[Reiwa 6th year remuneration revision] 
Explain the points to keep in mind for day services such as after school in Japan!

Supervisor: Tomoaki Takei
English translation of https://www.medical-jpn.jp/hub/ja-jp/blog/dayservice.html

In April 2024, the revision of remuneration for disability welfare services in FY6 of Reiwa came into effect. The revision is based on three basic concepts: 

(1) Community development that realizes the desired community life for persons with disabilities.

(2) Detailed responses to the needs of children with disabilities and people with disabilities in line with changes in society. 

(3) Review of remuneration for the realization of sustainable and high-quality welfare services for people with disabilities.

In this article, we will explain in detail the remuneration for after-school and other day services in support of children with disabilities.

・What are after-school day services?
・Revision of major remuneration 
・Revision of operating standards 
・Individual support plan 
・Conclusion

After-school day services are welfare programs established in April 2012 under the Child Welfare Act, designed for elementary, junior high, and high school students with disabilities, ages 6 to 18. Initially, day-care support services catered to both preschoolers and school-aged children together. However, following the 2012 revision of the Child Welfare Act, these services were split into child development support for preschoolers and day services for school-aged children, such as after-school programs. The after-school day service is available after school, on holidays, and during extended breaks like summer and winter vacations.

In after-school and other day services, an after-school day service plan (individual support plan) is based on a comprehensive understanding of the child's developmental progress, characteristics, and adaptive behavior, providing targeted developmental support.

Based on the child's developmental stage, activities will be conducted to support essential daily life skills, such as cleaning and dressing, as well as fostering independent living. Through play, it will establish a system that encourages children to participate voluntarily and achieve small successes, thereby boosting their self-esteem. 

Students find joy in expressing themselves through activities such as dancing, drawing, and playing musical instruments. By providing opportunities to connect with nature and encouraging curiosity about the changing seasons, a deep sense of awareness and appreciation is cultivated. 

To ensure that experiences are not limited by disability, engagement with the local community by coordinating various learning, experiential, and exchange activities available in the area and by welcoming volunteers. In some instances, social tours may be organized on Saturdays, Sundays, and holidays. 

Students will have the opportunity to play games that they are interested in and select activities, such as exercises, to help them relax. Additionally, depending on the type of job assigned, there are businesses that offer services including rehabilitation, such as occupational therapy (OT) and speech therapy (ST). 

Let's now examine the changes in compensation for after-school and other day services. 

One of the key features of this revision is the implementation of a new time classification system. Before the revision, remuneration credits were allocated based on the end of classes and school holidays, with 604 credits for after classes and 721 credits for school holidays. However, with this revision, the distinction between after classes and school holidays has been removed, and three new categories have been established based on the time utilized. The new divisions are as follows: 

The following considerations should be noted concerning the newly implemented time classifications:

• The time classification is primarily based on the planned time outlined in the individual support plan.
  • In the individual support plan developed by the day service, such as after-school programs, it is essential to establish the planned time, which is the time needed for support, for the daily assistance provided to each child. The basic remuneration is calculated based on the planned time outlined in this individual support plan.
     
• Set a minimum time of 30 minutes
  • Generally, short-term assistance lasting less than 30 minutes is not included in the calculation. However, if brief support is needed to help acclimate to the environment, the planned time in the individual support plan can be set to under 30 minutes with municipal approval. In such cases, remuneration can be calculated even for periods shorter than 30 minutes.
     
• Category 3 “3 hours to 5 hours” is calculated only on school holidays
  • Category 3 of the longest time has the highest unit of basic remuneration, but it is important to note that it can only be calculated on school holidays.

If the planned time, which serves as the basis for calculating remuneration, differs from the actual support time, the response is categorized into the following scenarios.

• When the support time is shortened:

• When the support time becomes longer

However, if the support time is anticipated to be longer due to shortened classes at school or similar reasons, it can be calculated, provided that the specific details of the expected support plan are outlined in the individual support plan and the necessary system is established.

If you utilize day services, such as after-school programs, beyond the designated time category, you will be assessed under the extended support addition system. This system has been revised, and more details will be provided in the "Review of Extended Support Addition" section. 

