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Our unit determines whether
consumers are eligible for Mental Retardation Division Services through
the MHMRA of Harris County. The eligibility determination process includes
three (3) parts:
- A financial eligibility
assessment with a financial counselor to explain MHMRA financial policies
and to determine whether co-payments or other fees apply and whether
MHMRA is a part of your Insurance Provider Network.
- A diagnostic assessment
is performed by a Licensed Psychologist or a psychologist certified
by the Department of Aging and Disabilities Services (DADS) to perform
a Determination of Mental Retardation (DMR) in accordance with the "Diagnostic
Eligibility Rule" (formerly "The DMR Rule"). The DMR
Rule is published in the Texas Administrative Code, Title 40, Part I,
Chapter 5, Subchapter D.
- An intake interview with
a staff member called an Eligibility Coordinator to explain consumer
rights, programs and services and to obtain needed consents.
Any Harris County resident who is at least three years
of age and is believed to have one or more of the following may apply
for a DMR evaluation:
- Mental Retardation
- Pervasive Developmental Disorder: Autistic Disorder,
Asperger's Disorder, Rett's Disorder, Childhood Disintegrative Disorder
or Pervasive Developmental Disorder-NOS.
WHAT
IS MENTAL RETARDATION?
Mental Retardation is a developmental disability that is expected
to be lifelong and to require ongoing services. The DMR rule defines
Mental Retardation as "Significantly subaverage general intellectual
functioning existing concurrently with deficits in adaptive behavior
and manifested during the developmental period (birth to 18 years
of age.)"
WHAT
IS A PERVASIVE DEVELOPMENTAL DISORDER?
Pervasive Developmental Disorders are a class of developmental disorders
that are also expected to be lifelong and to require ongoing services
similar to those needed by persons with mental retardation. The Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV) states that:
"Pervasive Developmental
Disorders are characterized by severe and pervasive impairment in
several areas of development: reciprocal social interaction skills,
communication skills, or the presence of stereotyped behavior, interests
and activities."
Autistic Disorder is probably
the most familiar of the Pervasive Developmental Disorders. Mental
Retardation and other developmental disorders are frequently seen
together in the same consumer. For example, the DSM IV-R states that
75% of children with Autistic Disorder function intellectually in
the range of mental retardation.
The parent, legal guardian,
primary caregiver or consumer may request a DMR by calling the MHMRA of
Harris County Help Line (713-970-7070).
The information you provide is forwarded to the MR Eligibility Center
and you will be contacted by a Consumer Services Assistant who will ask
for more detailed information, explain the intake process and explain
what documentation is needed. An Eligibility Coordinator will also be
assigned to assist you through the intake process.
Consumers provide their own
transportation to and from the DMR appointment. In special cases, consumers
may be able to make transportation arrangements by contacting Metrolift
or Red Cross.
There is no cost for the DMR
evaluation or to meet with the eligibility coordinator.
You will meet with a financial
counselor who will determine whether there would be co-payments or other
fees for other mental retardation services. The financial counselor will
review your insurance and determine whether MHMRA is a part of your Insurance
Provider Network.
All persons accessing MHMRA
services must provide financial and demographic documentation at the initial
appointment and annually thereafter or as financial status changes. If
the necessary documents are not presented at the initial appointment then
your appointment will be rescheduled, in order that the required documents
may be obtained.
- STEP
1: To request an eligibility determination, call the MHMRA
Help Line at (713) 970-7070 and tell them you would like to apply for
mental retardation services. The Help Line will take your information
and send a referral for you to the MR Eligibility Center.
- STEP
2: When the referral is received, an MR Eligibility Center
representative will contact you to verify demographic information and
provide explain the Intake/DMR process and the documents you will need.
- STEP
3: An Eligibility Coordinator is also assigned to provide
additional information and assistance and to meet with you during the
intake process. The Eligibility Coordinator will schedule the Intake/DMR
when copies of past assessments have been received.
- STEP
4: The Intake will include the financial eligibility assessment
and an interview with a psychologist to determine if further evaluations
are needed and an interview with an Eligibility Coordinator.
- STEP
5: If you are found eligible for MR services, the Eligibility
Coordinator will make a referral to a Service Coordinator who will begin
the service planning process.
