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Iowa Department of Human Services / CMH Waiver
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Serious Emotional Disturbance (SED) Defined
A serious emotional disturbance disrupts the daily functioning of children in the home, school, and community and affects one in ten young people nationwide.  The suspected causes of serious mental health disturbances are complicated and are attributed to the combination of biology and environment.

Children with a SED display unusual behaviors which are symptoms of an illness.  Serious emotional disturbances are diagnosed by a psychiatrist, psychologist or other mental health professional.  Some common childhood SEDs might include anxiety and mood disorders (depression), attention deficit and disruptive disorders, elimination disorders or eating disorders.  According to the Governor’s Healthy Iowans 2010 report, the incidence of SED among children is 10-12% (or as many as 85,000 children). The report also says, “Often thought of as an adult health problem, mental illness constitutes one of the greatest threats to the health and well being of children and adolescents. The good news is…mental illness is highly treatable” (Ch-12, p.1).

Children with serious emotional disorders may suffer more severely than adults with the same disorders.  The Surgeon General’s Report on Mental health said it well - “The science is challenging because of the ongoing process of development. The normally developing child hardly stays the same long enough to make stable measurements.”  

The Substance Abuse and Mental Health Services Administration has a wealth of resources available.  For instance, The Child and Mental Health Fact Sheet is a great place to start.  You can learn why mental health is important, what children with SED may experience, and see a list of other publications with important messages about children and adolescent mental health needs.

Viewing SEDs From Within The Children's Mental Health (CMH) Waiver
Serious emotional disturbance means: a diagnosable mental, behavioral, or emotional disorder that is of sufficient duration to meet diagnostic criteria for the disorder specified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) and has resulted in a functional impairment that substantially interferes with or limits a child’s role or functioning in family, school, or community activities.  Serious emotional disturbances do not include developmental disorders, substance-related disorders, or conditions or problems classified in the DSM-IV-TR as “other conditions that may be a focus of clinical attention (V-codes) unless they co-occur with another diagnosable serious emotional disturbance.”

Services provided under the Children’s Mental Health (CMH) Waiver must be individualized to meet the needs of each child. Service planning gives consideration to the child and family’s concerns for the child’s success in their peer group, school and community activities. 

The interdisciplinary team (IDT) determines what services will be provided. The services are planned with sensitivity to the child’s age, gender, race, ethnicity and culture.  The dollar amount of the services is based on an allowable maximum per month and/or the allowable maximum expenditure for each child in any single year.

The following requirements must be met for a child to be eligible for CMH Waiver services.  These requirements are found in IAC 441-83.122(249A).

The child must be under 18 years of age.

The child must be diagnosed with a serious emotional disturbance.

For the initial application to the HCBS CMH Waiver program, documentation that substantiates a mental health diagnosis of serious emotional disturbance as determined by a mental health professional must be current within the 12-month period before the application date.   A mental health professional must complete an annual evaluation that substantiates a mental health diagnosis of serious emotional disturbance. 

Level of Care
The child must be medically certified in need of a level of care that, but for the waiver, would be provided in a psychiatric hospital serving children under the age of 21.  The Iowa Medicaid Enterprise (IME) medical services unit shall certify the consumer’s level of care annually based on the Children’s Mental Health Waiver Assessment (form 470-4211).

Financial Eligibility
The child must be eligible for Medicaid under a SSI, SSI-related, FMAP, or FMAP-related coverage group; or

  • be eligible under the special income level (300 percent) coverage group; or

  • become eligible through application of the institutional deeming rules; or

  • would be eligible for Medicaid if in a medical institution.

For this purpose, deeming of parental or spousal income or resources ceases in the month after the month of application.

Choice of Program
The child must choose HCBS CMH Waiver services over institutional care.  This is indicated by the signature of the child’s parent or legal guardian on the Children’s Mental Health Waiver Assessment (form 470-4211).

Need for Service
The child must have service needs that can be met under the CMH Waiver, as documented in the service plan developed in accordance with IAC 441-83.127(249A).  The child must be a recipient of targeted case management services or be identified to receive targeted case management services immediately following program enrollment.

Who May Provide CMH Waiver Services?
Providers who are qualified to participate in the Children’s Mental Health waiver are approved based on the standards pertaining to each service component.  Follow the links below to view the standards for qualification as a CMH Waiver provider as found in IAC 441-77.46(249A).

  • Environmental modifications, adaptive devices and therapeutic resources providers - IAC 441-77.46(2)

  • Family and community support services - IAC 441-77.46(3)

  • In-home family therapy providers - IAC 441-77.46(4)

  • Respite care service providers - IAC 441-77.46(5)

You can learn more about getting started as a CMH Waiver provider within this website as well.

Linking Services to Children, Providers and Evidence-Based Practice (EBP)
Researchers are learning more about how a child’s rapidly developing brain complicates identifying what are best practices.  The definition of evidence-based practice is still being debated.  Practices that have been studied using scientific research methods and resulted in better outcomes for children have an evidence base.  On this website we may someday be able to point to specific evidence-based practices and say "yes, these are the ones to use."  However, we are not there yet though we can offer you links to research and organizations that are bringing us closer to that day.

Services designed for adults may not be the method of choice for a child.  We invite you to visit our Internet Links page and discover more about evidence-based practices for children.  But don’t stop there - follow the links to additional resources and webs.


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This page last updated: 4/18/2007

Copyright 2002 - 2007 ~ Iowa State University, Child Welfare Research and Training Project for the Iowa Department of Human Services

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