Case Studies — Accessibility Navigator

Mary, a 21-year-old student, is preparing to transition out of her specialized educational program (ages 18–22). With her 22nd birthday in three months, she and her IEP team must identify a Day Program aligned with her goals, interests, and support needs.

She met providers at a Transition Fair, and DDS provided an extended list. The team coordinated visits and decided on a program offering:

Day Habilitation (Day Hab) — Therapeutic supports for skill development and personal growth.
CBDS — Activities promoting independence and community integration.
Group Employment — Structured employment with job coaching.

Transportation

PT-1 approval for travel to/from Day Hab; DDS-funded transportation for community and employment activities.

Outcome

Smooth adjustment, growing confidence and independence. CBDS and Group Employment built natural supports and meaningful community participation.

Carlos wanted work but needed more structure than his CBDS program provided. His team submitted a Service Change to DDS for Independent Employment hours.

His plan included job shadowing, resume/interview prep, volunteering, and career assessments.

Transportation

DDS-funded transportation supported interviews, training, and the new job site.

Outcome

Secured a part-time job with continued job coaching — growing independence and financial stability.

Susan has a feeding tube, requires nursing oversight, and needs ADL support with a Hoyer lift. After a Day Habilitation Leveling Tool review and prior authorization under 130 CMR 419.000, her team enrolled her at a Day Habilitation program with the interdisciplinary supports her plan calls for.

Nursing involvement for tube care during program hours
ADL assistance and safe transfers
Structured daily activities tied to her DH service plan

Transportation

PT-1 transportation through the MassHealth HST broker for her region (MART or GATRA).

Outcome

A more consistent daily routine with the clinical supports identified at her PA review.

Exiting school under Chapter 688 with a history of behaviors of concern. The team identified Day Habilitation programs whose interdisciplinary team includes a behavioral professional and where the staffing pattern can support his assessed need at the level set by the DH Leveling Tool and prior authorization.

Day Habilitation enrollment under 130 CMR 419.000 with a behavior plan integrated into his DH service plan.
Plan grounded in DDS Positive Behavior Supports expectations and reviewed under DDS rights protections (115 CMR 5.00 and 115 CMR 3.09 Human Rights Committee).
Behavioral professional involvement with regular data review on the goals in his plan.

Transportation

Transportation arranged through the funding source identified in his plan (MassHealth PT-1 through HST or DDS-funded transport).

Outcome

A gradual transition with rights-anchored supports and clearer team data on progress.

Recently moved to Massachusetts from a state with limited adult services. Looking for a Full-Time Day Habilitation program where she can work on her walking gait with PT and continue communication goals with speech therapy.

Her team explored programs offering:

Daily PT and SLP services onsite
Recreational activities like puzzles and painting
Structured peer interaction in social groups

Transportation

PT-1 rides approved for FTDH program.

Outcome

Walking longer distances with PT support; participating in social activities including painting groups and Bingo. SLP reporting progress on articulation goals.

Refuses to attend his current CBDS program, frequently expressing dissatisfaction and paranoia, sometimes becoming aggressive. His guardian and DDS team agreed it was time to transition him to a more structured, therapeutic Full-Time Day Habilitation program.

His team toured programs offering:

Full-time Day Hab with behavioral clinician onsite
1:1 staffing during adjustment period
Activities tailored to his interests to build trust

Transportation

Due to safety concerns, a specialized DDS transportation vendor with trained escorts was arranged.

Outcome

Improved attendance consistency. His clinician identified preferred calming activities, and data shows reduced incidents of aggression during structured routines.

Enjoys social media but lacks safety awareness online. Her guardians requested a CBDS program focused on technology safety, peer relationships, and boundaries. They do not want her working until she demonstrates improved judgment and digital safety.

Bri toured CBDS-only programs offering:

Weekly lessons on online safety and digital citizenship
Small peer discussion groups on boundaries and friendships
Volunteering in a group setting to build social confidence

Transportation

PT-1 transportation approved by the new day program.

