July 2012
Dear Parent or Legal Guardian:
Thank you for your interest in NAMI Maine’s Respite Services Program. This program is funded by the Department of Health & Human Services (DHHS) and is designed to give families of children with special needs planned breaks. Upon completion of the application process, your family may be allotted up to 16 hours per month for planned respite service, as long as funding remains available.
If you are a returning respite family, please understand there are changes to the program including;
· All respite providers must obtain certification by 1/1/2013
· For some families, a co-pay must be charged based on income guidelines
· Families must complete satisfaction surveys at the end of each respite experience as required by DHHS
· Respite providers will be employees of NAMI Maine and subject to the policies, procedures and supervision of the agency
· Respite services are no longer available to anyone 18 years old or older
Enclosed in this initial application packet is the first set of forms to be completed in order to apply for respite services. Some of the enclosed forms must be completed for each child for whom you are applying for services. Please make sure all original forms are completed and returned to ensure a speedy process. Please send the original documents – not photocopies.
Please use the following checklist to make sure you have included everything that is required. These forms are also available electronically at www.NAMIMaine.org. Missing or incomplete information will result in delays so please contact NAMI Maine if you have questions.
Family Application includes:
□ Respite Care Services Application (complete all sections)
□ Determination of Fee Form (include supporting documentation)
□ Child Application Section (separate form for each child being served)
□ Family Report Form
Thank you for your inquiry. If you have further questions, please feel free to call NAMI Maine or email us at .
Sincerely,
Carol Carothers, LCPC, LADC
Executive Director