Health Policy Reform in America: Innovations from the States

By Howard M. Leichter | Go to book overview
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Another safety feature was the requirement that detailed program plans be developed before any actual placement could be made. These plans were supposed to be based on comprehensive evaluations and were designed to meet the program participants' individual needs. The plans were not supposed to be developed in a vacuum. Instead, they were to be developed by professionals and shared with clients and their parents or advocates. By developing a detailed and intricate process, clients were theoretically assured that their own input would be respected. It should also be emphasized that the case manager and representatives from both the institution and the proposed setting were supposed to be present during the planning stages.

The placement was to be monitored by several individuals, including the institution, the Texas Department of Mental Health and Mental Retardation, the local mental retardation authority and/or a community provider (if the authority was contracting the service to another community agency), and the case manager. This level of monitoring might be considered excessive and was certainly redundant. However, considering the problems associated with deinstitutionalization, most professionals would agree that in terms of monitoring, more is better than less.

Finally, if for some reason none of these safety features worked, the client had one more remedy at his or her disposal. If the placement was either inadequate or unacceptable to the client or his or her family, the client could petition the mental retardation authority and could be returned to the originating institution. This right applied to every participating client and could be exercised for life. This right went a long way toward meeting the major objections of many parents, who could justifiably ask, "What would happen if the placement failed?" By assuring each client and parent the right to return to the institution in the event of program failure, the parent and client were undertaking only a minimal risk.

These safety features were incorporated in the program to prevent the horror stories that have taken place in many states. Persons with mental retardation would not become part of the urban homeless, living in the streets or under the bridges in Texas cities.


The Texas policy of deinstitutionalization in the late 1980s was im


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Health Policy Reform in America: Innovations from the States


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