Home and Community Based Services Waiver
Guidance Document
Division of Children and Families

Policy

An additional aspect of the initial service plan is the development with the family and child of a specific plan to address identified safety issues. The HCBS Waiver Safety Alert Plan is used for this purpose. All ICC agencies are required to use this form. It is essential that the family agree with the components of the plan to better assure compliance. The Safety Alert Plan must be in place for each child and family. All elements on the form must be completed. This must be dated and signed by the child, family member, ICC, ICC supervisor and school representative, if indicated. If a child is unable to sign, the reason is to be stated on the plan. A copy must be given to the family. A Safety Alert Plan is developed with the child and family by completion of the Initial Service Plan. They are reviewed, signed and updated at each Service Plan Review and as needed. A “child–friendly” contract, HCBS Waiver and Child Safety Contract, may be used in addition to the Safety Alert Plan and this may be adapted to each agency’s needs.

Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.