Chapter 2: CRS Principles

2.1 Overview

This chapter introduces CRS program staff members to the philosophies and principles of the CRS program as they apply to the consumer. The chapter defines the terms initial contact and Interest List. It explains the application for services, diagnostic interview, eligibility determination, the Individualized Written Rehabilitation Plan, and the Waiting List. It also explains the importance of building strong ethical relationships with consumers, empowering consumers to make informed choices, practicing good stewardship, and maintaining quality documentation.

2.2 Purpose

The purpose of the CRS program is to assist eligible consumers who have a traumatic brain injury (TBI), traumatic spinal cord injury (TSCI), or both, function independently in the home and community in regard to communication, mobility, and self-care.

The CRS program offers the following service arrays to address functional ability for TBI and TSCI:

  • Inpatient Comprehensive Medical Rehabilitation Services
  • Outpatient Therapy Services
  • Post-Acute Rehabilitation Services:
    • residential services (TBI Only)
    • non-residential services (both TBI and TSCI)
  •  Ancillary Goods and Services

2.3 Philosophy

The CRS program is committed to ensuring that Texans with disabilities:

  • enjoy the same opportunities as other Texans;
  • pursue rehabilitation goals that are suitable and are according to their choice;
  • live as independently as possible; and
  • lead productive lives.

Although many policies and procedures in this manual are mandatory, a consumer's application is individualized to his or her situation and rehabilitation needs. Every interaction with a consumer is unique and therefore requires a unique response and the consumer’s informed choice.

At any point while receiving services, a consumer has the right to decline services or withdraw from services without financial penalty, excluding the consumer’s previously agreed cost of participation.  

2.4 Understanding the CRS Process

The CRS process begins with the initial contact, followed by the application for services, diagnostic interview, eligibility determination, creation of the Individualized Written Rehabilitation Plan, the provision of services, and closure. Assessing and planning and/or counseling and guidance occur between each step of the process.

2.4.1 Initial Contact

Initial contact is the term used to describe the point at which the consumer or consumer’s representative contacts the CRS program to express an interest in receiving services for CRS. You will document the contact by creating an initial contact entry in ReHabWorks and then schedule your first appointment.

2.4.2 Interest List

Once an initial contact has been created in ReHabWorks, consumers are considered interested in receiving services for CRS and are placed on the Interest List. Consumers remain on the Interest List until an Individualized Written Rehabilitation Plan has been completed and signed.

2.4.3 Application and Diagnostic Interview

During the consumer’s first appointment, complete the application process and the diagnostic interview. During this appointment, you will complete the application-related tasks outlined in ReHabWorks (RHW). The application process consists of obtaining demographic information about the consumer, and information on the consumer’s financial situation and disability. A consumer moves on to the application phase after signing the Application for Services, either in RHW or on the paper application.

Next is the diagnostic interview, which is your first opportunity to investigate the impact of the consumer’s disability on the consumer and the consumer’s ability to live independently. A sound diagnostic interview assists in determining the consumer’s eligibility for services. The diagnostic interview is a means for collecting information because it allows the consumer to provide you with his or her social, medical, and rehabilitation history.

If you have not sufficiently collected information, you may fail to realize the need for a medical or neuropsychological evaluation, a failure that could lead to a poor eligibility decision or developing a less than optimal plan for independence. The diagnostic interview is a critical part of planning and decision-making. Your role in conducting the interview is to listen effectively and ask questions, as needed. Observation can also provide invaluable insight into the consumer's personality, mood, social functioning, and other characteristics and key attributes. The outcome of the diagnostic interview should be that you have a better understanding of the consumer's situation and that the consumer has increased his or her self-awareness.

2.4.4 Eligibility

Eligibility is determined through your review of documents substantiating what the consumer expressed during the diagnostic interview. Supporting documents may include medical records or neuropsychological evaluations. You will receive supporting documents either directly from the consumer or medical provider, or from a records request.

2.4.5 Individualized Written Rehabilitation Plan (IWRP)

The IWRP is developed based on discussions held between you and the eligible consumer during the assessment and planning process.

The IWRP outlines services agreed upon between you and the consumer or the consumer’s representative. Services outlined on the IWRP are meant to assist the consumer in reaching the goal of independence, particularly in regard to self-care, mobility, and communication.

2.4.6 Waiting List

Consumers are considered to be on the Waiting List for services when an Individualized Written Rehabilitation Plan (IWRP) has been developed and signed but funding for the services described in the IWRP has not yet been issued. ReHabWorks automatically removes the consumer from the Interest List and assigns them a Waiting List number.

