REFUGE HOUSE, INC.

PURPOSE:

To establish a standardized, trauma-informed process for completing admission assessments for children and youth placed in Refuge House foster homes, ensuring required information is gathered within regulatory timeframes while building trust and establishing the foundation for healing through Trust-Based Relational Intervention (TBRI®) principles.

RESPONSIBILITY:

• Case Managers
• Program Director/LCPAA
• Treatment Director (when applicable)
• Intake Department
• Foster Parents
• Licensed Therapist (Mental & Behavioral Health)
• Registered Nurse (IDD/Autism)

PROCEDURE:

1. ADMISSION ASSESSMENT TIMELINES

Purpose and Overview

The admission assessment serves as both a regulatory requirement and the first opportunity to build trust with children entering care. Through TBRI®-informed practices, we transform the assessment from a clinical evaluation into a relational experience that communicates safety, respect, and hope. As stated in our policy, "the assessment process itself is an intervention" that begins the healing journey.

The specific timelines for completing assessments vary based on placement type, with CRITICAL TIMEFRAMES established by TAC §749.1187 (completion timelines) and §749.1133 (required content). However, our approach prioritizes the child's emotional safety and readiness throughout the process.

2. INFORMATION GATHERING

Purpose and Overview

Comprehensive information gathering is the foundation for understanding each child's unique needs, strengths, and experiences. Our policy emphasizes "taking into consideration valuable resources of information from CPS, previous foster agencies, and any other invested entities." This collaborative approach ensures we have the most complete picture possible while recognizing that some information may only be revealed as trust develops over time.

The TBRI® lens reminds us that all behavior has meaning. During information gathering, we seek to understand not just what behaviors occur, but what needs they communicate and what past experiences may drive them.

3. TBRI®-INFORMED ASSESSMENT COMPONENTS

Purpose and Overview

Our Evidence-informed Treatment Model, TBRI®, shapes how we approach every aspect of the assessment. By integrating Connecting, Empowering, and Correcting principles throughout the assessment process, we create opportunities for healing even as we gather necessary information. This section operationalizes the TBRI® integration described in our policy.

4. SPECIAL POPULATION CONSIDERATIONS

Purpose and Overview

Certain populations of children require additional assessment considerations to ensure their unique needs are identified and addressed. Our policy recognizes that "characteristics unique to each child are emphasized" and this section provides specific guidance for various special populations to ensure comprehensive, culturally sensitive assessment.

5. ☑ Mental & Behavioral Health ENHANCED ASSESSMENT PROCEDURES

Purpose and Overview

Children receiving Mental & Behavioral Health Support Services require enhanced assessment procedures that address their complex emotional, behavioral, and therapeutic needs. These procedures align with the T3C Blueprint requirements for comprehensive clinical assessment and ensure the child receives appropriate therapeutic interventions from the onset of placement.

6. ☑ IDD/Autism SPECIALIZED ASSESSMENT PROCEDURES

Purpose and Overview

Children receiving IDD/Autism Spectrum Disorder Support Services require specialized assessment procedures that evaluate developmental functioning, communication needs, sensory profiles, and support requirements. These procedures ensure comprehensive understanding of the child's abilities and needs while planning for maximizing independence and quality of life.

7. ☑ Substance Use Support Services ASSESSMENT PROCEDURES

Purpose and Overview

Children receiving Substance Use Support Services require specialized assessment procedures that evaluate substance use patterns, recovery readiness, and co-occurring conditions. These procedures ensure comprehensive understanding of the child's substance use history while maintaining a non-judgmental, recovery-focused approach that aligns with TBRI® principles. Drug screening, when utilized, serves as a clinical tool to support treatment planning rather than as a punitive measure.

8. ☑ Short-Term Assessment Support Services ASSESSMENT PROCEDURES

Purpose and Overview

For children receiving Short-Term Assessment Support Services, assessment is the primary purpose of the placement. These procedures establish an expedited, comprehensive assessment process designed to gather information across all domains within shortened timeframes to support Service Package recommendations for transition to appropriate ongoing placement. Add-On Services are not eligible for this package.

9. ☑ T3C Treatment Foster Family Care ASSESSMENT PROCEDURES

Purpose and Overview

Children receiving T3C Treatment Foster Family Care require enhanced clinical assessment procedures that document eligibility criteria, verify DSM-5 diagnoses, and establish step-down planning from Day 1. Due to the time-limited nature of this package (maximum 365 days), assessment must include treatment intensity evaluation and preliminary transition planning. The Treatment Director must provide written clinical approval as required by Texas Family Code Section 264.1073.

10. DOCUMENTATION AND FINALIZATION

Purpose and Overview

Thorough documentation ensures continuity of care and compliance with regulatory requirements. The assessment becomes the foundation document for all future service planning and must be comprehensive, accurate, and submitted timely. Our policy emphasizes the assessment's role in "guiding the development of the child's service/permanency plan, goals, engagement in services, and overall care."

ADMISSION ASSESSMENT — REQUIRED ELEMENTS BY TIER (TAC §749.1133)

This checklist enumerates the regulatory content the Admission Assessment must capture under TAC §749.1133, organized by the completion tiers in §749.1187 (Emergency → Full → Updated). The tiers are cumulative: each tier includes all elements of the prior tier. The package-specific procedures above (Sections 4–9) supplement these baseline elements; several §749.1133 elements — developmental history, mental-health baseline, and a recommended behavior-management plan — are required for every admission, including Basic Foster Family Home placements, not only the enhanced packages.

