REFUGE HOUSE, INC.

PURPOSE:

To establish a comprehensive, trauma-informed approach to initial assessments of children and youth admitted to Refuge House foster homes, ensuring all regulatory requirements are met while integrating Trust-Based Relational Intervention (TBRI®) principles throughout the assessment process. The assessment serves as the foundation for understanding each child's unique strengths, needs, and experiences of trauma, enabling the development of individualized, healing-centered service plans.

BACKGROUND:

Refuge House recognizes that every child entering care has experienced relational trauma through separation from their family of origin and potentially other traumatic experiences. Our admission assessment process is designed to gather essential information while building trust and establishing the foundation for healing relationships. By integrating TBRI® principles from the moment of admission, we create an environment of felt safety that supports accurate assessment and effective service planning.

POLICY:

Refuge House utilizes a cooperative, trauma-informed approach to the development of the Admission Assessment, taking into consideration valuable resources of information from CPS, previous foster agencies, and any other invested entities. The assessment process incorporates the three core TBRI® principles - Connecting, Empowering, and Correcting - to ensure that children feel safe, valued, and understood throughout the evaluation process.

Refuge House utilizes a strengths-based approach to the development of the Admission Assessment while ensuring that characteristics unique to each child are emphasized to focus on integrating the child into the family in a way that guides the development of the child's service/permanency plan, goals, engagement in services, and overall care. Through the lens of TBRI®, we recognize that all behavior has meaning and seek to understand the needs being communicated through both adaptive and maladaptive behaviors.

TBRI® INTEGRATION IN ASSESSMENT:

Connecting Principles in Assessment

The admission assessment process prioritizes building trust and connection by:

• Conducting assessments in environments where children feel safe and comfortable
• Using warm, accepting tone and body language during all interactions
• Allowing children to have a trusted person present during assessment activities
• Beginning with strengths and interests before exploring challenging topics
• Respecting the child's pace and readiness to share information
• Recognizing that trust must be earned before children will share their full story

Empowering Principles in Assessment

The assessment addresses physiological and environmental needs by evaluating:

• Current and historical patterns of eating, sleeping, and hydration
• Sensory processing preferences and sensitivities
• Physical activity needs and preferences
• Environmental factors that promote or hinder felt safety
• Medical conditions that may impact behavior or emotional regulation
• Need for predictable routines and transitions

Correcting Principles in Assessment

The assessment identifies opportunities for growth and skill-building by:

• Viewing challenging behaviors as survival skills that can be redirected
• Identifying proactive strategies that have been successful in the past
• Assessing the child's current social and life skills
• Understanding triggers and patterns in behavioral responses
• Documenting both strengths and areas for growth without judgment
• Planning for teaching moments rather than punitive responses

ADMISSION ASSESSMENT REQUIREMENTS:

CORE REQUIREMENTS

1. Placement Types and Assessment Timelines

   A child/young adult may be placed in a Refuge House foster home in one of two ways:

   • Emergency Placement – for a child/young adult who is newly placed in state custody and requires immediate placement
   • Routine Placement – for a child/young adult who has been in state custody and requires new placement

2. Communication Standards

   Refuge House does not have contact or direct working relationships with the biological family members of children in the agency's care. All contact with biological family members is conducted through DFPS/SSCC as appropriate.

3. Assessment Content and Completion Requirements

   Refuge House must complete an admission assessment for every child admitted to care that captures the information required by TAC §749.1133 and is completed within the timelines required by TAC §749.1187. For emergency admissions this means an Emergency Admission Assessment on the day of admission, a Full Admission Assessment within 10 days, an Updated Admission Assessment within 15 days, and all required elements within 40 days; for routine admissions, a Full Admission Assessment on or before the day of placement and an Updated Admission Assessment within 30 days. For children receiving treatment services, the assessment must fall within the windows required by TAC §749.1135. Where required information is unobtainable, at least three reasonable attempts must be documented (TAC §749.1133(b)(11), §749.1137).

   The assessment must address, at minimum, the content required by §749.1133 — including identifying information; the circumstances of removal and of the need for placement; history of abuse or neglect; medical, dental, mental-health, developmental, educational, and behavioral status; permanency goals; and family and placement history. A developmental history, a mental-health baseline, and a recommended behavior-management plan are required for every admission, including Basic Foster Family Home placements. A suicide-risk screening using a validated tool is required at admission per TAC §749.137. Medical and dental requirements at admission are governed by TAC §749.1151 and §749.1153, and the pre-placement discussion with the child by TAC §749.1253.

   The specific element checklist, internal completion cadences, system-entry steps, screening tools, and assignment of tasks are operational and are maintained in the corresponding procedure (FC2-01.1), so they may be updated as implementation evolves without amending this policy.