In this revision, the previous professional support addition and special support addition will be combined. The new system will be assessed in two stages: the professional support system addition, which evaluates systems providing specialized support, and the professional support implementation addition, which assesses the planned implementation of individual and intensive support by specialized personnel.  

The ratings for each are as follows:

One of the key highlights of this revision is the update to the extended support surcharge. Previously, it was calculated when the business site's operating hours, as specified in the regulations, were 8 hours or more, and support was provided outside of these hours. However, as previously mentioned, with the introduction of time divisions in basic remuneration in this revision, the extended support addition has also been re-evaluated.

To qualify for the extended support supplement in this revision, the following requirements must be met.

• In addition to offering developmental support for 3 hours on weekdays and 5 hours on school holidays, support that addresses childcare needs is systematically provided both before and after these periods.

• At least two staff members must be present, one of whom should be assigned according to personnel standards, including a child development support manager.

• The extension time category of 30 minutes or more but less than 1 hour can only be calculated if the extension time is shorter than planned due to the user's convenience.

The new additions for children with disabilities who use day services such as after school are as follows.

The Cooperation Supplement with Related Organizations is an addition aimed at enhancing the quality of services in collaboration with children who use day services, such as after-school programs. Specifically, through meetings about after-school and other day service plans, information will be shared among relevant parties to deepen the understanding of the children. In the recent remuneration revision, a new Cooperation Supplement (III) and an Affiliated Institution Cooperation Supplement (IV) were introduced.

The additional amount for each category is as follows:

Severe behavioral disorder is characterized by behaviors that significantly impact the lives of those around the individual, such as putting non-food items in their mouth, running into the street, exhibiting violence, and breaking objects, occurring with unusually high frequency. The Severe Behavioral Disorder Child Support Supplement is an additional benefit that can be calculated when a service is provided to a child with a severe behavioral disorder by someone who has completed the Severe Behavioral Disorder Supporter Training or Core Human Resource Development Training.  

In this remuneration revision, the number of credits and calculation requirements for supporting children with severe behavioral disorders have been updated. These updates include the need to assign staff with specialized support skills and to develop support plans, all aimed at enhancing support for these children. 

The support units for children with severe behavioral disorders are outlined as follows: 

Medical Japan is hosting the [Elderly Care & Welfare EXPO], where nursing care equipment, systems, welfare products, rehabilitation equipment, and more will be showcased. Additionally, there will be a special [Child Development Support and After-School Day Service Fair], attracting managers, presidents, and leaders from developmental support organizations.

Up to this point, we have discussed the items related to the remuneration revision; however, the operating standards for after-school and other day services have also been updated. Next, the main aspects of the revision of these operating standards. 

This revision has clarified in the operating standards that comprehensive support, encompassing all five areas of support for after-school and other day services, will be provided. The "five areas" are as follows:

1. Health and life
2. Motor and perception
3. Cognition and behavior
4. Language and communication
5. Human relations and social skills

Concerning the content of support, it is requested that the connection to the five areas be clearly defined in the individual support plan at the business site. As there is a requirement to address all five areas, after-school and other day services that focus on specific rehabilitation content may need to review their content and management policies. Therefore, special attention should be given to this aspect.

Inclusion involves the participation of children with disabilities in the community and the community's acceptance of these children. The Ministry of Health, Labour, and Welfare (MHLW) has been evaluating the role and extent of support that day services, including after-school programs, should provide to promote inclusion. 

The following two points are the main points of this revision:

There is now a need for initiatives to advance inclusion, such as transitioning to integrated daycare centers and daycare facilities. Furthermore, individual support plans developed at business sites must now detail specific initiatives and ensure the implementation of those outlined in the plan.

To foster inclusion, the enhancement of childcare and education transition support has also been reassessed.

Depending on the content of the initiative, the following units will be calculated:

The mandatory development of a Business Continuity Plan (BCP) is a key aspect of the revised operating standards. After-school and other day services, which are vital to the lives of the children and families who rely on them, must continue to deliver essential services while implementing countermeasures during unforeseen events, such as the new coronavirus pandemic or earthquakes. With the requirement to formulate a BCP, all business sites are now preparing to maintain service delivery, including establishing a financial foundation. Failure to develop a business continuity plan will result in a penalty, with a 1% deduction from the prescribed number of units. 

