Application for Residential Services

Thank you for your interest in the Behavior Treatment and Training Center (BTTC). The BTTC provides Residential Services to Medicaid eligible children 8 years of age to 17 years.

Admission Criteria for Residential Services

1. Age: 8 years old to 17 years old. Each child must have a legally authorized representative for consent purposes (example: parent, guardian, or managing conservator).
2. Diagnosis: A diagnosis of Mental Retardation, Autism, or Pervasive Developmental Disorder is required. An adaptive behavior level of II, III, or IV is required for individuals who are diagnosed with Autism or Pervasive Developmental Disorder.
3. Behavior: Problem behavior must be severe enough to threaten continued residence in the family home or group home, pose imminent risk of injury, or severely disrupt current programming or services in the community.
4. County of Residence:State of Texas
5. Discharge Site: Prior to admission, each family must agree to take the child back in the home.
6. Family Involvement: Family must be willing to make a time commitment to learn and practice specific skills necessary for the child’s behavior to continue improving even after discharging from the BTTC. This involves regular meetings at the BTTC, beginning within a few days of admission and continuing weekly for approximately 40 hours duration.
7. Payment: Medicaid Eligible. A child who does not qualify for regular Medicaid may qualify for Medicaid Assistance Only (MA0) during temporary placement at the BTTC if his/her income is minimal. Family income is not a consideration for MAO, only the child’s income.

Please complete the following application for services as thoroughly as possible and attach all appropriate documentation as noted. For assistance in completing this application, contact your service coordinator from the Mental Retardation Authority.

For information about the BTTC, call Peter Khwatenge at 281-239-1134 or 1-800-304-6047 Ext. 4016, peter.khwatenge@texanacenter.com or Tracy Woods at 281-239-1128 or 1-800-304-6047 ext 4025 tracy.woods@texanacenter.com Note: The BTTC Residential Center is not a crisis-intervention program, so if a child needs immediate intervention, the family should contact their local crisis-intervention services.

Residential applicants must enclose copies of the following:

1. ICAP Computer Printout and copy of ICAP booklet (completed by MRA).
2. Determination of Mental Retardation (completed by MRA).
3. Psychiatric Hospitalizations Discharge Reports (if applicable).
4. Copy of current month’s Medicaid form letter (if applicable).
5. Copy of current private health insurance card: front & back (if applicable).
6. Copy of birth certificate.
7. Copy of Social Security card.
8. Immunization Records (including Hepatitis B series vaccine – if begun).
9. Legal documents (if caregiver is not the natural parent or if child has joint custody).
10. Complete & return Medical History Questionnaire.

Once a child is accepted into the residential program, the following information shall be needed. Do not send the items below with the application:

1. DMR Update – not older than 3 Months at time of admission (completed by MRA).
2. Proof of current TB skin test (not older than 1 year at time of admission).
3. Copy of current physician’s orders for medication(s) the child is taking.
4. Hard copy of permanency planning (PP) for children and copy of approved PP from the care system. (do not complete at time of application).
5. Current school ARD/IEP objectives.
6. This Application (Right Click and select "Save-As")