Clinical Review and Approval

Each admission assessment is reviewed and approved before it is finalized — by the Program Director for standard placements and by the Treatment Director for treatment packages. T3C Treatment Foster Family Care requires written clinical approval by the Treatment Director as a condition of placement, per Texas Family Code §264.1073 and TAC §700.1335. Specific reviewer assignments and review timeframes by Service Package are operational and are maintained in FC2-01.1.

Enhanced and Specialized Assessment by Service Package

Children served under a treatment or specialized Service Package require enhanced or specialized admission assessment consistent with the applicable T3C System Blueprint requirements and Minimum Standards. The governing requirements are:

• Mental & Behavioral Health: enhanced evaluation of mental-health history and treatment needs, integrating any existing psychiatric/psychological evaluation or psychosocial assessment and CANS 3.0 results (TAC §749.1133(b)(7), §749.1135).
• IDD/Autism: specialized developmental, communication, and functional evaluation drawing on existing developmental and educational evaluations, with Registered Nurse consultation where the package requires it.
• Substance Use: substance-use screening and, where clinically indicated, a comprehensive substance-use assessment; drug screening, when used, is a clinical tool and is not used punitively.
• Short-Term Assessment: assessment is the primary purpose of the placement; comprehensive, multi-domain assessment is completed within the package's expedited timeframes to support a Service Package recommendation. Add-On Services are not eligible for this package.
• T3C Treatment Foster Family Care: documentation of the DSM-5 diagnosis and additional eligibility criteria, the Treatment Director's written clinical approval (Texas Family Code §264.1073; TAC §700.1335), and step-down planning integrated from Day 1.

The specific evaluation domains, tools, timeframes, and documentation steps for each package are operational and are maintained in FC2-01.1.

2INgage Tier Rating and Primary Medical Needs

SSCC-2INGAGE — addition start (provider-specific; remove this block if the 2INgage contract ends)

For children placed through 2INgage, 2INgage assigns an Authorized Placement Score (Tier 1–4) through the ECAP system. Within 30 days of a new placement, Refuge House may request a rescore by contacting cmd@2INgage.org; reassessments are completed within seven days of request. (2INgage Provider Manual Rev. 1.2026 §5, p.26)

Primary Medical Needs / Habilitative placements (scoped — applies if/when Refuge House holds the credential). For a habilitative or primary-medical-needs placement, a staffing is held with the DFPS Well-Being Specialist and STAR Health prior to, or within 2 business days after, placement. Refuge House is not yet credentialed for Complex Medical / Primary Medical Needs; this is captured as implementation guidance pending that credential. (2INgage Provider Manual Rev. 1.2026 §4, pp.25–26)

SSCC-2INGAGE — addition end

SSCC-EMPOWER — addition start (provider-specific; remove this block if the EMPOWER contract ends)

For children placed through EMPOWER, EMPOWER Intake & Placement assigns an Authorized Placement Score (Tier 1–4) via ECAP; within 30 days of a new placement Refuge House may request a rescore at placement@3empower.org, with reassessment completed within 7 days (EMPOWER Provider Manual Rev. 1.2026 §5, pp.29–31). Primary Medical Needs / Habilitative (scoped — applies if/when Refuge House is credentialed): a staffing with the DFPS Well-Being Specialist and STAR Health occurs before placement, or no later than 2 business days after (EMPOWER Provider Manual Rev. 1.2026 §4, p.29). Verified kinship: Refuge House notifies EMPOWER Intake & Placement at CLASS submission and does not begin the placement until EMPOWER verifies the family is active in CLASS (EMPOWER Provider Manual Rev. 1.2026 §4, p.28).

SSCC-EMPOWER — addition end

SSCC-OCOK — addition start (provider-specific; remove this block if the OCOK contract ends)

For OCOK habilitative / primary-medical-needs placements (scoped — applies if/when Refuge House is credentialed), a telephone staffing (caregiver, Provider case manager, DFPS Well-Being Specialist, Regional Nurse, and STAR Health) is held before placement, or no later than 2 business days after (OCOK Network Management Operations Manual Rev. 7-1-2025 §5.04, pp.99–100).

SSCC-OCOK — addition end

SSCC-BELONG — addition start (provider-specific; remove this block if the Belong contract ends)

For Belong habilitative/primary-medical-needs placements (scoped — applies if/when Refuge House is credentialed), a staffing occurs no later than 2 business days after placement (Belong Stage I & II Provider Manual, p.15). For verified-kinship placements, Refuge House notifies the Belong Director of Intake & Placement and the Permanency/Adoption Supervisor at CLASS submission and immediately upon CLASS approval (Belong Stage I & II Provider Manual, p.16).

