How to Be a QMRP

At the very basic level, the QMRP is simply a qualified intellectual disability (formerly known as mental retardation) professional. According to standard W160, a QMRP must have “at least one year of experience working directly with persons with [intellectual disabilities] or other developmental disabilities.” Further in W180 a QMRP “must have at least a bachelor’s degree in a human services field.”

While these are the very basic standards to be a QMRP, it should be noted that the guidelines under federal standards goes further. The QMRP must be able to fulfill the role of the QMRP despite the type of degree and the amount of experience that he or she may have.


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    Learn about the role of a QMRP.
    • For a more informative guideline on being a QMRP a person must study and review the section known as “Facility Practices” found under W159. Providers know W159 as “The Q Tag” and as you will see by the guidelines, it is definitely “The Q Tag”.
    • The first requirement under the guidelines is that the facility has a QMRP assigned to the individuals served. This is met at the basic level with W180 and W160. The QMRP must then function in the capacity that is further indicated by the standards.
    • The QMRP must observe individuals, review data and progress, and revise programs based on individual needs and performance. This indicates that the QMRP must “know” the residents that he or she serves. It is not enough to know names, ages, and statistics, rather the QMRP must know the person. For example, can the person cook, or does the person want to learn to cook can be very basic questions that the QMRP should have a basic knowledge about. Only through direct observations can the QMRP learn about the individual. During those observations, the QMRP must take time to talk with the individuals and develop a complete understanding pertaining to the individual’s hopes, dreams, desires, etc. Once the QMRP knows the individual, he or she can assist the individual in finding areas the individual desires to improve.
    • The overall improvement of the individual’s participation in society and life was the primary driving force behind the ICF/MR concept. The ICF’s were designed to remove people from institutional settings or environments where they learned very little about living in society, and place them in a home where they could learn to be a part of society. In the ICF, we are constantly seeking a way to help the individuals “move up” or “move on” into a less restrictive environment. The fundamental way this goal is accomplished is through reviewing data and progress and revising programs as needed. Programs are simply the IPP's of the individual served. These IPP’s must focus on four basic areas and other areas as identified by the individual served and his or her ID Team.
    • An IPP must focus on money management skills, adaptive equipment skills, independent living skills, and self-medication skills. These four areas are seen by federal guidelines as the basic areas needed to live in less restrictive environments. For example, without the ability to manage money, you can not pay your basic bills, buy food, or pay for shelter and transportation. Without the ability to take care of adaptive equipment, you can not care for glasses, dentures, wheelchairs, etc on your own. Independent living skills covers a range of areas such as cooking, cleaning, laundry, vocational, etc. Finally, a self-medication skill is simply the focus on the ability to administer your own medications. This could be something as simple as taking a Tylenol for a headache, to as advanced as taking a psychotropic medications four times per day. The basic IPP must ensure these areas re met.
    • The QMRP’s role with the IPP must be to review data collected by the staff. This review should indicate progress, lack of progress, or changes needed to assist in progress. As part of this review, the QMRP may find that progress is occurring and that the individual has mastered a particular area. It would be the QMRP’s duty at this point to move the person on to the next targeted objective area. For example, the person served may be able to brush his or her teeth with two verbal prompts. The next objective may indicated that one verbal prompt should be used, and the QMRP would issue new data with the one verbal prompt as indicated. On the same accord, the person may have no progress and the data may need to be modified to assist progress. In the case of two verbal prompts to brush teeth, the goal may have to be revised to allow three verbal prompts. The QMRP may move the person up to the next objective when the goal has been mastered without ID Team intervention. However, should there be a lack of progress, the person almost masters the goal, or changes are needed to assist in progress, then the QMRP must initiate an Interim Staffing. The Interim Staffing would then determine the next action with the IDTeam’s input. Generally, the QMRP writes the Interim Staffing with suggested changes or modifications, sends it to the IDTeam for review and signatures. Should the IDTeam disagree with the QMRP’s recommendations, then other recommendations may be submitted with the individual’s served approval.
    • The next guideline for the QMRP found in W159 is that the QMRP must ensure “consistency among external and internal programs and disciplines.” The QMRP must “coordinate” the program to ensure consistency. While day programs and evening programs are a part of this equation, there is also the factor of physician recommendations, dietician recommendations, social worker recommendations, etc. For example, a dietician may recommend a reduced fat diet for a person. The physician must sign off an order for that diet. Generally, the LVN would take the recommendation to the physician and obtain the order for the diet change. It is the QMRP’s responsibility to ensure this action is taken. A QMRP may simply review the dietician’s recommendation and compare it to the physician’s order, or the QMRP may direct each portion of the equation (i.e. inform the nurse to obtain the order, etc). As the progress in the consistency occurs, the QMRP is responsible for ensuring IDTeam members are aware of the changes. It is most important that the individual served is aware of the changes. The QMRP must also ensure the consistency among all programs. In the case of the diet change, the staff working with the person at the home should be trained, if the person attends an outside program (i.e. school, work center, etc) that program must be informed of the diet change, family members should be informed. Once again, the QMRP must then monitor and observe to ensure consistency occurs in the external and internal programs as designed.
