the greater community. Supports may vary from a few hours per month up to 24 hours per day of one-on-one support. Supports are based on individual need and the sharing of support within a household. The following are programs that offer Certified Residential Services:

  • Group Training Homes are community based residential facilities serving two or more adults. Individuals pay a participation fee to the provider for room and board. They are certified by Residential Care Services (RCS) as well as being contracted for services with DDA.
  • Group Homes have all of the above criteria as well as being licensed by RCS as an Assisted Living Facility or Adult Family Home.
  • Supported Living services support persons to live in their own homes with one to three other persons and receive instruction and support delivered by contracted service providers. Individuals pay their own rent, food, and other personal expenses.

Community Residential Services include both Alternative Living Services and Companion Home Services, which are provided in typical homes or apartments in the community. 

  • Alternative Living Services are delivered in the clients own home with the goal of providing individualized teaching and training to assist the client gain the skills necessary to be as independent as possible.  Alternative Living may be authorized for up to 40 hours per month.
  • Companion Home Services are delivered in the Companion Home provider’s home with the goal of providing teaching and training to assist the client gain independence while providing access to 24-hour supervision.

Adult Family Home Services and Assisted Living Services are delivered in licensed facilities.

  • Adult Family Home Services are delivered in typical family homes that are licensed by Residential Care Services to support from 2 to 6 clients.  Caregivers provide assistance with individualized care tasks and residents can access support 24 hours per day.
  • Assisted Living Facilities are licensed facilities and may contract with DSHS to provide supports as Adult Residential Care providers or Enhanced Residential Care providers to serve 7 or more clients.  Caregivers provide assistance with individualized care tasks and residents can access on-site support 24 hours per day.

Community Crisis Stabilization Services (CCSS) is a community-based, state-operated, short-term (180-day) program. CCSS provides behavioral health stabilization and intensive supports to children enrolled and eligible for services with DDA who are in crisis and at risk of hospitalization or institutionalization. The program is located in Lakewood Washington. CCSS can serve up to three children at a time.

Community Protection Program offers an array of specialized supports within a supported living model which are designed to assist those individuals that have been identified as a potential risk to the safety of the community. Eligibility for the program is determined by:

  • Regional Committees and is based on a client's history.
  • A formal Risk Assessment which is completed by a qualified professional contracted with DDA.
  • The client's voluntary agreement to participate.
Enhanced Respite Services are planned to provide families with:
  • A break in caregiving
  • The chance for behavioral stabilization of the child
  • The ability to partner with the state to create an individualized service plan.

Enhanced Respite Services are designed to give DDA enrolled children and youth access to short term respite in a DDA contracted, and Division of Licensed Resources (DLR) licensed, staffed residential setting. 

A child or youth may access Enhanced Respite Services a maximum of 30 days in a calendar year.

Mental Health Program offers a broad range of supports for client's that are experiencing a crisis or are at risk of a crisis related to a psychiatric or behavioral condition. Services are generally accessed through Regional Clinical Teams and may include individualized behavioral supports, medication management or consultation, and temporary residential supports. 

Clinical Teams also will work with medical and mental health services providers (both in-patient, and out-patient) to advocate for appropriate client care and facilitate coordination between MH services with those available through DDA.

Overnight Planned Respite Services (OPRS) is a community-based service for adult clients of DDA who live in the family home. These services offer a break to family members. OPRS offer individualized activities and support for the adult client. Services are provided in a community setting, such as a home or apartment staffed by contracted, certified providers. Each respite setting serves one person at a time, using a person-centered plan developed with the individual and family to create a schedule and activities that meet the person’s needs. The maximum length of stay is fourteen days within a calendar year.

Voluntary Placement Services (VPS) offer an array of services to a child living in a licensed setting outside of the family home. These services are offered in communities throughout Washington. 

Parents keep custody of their child and work in partnership with the licensed provider to create a shared parenting model that supports their child and his or her individual, unique needs. VPS engages local communities, service providers, DSHS Children’s Administration, and other stakeholders to partner and coordinate services that support the child.

Residential Habilitation Centers (RHCs) provide support to individuals who need Intermediate Care Facility (ICF) or Nursing Facility (NF) level of care. The ICF level of care includes aggressive, continuous active treatment for individuals with intellectual and developmental disabilities. The ICF level of care assists the individual to become as independent as possible so that they can move to a less restrictive environment. NF level of care provides support and engagement to maintain skills for a better quality of life.

There are four RHCs statewide:

There are also 7 privately run community ICF homes:

  • Lincoln Park in West Seattle
  • Camelot Society has 5 homes between Duvall, Woodinville, and Seattle
  • Rocky Bay Healthcare Facility in Gig Harbor

Medicare Reimbursement Program provides additional benefits to DSHS clients, both by providing additional money and health coverage to DDA RHCs, state psychiatric hospitals and DDA community clients. The program also offsets Medicaid expenditures for clients in these settings. The Medicare Reimbursement Program encompasses the Medicare Part D program and the Disabled Adult Child benefits program.  The Medicare Part D Program collects $8 million to $9 million in annual revenue to offset institutional and Medicaid costs from both DDA and Behavioral Health Administration facilities.