Outcome

Demonstrating better online habits and seeking adult guidance when unsure. Participating in group discussions on boundaries and building peer connections through volunteering at a senior center.

Paul has chronic pain and a G-Tube (NPO status). He reacts strongly to food smells, often becoming aggressive or engaging in SIB. He has attempted to drink unsafe liquids and requires 1:1 eyes-on supervision at all times.

His team is seeking a new program offering:

Strict protocol adherence for G-Tube feedings
BCBA support and behavior data tracking
Staff consistency and low exposure to food items during the day

Transportation

Trained transportation aides through PT-1 authorization.

Outcome

Reduced aggression and reports feeling calmer. Enjoys individualized sensory activities and has expressed appreciation for a quieter space.

Cheerful and enjoys child-like play, frequently bringing toys to program. Her team would like her to expand into more age-appropriate activities while supporting her social growth.

Her ISP team sought a Full-Time Day Hab program with:

Gentle exposure to adult social groups and interests
Support for self-expression in a safe, nonjudgmental setting
Structured, exploratory activities focused on peer engagement

Transportation

PT-1 rides approved by her new program.

Outcome

Participating in music and crafting clubs. Enjoys telling staff about her day and has started initiating conversations with new peers.

Engages in head-hitting SIB behaviors when upset and has a protocol involving helmet use. His team believes that a more engaging schedule will help reduce triggers and self-injury episodes.

Bret toured Day Habilitation programs with:

Smaller groups and low-noise environments
Staff trained in ABA and SIB redirection strategies
Activity choice boards with clear visual supports

Transportation

Transportation with trained staff on behavioral plan through PT-1.

Outcome

Participates in a daily drumming group and sensory crafts. Incidents of head-hitting have decreased, and he wears his helmet less often.

Relocating to a new group home and can no longer commute to his current day program. He is seeking a blended CBDS and Day Hab program close to his new residence and needs a gradual transition schedule.

His team created a soft-start plan and toured programs offering:

Progressive weekly attendance increase from 2 to 5 days
Peer mentor assignments to help him adjust
Dedicated support for building peer relationships

Transportation

PT-1 transportation arranged with coordination between the program and group home for pick-up and drop-off times.

Outcome

Begun making friends and participates in board game groups. Now attends 5 days a week and no longer clings to staff for social comfort.

Exhibits attention-seeking behaviors and emotional dysregulation. Her current program is not supportive, and she is unaware that peers often bully her. Her team agrees that a fresh start after 15 years is needed.

Her team found a blended program offering:

Social coaching and emotional expression activities
Bullying prevention and staff-led peer modeling
Rotating weekly activities to maintain engagement

Transportation

PT-1 rides continued with her new route updated through MassHealth.

Outcome

Made new friends and enjoys staff-led yoga and journaling groups. Reports feeling happier and more included at her new program.

Enjoys cooking and baking but her current program cut those activities due to staffing. The daily schedule has become repetitive and lacks enrichment. Her team is searching for a CBDS/DH program that supports her hobbies and adds variety.

The team explored programs offering:

Hands-on cooking classes and food prep labs
Volunteering in local kitchens and senior centers
New weekly clubs and peer-led hobby groups

Transportation

PT-1 transportation approved by her new program.

Outcome

Now bakes weekly with her peers and leads a snack group. Says the new activities make her feel proud and helpful.

Spends most of his time doing sensory-based activities, which he enjoys. However, his team is concerned about a lack of communication skill development and access to therapeutic services. His current program does not have OT, PT, SLP, or BCBA on staff.

Jose's team sought a program offering:

Therapists (SLP, OT, PT, BCBA) employed onsite with ongoing service delivery
Structured sensory stations with communication goal prompts
Social skills and AAC integration support

Transportation

PT-1 transportation approved, with the new provider trained on his communication device.

Outcome

Works with his SLP three times a week and is using picture cards to make snack and break choices. His sensory needs are still supported, but with more skill-building embedded throughout the day.