The DMR evaluation is conducted
by a DMR Certified Psychologist or Licensed Psychologist and typically
consists of the following:
- Review
of Past Testing: The psychologist will review previous evaluation
reports to help understand the individual's historic levels of functioning.
The review of past testing may also reveal improving or declining levels
of functioning over time. Previous test results are also used to verify
that the diagnostic criteria for Mental Retardation existed before 18
years of age.
- Interview:
This typically includes the consumer and caregiver. The psychologist
will usually ask about developmental history, family history, educational
history, physical/medical problems, psychiatric history, problem behaviors,
services needed and other concerns the family and consumer have.
- Adaptive
Behavior Assessment: The psychologist administers an adaptive
behavior assessment. The adaptive behavior assessment is performed by
interviewing a person who is familiar with the consumer's communication,
self-help and social skills. The individual's adaptive behavior level
is then compared to what is typically expected of persons in his or
her age group to determine if the individual's adaptive behavior level
falls within the range of mental retardation.
- Intellectual
Assessment: The psychologist administers an intelligence
test (IQ test) to determine if the individual's level of intellectual
functioning falls within the range of mental retardation. The IQ test
is given to the individual directly and requires the individual to solve
a variety of problems that measure reasoning abilities.
- Other
Assessments: The psychologist may administer other assessments
on an as needed basis to aid in the diagnosis of Autism or other Pervasive
Developmental Disorders.
DOCUMENTATION
REQUIRED FOR THE FINANCIAL ASSESSMENT
- Proof of residency for
Harris County (Utility bills or a tax statement)
- Proof of your income
(Pay check stub, IRS W-2 form (for consumer if 18
years of age or older, for parent/guardian if under 18 years of
age)
- Any extraordinary expenses
- The number of family
members
- Proof of any insurance
coverage (Medicaid, SSI, or other insurance card)
- Proof of Guardianship
or Power Of Attorney (If you are the individual's
Legal Guardian, bring a copy of the current guardianship letter
from the court. If you have been given Power of Attorney to consent
for treatment for the individual, bring a copy of the Power of Attorney.)
- Copies of Previous Evaluation
Reports (If the individual has received Special Education
services, send copies of their Full Individual Evaluations (FIE's)
and Comprehensive Individual Assessments (CIA's) ahead of time for
review. You will need to request both FIE's and CIA's because FIE's
have only been done since about the year 2000. Prior to that, the
evaluations were called CIA's (see Terminology section below). If
you do not have copies of these evaluations, you may be able to
get them from the school. Also, send copies of any other evaluations,
including psychological evaluations by private psychologists, and
other agencies medical and developmental evaluations.)
DOCUMENTATION
REQUIRED FOR THE DMR
- If the individual has
received Special Education services, you will need to obtain copies
of their Full Individual Evaluations (FIE's) and Comprehensive Individual
Assessments (CIA's) for review by the psychologist.
- Copies of any other
evaluations, including psychological evaluations by private psychologists,
and other agencies medical and developmental evaluations.
- Proof of Guardianship
or Power Of Attorney: If you are the individual's Legal Guardian,
bring a copy of the current guardianship letter from the court.
If you have been given Power of Attorney to consent for treatment
for the individual, bring a copy of the Power of Attorney.
Legal
Guardian: It is
important for parents and others who were given guardianship of minor
children to understand that they are not automatically the legal guardians,
even of their own child, once that child becomes an adult on the child’s
18th birthday. This is true regardless of how severely
impaired their child may be. A legal guardian has legal authority
to make certain decisions on behalf of another person, whether that
other person agrees with those decisions or not. Most people with
mental retardation do not need legal guardians. However, for those
who do, in order to be the legal guardian of anyone 18 years of age
or older, a hearing must be held in a probate court to determine the
extent to which the person who is said to need a guardian is capable
of managing his or her own affairs. The court will then determine
if that person needs a guardian and what decisions the guardian may
make on behalf of that person. Once a guardian has been appointed,
the court will set the length of time before the guardianship has
to be renewed. In other words, guardianships must be kept current,
or they will expire at the end of the time specified by the
court for renewal. Once a person reaches her or his 18th
birthday, only someone with power of attorney or a legal guardian
may request the consumer’s school records, for example. A power of
attorney is not the same thing as a legal guardianship (see "Power
Of Attorney" below). To learn more about guardianship you may
call any of the Harris County Probate Court offices:
- Court No1: 713-755-6084
- Court No2: 713-755-6090
- Court No3: 713-755-6953
- Court No4: 713-755-5959
Power
Of Attorney: Most
people with mental retardation do not need a guardian. These consumers
typically need someone who can help them with certain tasks and responsibilities
they cannot handle on their own. A power of attorney is a simple and
relatively inexpensive way for caregivers to assist a consumer with
mental retardation who does not need a guardian. The power of attorney
is a document stating that the consumer gives her or his consent for
another person to do certain things on her or his behalf. These could
include handling finances, requesting school records, applying for
government assistance, making doctor’s appointments, and the like.