SSCC-BELONG — addition end

SSCC-STFRANCIS — addition start (provider-specific; based on the publicly-sourced July-2020 SFCS manual — confirm against the current SFCS manual; remove this block if the SFCS contract ends)

For SFCS habilitative/primary-medical-needs placements (scoped — applies if/when Refuge House is credentialed), a telephone staffing occurs no later than 2 business days after placement (SFCS Placement Provider Manual, July 2020 §2.3, p.16). For verified-kinship placements, Refuge House notifies the SFCS Kinship Child Case Manager at TXReg1Kinship@st-francis.org, and official placement does not occur until SFCS approval (§2.5, p.17). Level of Care is set via Youth for Tomorrow (YFT), reviewed every 365 days (basic) / 90 days (therapeutic) (§2.13, p.25).

SSCC-STFRANCIS — addition end

Caregiver Information-Sharing

Refuge House shares admission assessment information with caregivers as required by TAC §749.1255 — for non-emergency placements, before placement; for emergency placements, available information at placement and the full assessment within 10 days of completion — and documents the information shared, any information withheld and the reason, and how the placement can meet the child's needs. A day-of-admission caregiver briefing is conducted per TAC §749.1115.

Kinship Foster Home Admissions

Kinship foster home admissions are governed by TAC §749.4443–§749.4449, including obtaining the required initial admission information before verification or admission (§749.4445), a signed Placement Agreement (§749.4447), completion of the admission assessment within the regulatory maximum (§749.4449(b)), and sharing the completed assessment — or the DFPS CANS in its place — with the kinship caregivers (§749.4449(e)).

2INgage Verified-Kinship Approval

SSCC-2INGAGE — addition start (provider-specific; remove this block if the 2INgage contract ends)

For a verified-kinship placement under 2INgage, Refuge House notifies the 2INgage Intake & Placement team at CLASS submission and does not make an official placement until 2INgage approval is received. (Refuge House licenses kinship homes under the T3C Kinship add-on.) (2INgage Provider Manual Rev. 1.2026 §4, p.25)

SSCC-2INGAGE — addition end

DEFINITIONS:

Assessment Coordination Plan: Written plan identifying all assessment domains requiring evaluation, responsible parties, timelines, and STAR Health authorization status, required for Short-Term Assessment placements within 72 hours of admission.

CANS 3.0 Assessment: Child and Adolescent Needs and Strengths Assessment tool used to support decision-making regarding service planning and to monitor outcomes.

Comprehensive Substance Use Assessment: Professional evaluation of substance use patterns, history, co-occurring conditions, and treatment needs, conducted through STAR Health authorized provider.

DFPS: Department of Family and Protective Services

DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Emergency Placement: For a child/young adult who is newly placed in state custody and requires immediate placement, assessment initiated within 24 hours

Evidence-informed Treatment Model: Trust-Based Relational Intervention (TBRI®) - a holistic approach that addresses trauma through connecting, empowering, and correcting principles

IDD: Intellectual or Developmental Disability

Routine Placement: For a child/young adult who has been in state custody and requires new placement, assessment follows standard timelines

SSCC: Single Source Continuum Contractor

Step-Down Planning: Process of identifying treatment goals and timeline for transitioning from Treatment Foster Family Care to less-intensive placement, integrated into assessment from Day 1.

TBRI® (Trust-Based Relational Intervention): An evidence-informed approach designed for children who have experienced relationship-based traumas, focusing on building trust and secure attachments through three principles: Connecting, Empowering, and Correcting.

RESPONSIBILITY:

Standard Assessment Responsibilities

• Program Director: Approval of standard T3C Basic Foster Family Home assessments
• Case Manager: Assessment coordination and documentation

Mental & Behavioral Health Support Services

• Treatment Director: Clinical review of assessment documentation
• Licensed Therapist: Crisis response planning oversight
• Case Manager: Clinical assessment documentation

IDD/Autism Support Services

• Treatment Director: Clinical review of developmental assessments
• Licensed Therapist: Communication and behavioral assessment oversight
• Case Manager: Assessment coordination

Substance Use Support Services

• Treatment Director: Clinical eligibility review
• Case Manager: Substance use screening and STAR Health authorization initiation

Short-Term Assessment Support Services

• Treatment Director: Assessment plan approval
• Licensed Therapist: Assessment coordination oversight
• Case Manager: Assessment coordination and timeline monitoring

T3C Treatment Foster Family Care

• Treatment Director: REQUIRED clinical review per Texas Family Code §264.1073
• Licensed Therapist: Treatment planning and step-down planning
• Case Manager: Clinical documentation and coordination

REFERENCES:

