Who's Who:  A Family Guide to Providers
Community-Based Supports & Services

In the State of New Hampshire, there is a stong tradition of supporting individuals with disabilities in their local communities.  The Granite State was the first in the nation to close its institution for citizens with developmental differences and to create an entirely community-based developmental services system.  Similarly, the community mental health system emphasizes outpatient care, recovery, and full community inclusion.

These two systems of care touch the lives of individuals with ASD through a number of programs, specific to the age of the client.  If identified before age 3, children who exhibit signs of developmental delay may receive Early Supports and Services.  Children and Youth at high risk for institutional placement may receive In Home Supports.  Eligible families can also receive respite.  And long-term care can be arranged for adults who experience significant functional limitations due to ASD.  The community mental health system is commonly accessed by individuals with ASD who have a co-morbid mental illness, as well as by some seeking direct instruction in social skills.

New Hampshire's developmental services are delivered by ten regional agencies (the Area Agency System) and a host of other organizations that subcontract with these agencies (known as "private providers"). Community mental health centers were developed along similar lines, with each region of the state assigned to a specific agency.  In a couple of cases (the North Country and the Dover area), a single regional agency has been designated by the state to provide both developmental and mental health services.  Each of these individual agencies is an independent non-profit corporation governed by a volunteer Board of Directors. By law these Boards must include representation from individuals who receive services and family caregivers.
  • Provides one-on-one support, often in accordance with specific learning objectives
  • Facilitates relationships with other community members
  • May accompany and transport an individual to  recreational activities, therapies, doctor  appointments, etc.
  • May assist individual in activities of daily living
  • In the case of ASD, may provide one-on-one behavioral therapy under the direction of a supervision professional (see therapeutic intervention).
  • Should receive training in direct support generally and autism specifically (see resources).
Direct Support Professional
  • Explains goals and requirements of Medicaid funded programs
  • Assists individual or family in monitoring their budget
  • Assists with paperwork and accessing  reimbursment as needed
  • May attend school or other meetings to help insure consistency between community-based and other services

  • Anything you would expect from a friend, family member, volunteer, or neighbor
What They Do
Who They Are
For a printable version of this chart, link here
Natural Supports
Area Agency Case Manager
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Systems of Care, Community-Based Care

The NH Council on Autism Spectrum Disorders
21 S. Fruit Street
Concord, NH  03301

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New Hampshire Council on Autism Spectrum Disorders
Putting the Pieces Together in the Granite State

The vast majority of services provided by the area agencies and the community mental health centers are paid for through the Medicaid program, though private health insurance and philanthropy also play a role. Medicaid is funded jointly by the federal government and the state. In New Hampshire, the cost share is a 50/50 split.  The regulations that govern Medicaid are multi-layered and complex. Moreover, while the NH Department of Health and Human Services has considerable authority over the regional agencies, each remains an independent, non-profit entity, making NH's community care system relatively decentralized. Families often comment on the fact that agencies differ in how they conduct business. This complicates the already difficult task of understanding the services for which one's family member may be eligible.

The links from this page will:
  • Introduce core principles of the Medicaid program
  • Explain available programs and their eligibility requirements
  • Map the two regional systems of care and the private providers that contract with them

Currently both systems of care are undergoing considerable change. In 2011, the state legislature voted to move NH's Medicaid-funded programs to a new service delivery model called "managed care." This is likely to impact those who use Medicaid as their primary form of health insurance and the community mental health agencies first, probably in early fall, 2013. It is less clear how and when the area agencies will be involved.  For all of these reasons, parents must become highly educated consumers in order to effectively advocate for services and supports. 
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