The Disabled Adult Child Program leads a statewide effort to identify and coordinate applications, Railroad, Federal Retirement, Veterans Administration and Medicare benefits from parental benefit claims on behalf of clients.  Program staff work closely with guardians, payees, DDA field services administrators, and DDA case managers to apply for benefits and review DSHS Automated Client Eligibility System to ensure the benefits are correctly applied to the client’s case eligibility when approved.

Private Duty Nursing is a shared program with the Aging and Long-Term Support Administration to provide in home skilled nursing care to Medicaid clients 18 years of age and older who would otherwise be served in an institutional setting.  These services can be provided through a Home Health or Home Care agency or by independent contracted RN’s. Clients must:

  • Meet the Private Duty Nursing rule
  • Require four hours continuous nursing care on a daily basis with complex medical needs
  • Have informal family support

Private Duty Nursing (PDN) hours are determined by DDA for up to 16 hours per day.  PDN can be provided in specialized adult family homes.  

Medically Intensive Nursing provides skilled nursing service to children ages 17 and younger.  These children have complex medical needs that requires a registered nurse to provide support.  Nursing services may be provided in the family home, foster home and in contracted medically intensive children’s group home and staffed residential homes.

Skilled Nursing consists of independent nurses who are contracted with DDA to provide direct care services, consultation and nursing care for chronic long term nursing tasks.

Nurse Delegation is a specific program where a non-nurse legally performs nursing tasks such as giving medication in a client’s home, an adult family home (AFH) or an Assisted Living home, in supported living, group training home or companion homes.  Nurse delegation is where a provider is “delegated” by a registered nurse to provide tasks that are usually performed only by a licensed nurse.  State law requires that when a task is “delegated” specific rules are followed, both by the nurse delegating the care and by the provider who performs the task.  The rules are written by the Nursing Commission, to make sure the public is safe, and that everyone who participates in nurse delegation does it in the same way.

Skin Observation Protocol is the method used to check if there is a potential for a pressure injury. The CARE assessment is completed the skin observation protocol (SOP) may be triggered.  It is the policy for DDA to have the case manager refer to the appropriate nurse or nursing agency that SOP was triggered in CARE.  The nurse must perform a direct skin observation.

Health Home is a network of services that provide coordination of primary, mental health and long-term services and supports.  Health home is focused on serving individuals with one or more chronic health condition who have been determined as frequent utilizers of emergency services and hospitalization, thus identified as high-risk/high-cost Medicaid clients.

Employment and Day supports employment through contractual partnerships with Washington State’s 39 counties. Counties work with multiple, local agencies and partners to provide services to approximately 8,000 individuals receiving employment supports with a goal of integrated employment and minimum wage.

Individual Supported Employment services are a part of an individual’s pathway to employment and are tailored to individual needs, interests, abilities, and promote career development.

  • These are individualized services necessary to help persons with developmental disabilities get and continue integrated employment at or above the state’s minimum wage in the general workforce.
  • These services may include intake, discovery, assessment, job preparation, job marketing, job supports, record keeping and support to maintain a job.

Group Supported Employment services are a part of an individual’s pathway to integrated jobs in typical community employment.  These services are intended to be short-term and:

  • Include the elements outlined in Individual Supported Employment
  • Offer ongoing supervised employment for groups of no more than eight workers with disabilities in the same setting
  • Service outcome is sustained paid employment leading to further career development in integrated employment at or above minimum wage.

Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment in community settings.

Pre-Vocational services (sheltered work) are a part of an individual’s pathway to integrated jobs in typical community employment.  This service category is closed to new clients at this time per the Washington State DDA Centers for Medicare & Medicaid Services transition plan.

  • Pre-Vocational services (often called sheltered workshops because of the segregated setting in which the work takes place) generally provide training and skill development to groups of people with disabilities in the same setting.
  • Services are intended to be short term and include the elements described in Individual Supported Employment.

Community Access services are individualized services provided in typical integrated community settings. Services and activities:

  • Promote the persons’ competence, integration, physical or mental abilities
  • Are for individuals who are 62 or older who have retired or choose to not work after seeking employment for 9 months.
  • Assist individuals to participate in integrated activities, events and organizations in the local community in ways similar to others of similar age.
  • Provide opportunities to develop relationships and to learn, practice and apply skills that result in greater independence and community inclusion.

These services may be authorized instead of employment support (Individual Employment, Group Supported Employment or Pre-Vocational services) for working age individuals (age 21 or older).

Information/Education provides a variety of activities and strategies developed to assure that individuals with developmental disabilities and families have full access to current information about services and supports that will assist them in becoming full participants in their communities.

  • Activities to inform and/or educate the general public about developmental disabilities and related services.
  • These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities.
  • If a County provides Community Information and Education services under additional consumer services, then activities must include outreach efforts to federally recognized local tribes.

Individualized Technical Assistance services provide assessment and consultation to the service provider, client and their support system to identify and address existing barriers to employment.

  • This service provides assessment and consultation to the employment provider to identify and address existing barriers to employment.
  • This is in addition to supports received through supported employment services or pre-vocational services for individuals who have not yet achieved their employment goal.

Child Development Services provide early intervention services designed to meet the needs of a specific child.

  • Birth to three services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child’s development.
  • Services may include specialized instruction, speech-language pathology, occupational therapy, physical therapy, assistive technology, and vision services. Services are provided in natural environments to the maximum extent appropriate.