Form 2260, LIDDA Permanency Planning Instrument (PPI) for Children Younger Than 22 Years, Family Directed Plan

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Documents

Effective Date: 4/2025

Instructions

Updated: 4/2025

Procedure

When to Prepare

The LIDDA must use Form 2260 to conduct initial permanency planning at the time of the person’s enrollment or admission.

Subsequent permanency plan reviews must use Form 2260 and be completed within six months of the previous review.

Transmittal and Responsibilities

LIDDA staff must complete initial permanency plans and enter them into CARE within 10 calendar days after meeting with the person and family or legally authorized representative (LAR). Permanency plan reviews must be entered into CARE within 10 calendar days after the review date.

Responsibilities of the permanency planner include:

  • Waiver interest lists. Make sure the child or young adult’s name is on appropriate waiver interest lists.
  • Documents to families or LARs. Provide and review A Message for Families document with the person and family or LAR.
  • Distribution of copies. Provide copies of the permanency plan to the person and family or LAR and to the facility.
  • Submit plans for children younger than 10 to IDD_Program_Improvement@hhs.texas.gov for review and approval.

Detailed Instructions

A. Type of Review, choose one – Select initial or six-month.  Note: The Six-Month Second Level Review must be reviewed and approved by a supervisor or director. See Section Q.

B. Identifying Information

Person's First, Middle and Last Name – Enter the person’s full name.

Medicaid No., Client ID – Enter the person’s Medicaid number.

Person’s Social Security No. – Enter the person’s Social Security number.

Date of Birth – Enter the person’s date of birth.

Person’s Age – Enter the person’s age.

Facility Admission Date – Enter the date the person was admitted to the current facility, such as an intermediate care facility for persons with an intellectual disability or related conditions (ICF/IID), state supported living center (SSLC), nursing facility or Home and Community-based Services (HCS) supervised living or residential support.

Local Intellectual and Developmental Disability Authority (LIDDA) Comp Code, Component – Enter the component code for the LIDDA.

Local Case No. – Enter the person’s unique local case number assigned by the LIDDA.

Review Date – Enter the date of the permanency planning meeting.

Facility Name – Enter the facility name.

Facility Physical Address – Enter the facility street address, city, state and ZIP Code.

Name of Facility Contact – Enter the facility contact’s name.

Facility Contact Area Code and Phone No. – Enter the facility contact’s area code and phone number.

Family or Legally Authorized Representative (LAR) Name – Enter the name of a family member or LAR.

Family or LAR Area Code and Phone No. – Enter the family member’s or LAR’s area code and phone number.

Facility Name – Enter the address for the family member or LAR facility name.

C. PPI completed based on, mark all that apply – Check all that indicate applicable sources of information used to develop the plan.

D. PPI Completed By – Enter the name, agency or affiliation, email address and area code and phone number of the person who completes the form.

E. Information about the Person

  1. Describe the person. Include their personality characteristics, attributes, likes, dislikes, behavior and reaction to others. Do not use jargon, technical terms or acronyms. – Provide a narrative that documents direct observations, paraphrases and quotes of informants, and facts from records. Include personal observations of the child or young adult and comments by them and others who provided information. Address each of the following:
  • Description – Include age, sex, ethnicity, physical appearance, communication methods and mobility methods.
  • Personality characteristics and attributes – Include descriptors of general disposition, temperament, activity level and alertness to environment.
  • Likes and dislikes – Include what the person identifies, other indicators and the source, such as informants’ reports, and what is evident from observations of the person and their environment.
  • Behavior and reactions to others – Include how the person generally interacts with others and under unusual circumstances, particularly pleasant or stressful situations.
  1. Level of intellectual disability, choose one – Check the appropriate description.
  2. Sensory impairments, mark all that apply – Check vision, hearing or both.
  3. Related condition diagnosed by a licensed physician if applicable – Enter a diagnosis by a licensed physician based on documentation that attests the condition occurred before age 22 and resulted in substantial functional limitations in at least three of six major life skill areas. For more information refer to the Approved Diagnostic Codes for Persons with Related Conditions.
  4. Personal care needs – Identify the level of independence or assistance needed for activities of daily living, such as eating, dressing, grooming and toileting.
  5. Communication methods – Identify the means of communication used, such as verbal, facial expressions, gestures, signs or use of devices, fluency and levels of comprehension by persons both familiar and unfamiliar with the person.
  6. Mobility methods –  Identify the means of mobility, level of assistance needed, use of devices and circumstances where devices or assistance are needed.
  7. Ability to self-direct – Identify the person’s level of ability to understand their own needs, express wishes, and execute or direct others to execute preferences and choices.