    • The QMRP must next ensure that “service design and delivery” provides each individual with “an appropriate active treatment program.” The only way for the QMRP to do this is to know the individuals that he or she serves. Let’s say that Johnny X has been assigned to QMRP A. QMRP A gives Johnny X several goals in the annual staffing. One of these goals requires that Johnny X write out a check each week for his own personal spending money. QMRP A has the IDTeam’s approval to do this goal. The only problem is that the assessments show that Johnny X can not write, does not know his numbers, does not know the months and days of the year, and can not sign his own name (not even a mark for his name). QMRP A has started Johnny X on a goal that he can never master because he has not mastered the first requirement for this goal, being able to write. In this case, the design and delivery of the active treatment program is not appropriate for Johnny X. QMRP A would need to read all assessments, observe Johnny X and learn about him prior to suggesting or entertaining suggestions pertaining to Johnny X writing his weekly spending money check. If QMRP A knows Johnny X, then he will have an appropriate active treatment program. In this case, it may be more appropriate (depending on assessments and observations) for Johnny X to start out by learning to write his name.
    • The QMRP must also ensure “that any discrepancies or conflicts between programmatic, medical, dietary, and vocational aspects of the individual’s assessment and program are resolved.” This statement covers a wide variety of possible problems. A basic problem could be that the physician has written a physician’s order with the person’s disability being described as Mild MR, and the psychologist has suggested that the person has a disability of Moderate MR. The QMRP would need to ensure this discrepancy was resolved. As stated before, this statement covers a wide variety of various problems, but the QMRP is the chief person that must ensure they are resolved.
    • Another area noted in the “Facility Practices” section under W159 is that the QMRP “ensures a follow-up to recommendations for services, equipment or programs.” Basically, if recommendations are made, the QMRP must ensure there is a follow up to that recommendation. It may be that the IDTeam has an Interim Staffing and it is determined the person does not need or want the recommendation. On the other hand, the IDTeam may determine that the person does need or want the recommendation. Some basic examples of this might be recommendations for glasses, physical therapy exercises, speech therapy, wheelchairs, etc. The QMRP must ensure that any recommendations have appropriate follow-up.
    • The QMRP must also ensure “that adequate environmental supports and assistive devices are present to promote independence.” Environmental supports could be staff in the home to assist the individual in learning to iron, cook, clean, etc. It could also be the van for transportation, a fire alarm system for protection, etc. Assistive devices might be adaptive eating utensils, wheelchairs for mobility, glasses, hearing aides. The QMRP must ensure that these areas of supports are addressed and present as needed to assist in greater independence for the individual served.
    • There are several important suggestions under the “Guidelines” section of W159. In the first paragraph alone, the most important statement made is likely: “The paramount importance of having persons competent to judge and supervise active treatment issues cannot be overstated.” Simply put the QMRP must know the persons they serve and supervise the implementation of active treatment in that person’s life. This requires reading assessments, behavior reports, incident reports, physician and other reports, observing the person, talking with staff, and most importantly talking with the individual. The QMRP cannot be “competent to judge and supervise active treatment” unless he or she is familiar with the person served.
    • The ultimate role of the QMRP is to ensure adequate active treatment is provided to the person served in an ICF/MR setting. To provide adequate active treatment, the QMRP must know the person served as indicated above. Evergreen takes the word “adequate” out of the equation and requires that a QMRP provide “excellent” active treatment to the person served. Because of this requirement, it cannot be overstated that the QMRP must be knowledgeable about the person served. This, as stated, requires the QMRP to observe, review reports and assessments, listen to the individual his staff and others involved (i.e. family, physicians, nurses, social workers, dieticians, etc) and to make competent and informed recommendations to the IDTeam in the person’s served best interest.
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    Learn about the standards and how they relate to a QMRP.
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    Learn from people with intellectual and developmental disabilities (IDD). This will come from listening closely to people you meet, and reading essays by people with disabilities. Find out what types of services and treatments people with IDD want most.
    • Learn from people with disabilities themselves about how to be respectful towards them. It is crucial for professionals to treat them with dignity and listen closely to what they want.
    • Different IDD communities (notably the autistic community) have various presences online. They may talk in detail about their priorities.
    • Listening to a parent or therapist is not the same thing as listening to a disabled person. Sometimes you may even have to fight parents or therapist to protect the disabled person's wishes and best interests.
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    Presume competence. Assume that the disabled person can hear what you say (even if they don't signal that they can understand), and that they want to do their best to adapt. Respecting them and believing in them sends a clear positive attitude that can help motivate them and those around them to do their best.
    • It is not appropriate to give a 15-year-old tasks that are designed for a 3-year-old.
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    Focus on happiness and skills, not on normalization. IDDs are lifelong, and pushing someone to suppress things usually does not end well. Reassure family members and therapists that the person can live happily while being disabled.
    • For example, instead of eliminating harmless stimming through ABA, time might be better spent on sensory integration therapy or assertiveness training.
    • Look for ways to accommodate and assist them, rather than trying to hide the disability.
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    Focus on the individual. Every person with a disability is different, and deserves to be treated as an individual. What are their specific needs and goals? What support do they (and their family) want?


  • There is no way to ensure you will be a great QMRP. You must learn your individual state requirements, what regional surveyors expect, and what is expected by the organization you work for daily.

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Categories: Psychology Studies