Incapacity Determination - PEP Step V

Created on: 
Oct 21 2014

PEP Step V--Determining Level of Function of Mentally Impaired Individuals in a Work Environment

WAC 388-447-0070 Progressive evaluation process step V - How does the department determine the impact of a mental impairment on my ability to function in a work environment?

Clarifying Information

  1. Cognitive and Social Factors:

    Approvals at PEP step V based on cognitive and social factors are intended for individuals who are unable to perform the basic work functions necessary to learn the basic skills of a job, perform to an employer’s expectations, or behave in a manner acceptable in a work place.

  2. Mental Status Examinations (MSE):

    The purpose of a Mental Status Examination (MSE) is to assess the presence and extent of a person's mental impairment. The MSE may suggest specific areas for further testing or specific types of required tests. There are standardized and non-standardized Mental Status Examinations.

    1. A standardized MSE includes a series of specific questions designed to assess memory, thought process and content, perception, attention and concentration, judgment, intelligence, insight, and orientation. A standardized MSE should usually be given where psychotic or cognitive problems are indicated in the psychological/psychiatric evaluation. While the Folstein is the most common, many standardized MSE's are available.
    2. A non standardized MSE is not numerically rated and may be documented by indicating the degree to which a person is oriented (e.g.. "O x 3" means a person is normal in the "three spheres" of time, place, and person - or fully oriented) along with more comprehensive observations including assessment of appearance, movement and behavior, affect, mood, speech, thought content and process, cognition, judgment, and insight.
    3. The MSE must be conducted by an authorized provider and included within the psychological/psychiatric evaluation or attached as an addendum.
    4. When used in conjunction with the evaluation, the MSE provides objective information, which should be consistent with the diagnoses and ratings contained in the psychological/psychiatric evaluation.
      1. If the ratings on the psychological/psychiatric evaluation are inconsistent with the MSE, contact the provider for clarification before proceeding.
      2. Some mental status exams use a numeric rating system. For example, a score of 24 or more on the Folstein Mini Mental Status Examination is considered normal.
    EXAMPLE:

    The cognitive ratings on the DSHS13-865 are marked to indicate the client cannot follow simple one and two-step instructions. However, the client had no difficulty following instructions specifically developed to test this function - folding a piece of paper and placing it on the floor. Contact the provider and request clarification. The two pieces of information must be consistent to accurately reflect the status of the person being evaluated.

Worker Responsibilities

  1. Ensure an objective MSE accompanies or is included with the psychological/psychiatric evaluation.
  2. If the MSE is not consistent with the evaluation, obtain clarification from the provider.