F. Physical Health

  1. Height – Enter the person’s height.
  2. Weight – Enter the person’s weight.
  3. Person has a feeding tube – Select Yes or No.
  4. Person is ventilator dependent – Select Yes or No.

G. Current Physical Health Conditions – Enter the diagnoses for all current health conditions. Check Yes for any that require medication or professional evaluation, treatment, medical judgment or monitoring. In additional information, briefly describe the interventions in everyday language, such as type of treatment or medical equipment, positioning device, therapy. Do not use abbreviations without explanations.

H. Current Behavioral Health Conditions – Describe the mental health diagnoses or behavioral needs. Select Yes for any that require medication or professional evaluation, treatment, behavioral support strategies, counseling, therapy or monitoring. In additional information, describe the nature of the needed interventions in everyday language, such as type of therapy, clinical treatment or behavioral supports.

I.  Medical History – Describe any other health information or history not covered elsewhere on the form that should be known and discussed before a person moves out of the facility.

J.  Person’s Pre-placement History

  1. Describe the circumstances that first prompted the family to seek a living situation for the person outside the family home. – Provide details about the family’s or LAR’s situation when placement out of the family or LAR home was sought. The circumstances should include those related to the person’s disability, such as housing that could not accommodate a wheelchair, family discomfort with medical or mental health needs. Also provide details of any circumstances unrelated to the disability that may have affected caring for the child, such as poverty, rural location, number or age of other siblings, parent illness or disability.
  2. What help and support did the family receive to care for the person at home and who provided the help? What did and did not work? – Provide details about the services and supports the family or LAR needed when the child or young adult was living with their  family or LAR and of those, which were and were not received
  3. Reasons that led to the person’s initial facility placement, mark all that apply – Check the reasons as appropriate to the child or young adult’s history.
  4. Beginning with the first out-of-home placement, list all placement settings in chronological order. Include any interim placements in foster care or the family home.
  • Placement Setting – Enter the name of the facility, agency or provider if applicable.
  • Dates Placement Began and Ended – Indicate the actual dates of admission and discharge if known. If unknown, indicate the closest approximation. Make sure the dates cover all time periods following the first out-of-home placement to present.
  • Type of Facility – Identify the setting as an ICF/IID, SSLC, nursing facility, HCS supported living arrangement, foster home, residential treatment setting, Child Protective Services facility or other residential facility. Temporary hospitalizations, both medical and psychiatric, are not considered residences, but may be noted if the person had an extended stay, such as 30 days, and lost residential placement during the hospitalization.
  • Reason Placement Ended Provide a brief explanation for movement.

K. Person’s Relationships with Family or LAR and Significant Others

  1. If the person has been living outside the family home, what has been the family’s pattern of interaction with the person? For example, number of visits to the facility and back home, outings, letters and phone calls – Identify interactions, participation and availability of the responsible decision-maker, family members and significant others.

Pattern of interaction – Describe the extent of the family's or LAR's interaction with the person in the current facility. Identify impediments to the family's or LAR's interaction including distance from the facility or transportation problems. Provide details about the level and frequency of the following interaction over the past six months:

  • Contact frequency by family or LAR, such as new admission, daily, weekly, monthly, one to three times per quarter or none;
  • Number of visits by the family or LAR during the last six months;
  • Number of visits by the person to the family’s or LAR’s home during the last six months;
  • The family’s or LAR's expectations for ongoing interaction; and

  • Any discrepancies between the family’s or LAR’s report of visits and the facility’s report of visits.

    Participation in permanency and service planning – Describe the extent of participation in service planning by the family or LAR within the past six months, including participation in meetings in person, by phone, via email or through another means of communication. Provide details about the frequency and types of participation in planning. Indicate:

  • Family or LAR participation in the development of a service plan within the past six months;
  • Family or LAR participation in permanency planning;
  • If the family has been located in the last six months;
  • If the family or LAR responded in the last six months to requests for participation in permanency planning, annual meetings to discuss the plan of care or when medical consents were needed;
  • The family’s or LAR's expectations for participation; and

  • The family’s or LAR's participation in any prior residential settings.

    Available to the facility – Describe the extent to which the family or LAR has been responsive to the facility. Responsive means the family or LAR responded in a timely manner to the facility’s requests and provided input either verbally or in writing.