The power of attorney is given voluntarily and can be revoked by the
person granting it at any time.
Full
Individual Evaluation (FIE): Previously, this
evaluation was known as a CIA (see below). Texas public schools changed
the name from CIA to FIE several years ago. An FIE is an evaluation
conducted by professionals in order to determine whether a student
qualifies for special education services and to identify areas of
strength and need. The FIE consists of evaluations in the following
seven areas:
- Reason for referral
- Speech and language
- Physical
- Sociological
- Emotional
- Intelligence (IQ testing)
and adaptive behavior
- Academic achievement
The
FIE is conducted every 3 years for special education students. The
school may elect not to perform new testing every time an FIE is
due. However, the parent may disagree and ask that new testing be
performed.
Comprehensive
Individual Assessment (CIA):
This is an obsolete
designation and was replaced by the "Full Individual Evaluation"
(see above).
Admission,
Review and Dismissal (ARD):
A meeting involving
school personnel, assessment professionals, the student and parents
for purposes of educational placement, program planning and to address
other needs or difficulties the student has. An ARD report is written
after the meeting and the student/parent receive a copy. ARD reports
usually do NOT contain test results.
Individual
Education Plan (IEP):
A written educational
program plan that spells out instructional goals and objectives and
the criteria for mastery. The IEP is developed based on information
supplied by the FIE and input from ARD committee members. The student
and/or parents receive a copy of the IEP. An IEP usually does NOT
contain test results.
State
Audit Folder: The Texas Education Agency (TEA)
requires the school to maintain copies of the student’s special education
documents, including CIA’s, FIE’s, ARD reports and IEP’s in a file
called a State Audit Folder. School personnel may have to go to the
State Audit Folder to retrieve copies of older documents. Records
in the State Audit Folder must be retained for at least 5 years after
a student graduates or leaves the school district.
Texas
Education Agency (TEA): The state agency that
regulates the public school system in the State of Texas. Problems
that cannot be resolved with the school or school district itself
can be appealed to the TEA.
The discussion that follows
focuses on school records; however, it applies equally to confidential
records of any sort.
- The parent/legal guardian
of a minor child has a legal right to review and obtain copies of
their child's special education records. The school cannot legally
refuse to release copies of CIA's, FIE's, ARD reports or IEP's to
the parent/legal guardian of a minor child.
- Once a student has passed
his or her 18th birthday, she or he is automatically considered to
be a legally competent adult. In order to respect the consumer's right
to confidentiality, at the age of majority (18 years of age) the school
can require the now legally-competent adult student to give written
consent to release records, even to the consumer's parent. Once the
consumer reaches 18 years of age, the parent is no longer legally
entitled to obtain school records , unless the parent has one of the
following:
- Power of attorney
- Legal guardianship
- Written consent from
their son or daughter to do so
- The school must have written
consent from the proper person in order to release records to MHMRA
of Harris County. The following people may give consent to the school
to release information to MHMRA of Harris County.
- The parent or guardian
of a minor child
- For consumers 18 years
of age and older:
- The consumer himself
or herself
- A person with power
of attorney
- A consumer's legal
guardian if she or he has one
- Anyone authorized to obtain
school records must use a "consent for release of information"
form in order to have records released directly from the school to
MHMRA. It makes no difference whether the form used is an MHMRA or
school district form. MHMRA consent forms may be obtained from the
DMR Consumer Service Representative. School district consent forms
may be obtained from the school or school district main office.
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