Consumers are removed from the Waiting List by the CRS central office staff members on a first-come, first-serve basis when funding is available. Consumers are removed from the Waiting List, when funds for the consumer’s services have been allocated or when you close their case.

2.5 Building Ethical Relationships

Solution-focused, respectful, nonexploitative, and empowering counseling relationships are built on high ethical standards. Understanding the principles listed in the Code of Professional Ethics for Rehabilitation Counselors (the code) is at the heart of the ethical decision-making process. The code defines the level of competency needed in professional relationships to promote and protect the spirit of caring and respect for individuals with disabilities.

It is essential that staff members adhere to the ethical standards stated in the code, as well as to policy and procedure, and that they be accountable to those standards.

The code defines the following six basic principles of ethical behavior:

  1. Autonomy: to honor a consumer’s right to make decisions
  2. Beneficence: to do good to others
  3. No malfeasance: to do no harm to others
  4. Justice: to be fair and give equal justice to all
  5. Fidelity: to be loyal and keep promises
  6. Veracity: to be honest

Counselors who violate the code are subject to the actions defined in agency policies for performance management. Counselors certified through the Commission on Rehabilitation Counselor Certification are also subject to a commission action.

2.6 Principles of Informed Choice

It is important for each person involved in the rehabilitation process to apply consistently the concept of informed consumer choice.

The principles of informed consumer choice require that the counselor inform the consumer about, and involve the consumer in, choosing among alternative:

  • goals;
  • objectives;
  • services;
  • entities providing services; and
  • methods used to provide or procure services.

The consumer should enjoy the same rights as any person to make decisions that affect his or her life. To achieve positive outcomes, the consumer must be involved in decision-making at the greatest level at which the consumer is capable.

Informed consumer choice begins at the first meeting, when you explain:

  • the concept of informed choice;
  • the concept of an effective partnership between you and the consumer; and
  • the CRS process for receiving services.

Together, you and the consumer choose the providers who will provide assessments and other types of information necessary to determine the consumer’s eligibility.

During the development of the Individualized Written Rehabilitation Plan (IWRP), you and the consumer jointly:

  • consider a variety of suitable goals that will help the consumer overcome impediments to independence; and
  • assess which goals are most consistent with the consumer’s needs, abilities, and other key attributes.

After you have identified the consumer’s rehabilitation needs, give the consumer information about the services that are available to meet the consumer's needs and are consistent with laws, policies, and the highest ethical standards. Your good judgment leads to the development of reasonable options to discuss with the consumer, facilitating his or her ability to make an informed choice. In some cases, there may be only one appropriate alternative that meets the consumer's needs and supports the policy.

If the alternatives developed are not acceptable to the consumer, or if preferences expressed by the consumer are not among the alternatives presented, discuss the options until you and the consumer reach a mutually acceptable decision. If you and the consumer cannot reach a compromise, inform the consumer of his or her right to appeal.

2.7 Principles of Good Stewardship

Counselors make purchasing decisions using principles of good stewardship.

Before using CRS funds, you must use available comparable services and benefits to pay for services in whole or in part. You must provide the consumer with information on available public and private comparable services and benefits. The consumer, as a partner in the CRS process, must use comparable services and benefits from other programs for which he or she is eligible. Using comparable services and benefits ensures that CRS dollars are spent efficiently.

2.8 Quality Program Management in Documentation

How well you document each consumer’s case directly affects the quality of the services that you provide the consumer.

A key to the CRS program’s success is your ability to document accurately and in a timely manner the decisions that:

  • comply with the law and with state rules;
  • are made in partnership with the consumer;
  • result in the eligible consumer receiving services; and
  • result, ultimately, in the consumer’s increased independence at home and in the community.

The type of documentation kept in the case file includes:

  • information contained in ReHabWorks (RHW), including case notes; and
  • information contained in the consumer’s paper case file.

Create case notes in RHW to compile information gleaned from other sources, and from your interactions with the consumer, the consumer's family or representative, referral sources, service providers, and others, in order to:

  • convey compliance with state laws regarding the:
    • use of funds; and
    • decisions made about service delivery;
  • document your decision-making and application of the CRS process;
  • provide a clear and concise explanation of the consumer's progress through the rehabilitation process;
  • make clear the outcomes of planned interventions;
  • ensure the ability to seamlessly provide services to the consumer in the absence of the counselor of record; and
  • establish a sound record of the program’s effectiveness and efficiency.