  • If the family or LAR has not visited, provide details about any factors that may contribute to the lack of visits, such as distance, lack of reliable transportation or inability to afford transportation. Where distance is a factor, identify the miles from the family’s or LAR’s home to the facility and the time it would take to travel.
  • If the family or LAR indicates unwillingness to participate in permanency planning, provide details.
  • If the family or LAR is unavailable to the facility, indicate the steps taken to follow reporting requirements.
  1. Has the family participated in service planning with the facility within the past year and been available to the facility when they were needed for medical or other decisions? –  Check Yes or No.
  2. Identify the people in the person's life, including current and past caregivers, service providers or others, with whom the person has or has had a significant relationship of affection and attachment. Describe the nature, duration and continuity of each relationship and potential for sustaining each relationship. – Identify relationships with family members, including immediate family and extended family. Identify relationships with significant others, including people who are currently part of the person’s life and those who have been important in the past. Be alert to relationships with both current and past caregivers or service providers that have extended beyond employment responsibilities. Especially be aware of those who provide an opportunity to become an alternate family. Determine how the person knows the identified person, such as a blood or step relative or through a previous placement or service, how long the relationship has existed, and if the relationship has been continuous or has been interrupted by periods without contact.

L. Goals for the Future

  1. Choose one – Select the goal preferred by the family or LAR. If neither goal is preferred, select the best fit permanency goal the system can work toward on behalf of the person.
  2. Do the LAR and family support accomplishing Goal 1 or 2 within the next year? – Check Yes or No. Family or LAR support of the goal should be interpreted as support for achieving the goal within one year. If the family or LAR does not support movement to one of the family options within the next year, the answer should be No and their views explained in the summary section. The summary section should indicate if there is agreement with a family-based goal but with a longer time frame, or indicate the nature of their lack of agreement with the goal. In the case of a young adult without a guardian, the person’s preference should guide the selection of a goal. The person’s agreement with the goal of a family option should be used to answer the question about support of the goal. For a young adult with a guardian, the guardian’s preference should guide the selection of a goal and the extent of support of a family-based goal. In either case, both party’s preferences should be noted in the summary section.
  3. Do the LAR and family acknowledge an understanding that their legal rights are not lost or negatively affected by choosing a family-based alternative? – Check Yes or No.
  4. Summarize the discussion with LAR and family. Include the LAR’s and family’s level of support for the selected goal; all information on family-based options provided to the LAR and family; family-based options the LAR and family visited or expressed interest in visiting; and any issues, concerns and questions identified by the LAR and family. – Provide details about discussions with the person and family or LAR and describe your understanding of their perspectives. Be sure to address all prompts.

M. Supports Needed to Accomplish Goal 1 or 2 – Mark all that apply and explain each marked item. When identifying supports needed for the person to live successfully in a family or on their own, do not limit the selection only to services with known funding, existing programs or current availability. Identify support needs provided under Medicaid or a waiver program. Include a brief description that is unique to the person’s need for each identified support that indicates why it is needed. Refer to the CARE instructions for definitions of the support categories.

N. Waiver Program Options – Check all that apply and enter the waiver program name if applicable.

O. Action Plan for Next Six Months to Achieve Goal – Enter the task and responsible participant. Actions should reflect steps to achieve movement to a family living arrangement. Actions should take into account the family’s or LAR’s level of agreement with family-based options and the supports needed for the person to live with family or in their own home if an adult. If a goal for family life is not preferred at this time, actions may reflect ways to increase the family’s and LAR’s support of that possibility in the future. Actions may also reflect ways to assist the family or significant others to remain actively engaged while the person remains in the facility. Identify specific activities about:

  • Movement to a preferred family option, return home or move;
  • Continuing or increasing interaction between the person and family members or significant others;
  • Any other action that will further achievement of a permanency goal; and
  • Referrals to achieve a preferred living arrangement other than a family option.

P. Permanency Plan Contributors– Identify all persons who participated in the permanency plan and the person responsible for taking each identified action. Indicate participants in the planning process by entering names and titles or relationships to the person for whom the permanency plan is written. Enter the method(s) and date(s) of each person’s participation.

Q. Permanency Plan Secondary Review and Approval – Any Permanency Plan recommendations that include continued placement in an institution after the initial six-month extension must be reviewed and approved by a secondary reviewer. The secondary reviewer must be a supervisor who has successfully completed the permanency planning training. Entering the supervisor’s name, title and approval date.