• T3C Blueprint: FC 2.01, FC 2.02, FC 2.03, FC 2.05, FC 2.06
• T3C Blueprint: Pages 76-86, Mental & Behavioral Health Support Services
• T3C Blueprint: Pages 123-135, IDD/Autism Spectrum Disorder Support Services
• T3C Blueprint Standards: Pages 67-75, Short-Term Assessment Support Services
• T3C Blueprint Standards: Pages 136-147, T3C Treatment Foster Family Care Support Services
• T3C Blueprint Standards: Substance Use Support Services requirements
• TAC §749.1133 (admission assessment — required content), §749.1135 (treatment-service assessment windows), §749.1137 (information gathering / reasonable attempts), §749.1187 (assessment completion timelines)
• TAC §749.1151 (medical requirements at admission), §749.1153 (dental requirements at admission), §749.137 (suicide-risk screening)
• TAC §749.1253 (pre-placement discussion with the child), §749.1255 / §749.1115 (caregiver information-sharing and day-of briefing), §749.1605–1609 (records to obtain at admission)
• TAC §749.4443–§749.4449 (kinship foster home admissions); TAC Chapter 749, Subchapter H Division 2 (Admission Assessment) and Subchapter W Division 3 (Kinship)
• Texas Family Code Section 264.1073
• Texas Administrative Code Rule §700.1335
• DFPS 24-Hour RCC Requirements (FY26)
• SSCC Contract: (if applicable)
• COA Standards: PA-CFS5.04
• ICWA: 25 U.S.C. §§1901-1963
• TBRI® Pocket Guide, Purvis, K.B., Cross, D.R., Hurst, J.R., TCU Institute of Child Development

SSCC alignment (FY-26): 2INgage Provider Manual Rev. 1.2026 — §5 Utilization Management – Tier Rating (p.26); §4 (pp.25–26 PMN; p.25 verified kinship). Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC coverage tracker (temporary-reference/fy26-sscc-joint-monitoring/sscc-alignment/).

SSCC alignment (FY-26) — EMPOWER: EMPOWER Provider Manual Rev. 1.2026 — §5 (pp.29–31 tier); §4 (p.29 PMN; p.28 verified kinship). Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — OCOK: OCOK Network Management Operations Manual Rev. 7-1-2025 — §5.04 (pp.99–100 PMN staffing). Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — 4Kids: 4Kids4Families Joint Operations Manual (Dec 2025) / Subcontractor Agreement — reviewed; aligned (4Kids items here are casework/Minimum-Standards-level), no additional provider-specific provisions required in this document. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — Belong: Belong Stage I & II Provider Manual (Aug 2025) / Provider Services Agreement — p.15 PMN; p.16 verified kinship. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — SFCS: SFCS Placement Provider Manual (July 2020, publicly-sourced — currency unconfirmed) / 2019 Affiliate Provider Agreement — Manual §2.3 (PMN); §2.5 (kinship); §2.13 (LOC/YFT). Confirm against the current SFCS provider manual. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

RELATED PROCEDURES:

• FC2-01.1 Admission Assessment Procedure
• FC1-01 Admission Screening Policy
• FC1-01.1 Admission Screening Procedure
• INT-01.1 T3C Admission and Placement Matching
• FC2-04 Initial Health Screening Policy
• FC3-01 Individual Service Planning Policy
• FC12-04 Record Management Policy
• RH ICWA Policy
• RH Caregiver Manual
• TBRI® Implementation Guide
• FC-SU-01 Substance Use Support Services Policy
• FC-STASS-01 Short-Term Assessment Support Services Policy
• FC-TFFC-01 T3C Treatment Foster Family Care Support Services Policy

FORMS/ATTACHMENTS:

• Initial Health Screening Form
• Admission Assessment Form
• Service Planning Developmental Worksheet
• Mental & Behavioral Health Clinical Assessment Supplement
• IDD/Autism Developmental Assessment Supplement
• Crisis Response Planning Tool
• Communication Assessment Tool
• Substance Use Screening Tool
• Substance Use Assessment Authorization Request Form
• Short-Term Assessment Coordination Plan
• Short-Term Assessment Completion Tracking Log
• Treatment Foster Family Care Clinical Assessment Form
• Treatment Foster Family Care Step-Down Planning Worksheet

Note: By October 2025, the Admission Assessment Form in Radius will be enhanced to include integrated modules for:

• TBRI®-informed trauma and attachment assessment
• Sensory profile and regulation assessment
• Developmental age vs. chronological age evaluation
• Updated assessment tracking for returning children
• Mental & Behavioral Health specific screening tools
• IDD/Autism functional assessment components

This policy document establishes the governing principles for Admission Assessment. The corresponding procedure document (FC2-01.1) operationalizes these principles by providing specific implementation details (who, when, where, and how). While policies require Board approval and remain relatively stable, procedures may be updated by the Executive Director to adapt to regulatory changes, technological advancements, or operational improvements without requiring Board approval, provided such changes maintain alignment with the policy's intent.