Clearly written information is required to achieve these expectations. This manual often refers to the need for writing incidental case notes to explain or justify a course of action. When writing case notes, be objective, and write clearly and concisely enough for the reasonable reader to understand.

Your documentation must add value to the CRS program by revealing relevant information about:

  • the consumer’s participation in and progress made through the CRS process;
  • the staff member’s considered decisions; and
  • the outcomes of planned interventions.

In addition to prescribed incidental case notes, at a minimum, every RHW case file must document the actions taken on behalf of or with the consumer, as described in the following table.

Activity

Documentation

Completing an application and diagnostic interview

A case note or series of case notes that describes pertinent information obtained from the consumer, or the consumer's family or representative, and any available records, including :

  • information after a thorough examination of the consumer's medical history;
  • information or identified gaps in information needed to determine eligibility; and
  • information that may be used later during assessment to develop the Individualized Written Rehabilitation Plan (IWRP) for the eligible consumer.

Opening or reopening a previously closed case

A case note or series of case notes that describes the:

  • circumstances leading to previous closures and the need for opening a case;
  • changes needed for a successful case outcome; and
  • consultation with the manager, if applicable.

Determining eligibility

A case note or series of case notes that describes:

  • how the criteria for eligibility are met; or
  • the reasons for a consumer’s determination of ineligibility.

Assessing and planning

A case note or series of case notes that show how the assessment resulted in the:

  • identification of potential goals;
  • decisions that support the goals, objectives, and services of the IWRP;
  • consumer's informed choice; and
  • development of the plan for contact with the consumer.

Making changes to the original IWRP that result from:

  • a Joint Annual Review; or
  • other amendments.

A case note or series of case notes that describes the:

  • results of the IWRP review;
  • reasons for any changes that do not require amendment; or
  • reasons for an amendment and the nature and scope of the changes, including how objectives, services, and a plan for communicating with the consumer were developed, when applicable.

Service delivery notes

A case note or series of case notes that describe:

  • the decisions that support the necessary provision, extension, or addition of a service; or
  • actions taken to provide the service, such as:
    • using best-value information;
    • completing technical tasks or purchasing-related tasks;
    • making contacts; or
    • following up.

General contact notes

A case note or series of case notes that describes the consumer's rehabilitation story by reflecting conversations, observations, decisions, actions taken that support the consumer's progress, and the consumer’s opportunities to make informed choices.

Counseling and guidance

A case note or series of case notes that explains how counseling strategies and interventions were skillfully applied to support the consumer; for example, were applied to:

  • remove barriers;
  • help solve problems;
  • provide information and support to help the consumer make an informed choice;
  • help the consumer adjust to a disability; and
  • educate the consumer.

Joint annual review (JAR)

A case note or series of case notes that describe JAR activities, such as reviewing and discussing the consumer's:

  • personal information;
  • progress in achieving independence;
  • intermediate goals; and
  • responsibilities.

Closing a case

A case note or series of case notes that describe:

  • the reason the case was closed;
  • the circumstances that led to the decision to close; and
  • how the case meets the criteria for closing a case.

Specific documentation is needed before certain actions can be taken. The following table describes the minimum documentation required.

Action

Documentation

Services to family members or caretakers

A case note or series of case notes that describe:

  • why the services are needed;
  • which family members or caretakers need the services (include names and, if provided, include Social Security numbers);
  • what services are needed; and
  • how the services are expected to contribute to the consumer's goal of independence.

Identification and/or use of comparable benefits

A case note or series of case notes that explains the progress made toward accessing and applying for identified comparable services and benefits.

Making data corrections (maintaining data integrity)

A case note or series of case notes that describes data corrections in ReHabWorks, including the justification for the corrections and the approval obtained.

Adding "Consumer requires special attention"

A specific and factual report of the event that lead to the determination that the consumer poses a threat, including:

  • the date of the event;
  • the location of the event;
  • the names and addresses of witnesses and people involved;
  • an account of what was said or done; and
  • the names of those willing to testify.

Removing "Consumer requires special attention"

A case note or series of case notes that describes why the consumer no longer poses a threat.

Resetting of a Personal Identification Number (PIN) by a CRS program manager

A case note or series of case notes entered by a manager to:

  • note that the manager reset the PIN; and
  • explain the reason for resetting the PIN.

Obtaining management approval

A case note or series of case notes entered by the approving manager to explain the:

  • decision for approval;
  • parameters of approval; and/or
  • extent to which a policy is being waived.