Emotional Disturbance (SED) Defined
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.
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).
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.”
Abuse and Mental Health Services Administration has a wealth
of resources available. For
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.
SEDs From Within The Children's Mental Health (CMH) Waiver
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.”
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.
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
following requirements must be met for a child to be eligible for CMH Waiver
These requirements are found in IAC
The child must be under 18 years of age.
The child must be diagnosed with a serious emotional disturbance.
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.
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).
The child must be eligible for Medicaid under a SSI, SSI-related, FMAP, or
FMAP-related coverage group; or
eligible under the special income level (300 percent) coverage group; or
eligible through application of the institutional deeming rules; or
be eligible for Medicaid if in a medical institution.
this purpose, deeming of parental or spousal income or resources ceases in
the month after the month of application.
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
Mental Health Waiver Assessment (form 470-4211).
child must have service needs that can be met under the CMH Waiver, as
documented in the service plan developed in accordance with IAC
The child must be a recipient of targeted case management
services or be identified to receive targeted case management services
immediately following program enrollment.
May Provide CMH Waiver Services?
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
modifications, adaptive devices and therapeutic resources providers -
and community support services - IAC 441-77.46(3)
family therapy providers - IAC 441-77.46(4)
care service providers - IAC 441-77.46(5)
can learn more about getting
started as a CMH Waiver provider within this website as well.
Services to Children, Providers and Evidence-Based Practice (EBP)
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.
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