Regarding the measures to prevent the abuse of persons with disabilities, which became mandatory starting in FY2022, a 1% deduction from the basic remuneration has been established for workplaces that fail to implement these measures. Establishments that do not meet the following criteria will be subject to this deduction.

• Regularly convene meetings of the Abuse Prevention Committee and ensure that employees are thoroughly informed of the outcomes.

• Provide ongoing training for employees to prevent abuse.

• Designate a responsible individual to effectively oversee the implementation of these measures.

Furthermore, initiatives to eliminate the use of physical restraints have already been established, with a penalty of a 5-credit/day deduction from the prescribed number of units if the criteria are not met. This penalty has been reassessed, and now, if the criteria are not met, a 1% deduction from the prescribed number of units will be applied.

After-school and other day services are already mandated to publish self-evaluations to ensure compliance with the guidelines. However, with the revision of the operating standards, this requirement has been further strengthened.

The following guidelines apply to self-evaluations and guardian evaluations after the review:

• Conduct self-evaluations based on assessments by employees of designated child development support offices, and implement improvements based on parent evaluations.

• At least once a year, parents must be informed of the self-evaluation results, the guardian evaluation, and the specific improvements to be made following the evaluation. This information must also be published online or through other means.

A standard format has been introduced for individual support plans developed at after-school and other day-service offices. These are the "Individual Support Plan Reference Form" and the "Individual Support Plan Reference Form Appendix." Starting in May 2024, all individual support plans must utilize these templates. 

You can access the Individual Support Plan form by downloading it from the Children and Families Agency's website. 

In the newly released Individual Support Plan form, there are items that must now be included for the first time. I will detail each of these items.

For the scheduled time indicated, the plan must exceed the listed duration. As the basic remuneration varies according to the time category, please refer to the previously explained "Establishment of a Time Division in Basic Remuneration." 

The support time should be marked as extended either before or after the scheduled period. The reason for this extension must be detailed in the special notes section. 

Concerning the revision of the operating standards, I have previously explained that "mandatory comprehensive support covering five areas" and "promotion of initiatives for inclusion (new establishment and partial revision of operational support)" are key aspects. However, it is also essential to incorporate these elements into the individual support plan. 

The individual support plan is reviewed at least once every six months, and transitional measures have been put in place to facilitate the shift to the new system. Specifically, the transitional period runs from April 1 to October 31, 2024.  

During this time, you must use the "Appendix to the Individual Support Plan," found on the second page of the attached "Individual Support Plan Reference Form," to establish the planning time and the duration needed for extended support while also coordinating with the current individual support plan. It is essential to obtain the consent of the parent or guardian in the Appendix of the Individual Support Plan by the end of April 2024. 

In this article, we discussed the 2024 updates to remuneration for after-school and other day services, emphasizing the key details of remuneration and operating standards. While all the topics covered are significant, we will highlight the most crucial points individually.

• A particularly important aspect of the operating standards revision is the "Mandatory Comprehensive Support Covering Five Areas." Since it is now required to address all five areas, after-school and other day services that focus on specific rehabilitation content may need to reassess their content and management policies. Additionally, this change is expected to increase operational demands.

• A particularly important aspect of the remuneration revision is the "Establishment of Time Divisions for Basic Remuneration." Previously, remuneration was divided between after-school hours and school holidays, but now three new time divisions have been introduced. This should also be clearly outlined in the individual support plan.

It is essential to understand and adapt to the changes introduced by the revision. Please refer to this article for more information.

After-school and other day services have increasingly become a community resource for children with developmental disabilities in recent years. This revision aligns with current realities, such as adjusting the service unit price based on the number of hours. It ensures the provision of high-quality after-school day services and underscores their social importance.

Medical Japan is hosting the [Elderly Care & Welfare EXPO], where nursing care equipment, systems, welfare products, rehabilitation equipment, and more will be showcased. Additionally, there will be a special [Child Development Support and After-School Day Service Fair], attracting managers, presidents, and leaders from developmental support organizations.