Emergency Admission Assessment — completed day of admission

• All identifying information: name, gender, ethnicity, religion (if applicable), legal status (TMC/PMC/other) (§749.1133(b)(1))
• Caseworker name and contact information
• Tribal affiliation and contact information (if applicable)
• Foster family name and contact information
• Refuge House Case Manager name
• Service level
• Previous placement (if applicable)
• Brief description of emergency circumstances
• Circumstances of removal / referral — narrative of the circumstances that led to referral for substitute care (§749.1133(b)(2))
• Description of circumstances making placement necessary (what brought the child into substitute care; what brought the child into the Refuge House program; protective factors)
• Description of the child's history and current known behaviors, including appropriate and maladaptive behavior and any high-risk behavior (§749.1133(b)(3))
• How the family placement will meet the child's needs and best interests
• Any known high-risk behaviors and the need for a safety plan if necessary
• Suicide Risk Screening using a validated tool (§749.137(d)(4)): required at admission for every child age 10+; required under age 10 if there is a history of attempts/ideation or if requested by the parent, foster parent, or CPA; document the screening and the screener's training (§749.137(d)(3), (d)(7)); the 90-day re-screening cadence for children 10+ is initiated at admission (§749.137(d)(4)(C))
• Child's understanding of placement — narrative documenting the pre-placement discussion with the child about why placement is necessary, the child's response, and the date of discussion (§749.1133(b)(15); §749.1253)
• Parent / DFPS-communicated expectations regarding placement duration and family involvement, obtained through DFPS/SSCC (§749.1133(b)(14))

Full Admission Assessment — Routine: on or before the day of placement · Emergency: within 10 days

Includes all Emergency elements, plus the following (obtained through documents provided prior to placement by CPS and meetings with the child, CPS worker, and foster family):

• Medical information (current medical and dental status, §749.1133(b)(6)): known allergies; known medical conditions; last physical exam; last dental exam including current dental status; current medications; child's medical history; family medical history (if known); the 3-Business-Day Medical Exam ("3-in-30") by a Texas Health Steps physician — attach results once completed (distinct from the internal Initial Health Screening); the 30-Day Texas Health Steps / EPSDT checkup — schedule and document (Contracts §5100–5200); initial dental checkup per Texas Health Steps schedule (children 6+ months); TB screening within 30 days of placement for children age 1+ (OCOK §6.12); ECI referral within 3 calendar days of placement for all children under age 3 (unconditional written notice to the local ECI program, RCC §4810)
• Financial and medical assistance
• Determination of service type: use the Treatment Services grid to determine whether the child qualifies under Emotional Disorder, Mental Retardation, or Pervasive Developmental Disorder; services to be provided or initiated while in care (§749.1133(b)(12)); clinical rationale for appropriateness of admission including justification for the family chosen; evaluation of the child's special strengths and needs and whether RH can meet them; foster-family resources and their ability to meet the child's needs
• Determination of whether and how the agency can meet the child's needs (§749.1133(b)(16)) — Program Director sign-off statement: "Refuge House can / cannot meet the child's needs because…"
• Permanency plan information: permanency plan; date for achieving permanency; estimated length of stay in the foster home; immediate goals of placement (first 30 days) (§749.1133(b)(13)); long-range goals of placement, distinct from the immediate 30-day goals (§749.1133(c)(11))
• Child information: understanding and feelings about placement; personality, behaviors, interests; needs; tribal affiliation needs; cultural needs; biological family relationship needs; spirituality; skills, interests, and strengths (§749.1133(c)(9))
• Family history: adult relatives (name, address, phone); siblings (name, address, phone, placement status — sibling placement priority per provider manuals and TAC); other significant relationships; family medical history; family history of suicidal or homicidal behaviors; family history of drug use or criminal behaviors; family achievements and religious preference
• History of previous placements (§749.1133(c)(7)) — structured table: placement name/location, admission date, discharge date, reason for admission, reason for discharge
• Emotional and developmental functioning: emotional/psychological impact of physical, sexual, or emotional abuse/neglect (appropriate or maladaptive behaviors); history of abuse/neglect (physical, sexual, emotional) (§749.1133(b)(4)) — explicit narrative aligned with Attachment A (Child Sexual History Report) review; any history of trauma (§749.1133(b)(5)); recent psychological evaluation (date, evaluator, diagnosis, recommendations, strengths); documentation of any existing psychiatric/psychological evaluation or psychosocial assessment regardless of service package (§749.1133(b)(7); §749.1135); developmental history — required for every admission, with IDD/Autism supplement when applicable (§749.1133(c)(4)); developmental milestones; independent-living skills; activities of daily living; mental-health history baseline — required for every admission, including Basic Foster Family Home placements (§749.1133(c)(5)); substance-abuse history baseline (every admission); skills and special interests; recommendations for further assessment and testing (§749.1133(c)(12)); baseline developmental, educational, and behavioral level of functioning — required for every admission, not only IDD/Autism (§749.1133(b)(8))
• School and education: current grade level, current school, and known school problems (§749.1133(b)(9)); history of educational achievements; schools and dates of attendance; special-education services; school history — prior schools, dates attended, grades earned, special achievements (§749.1133(c)(6)) — tied to Education Portfolio requirements; school enrollment within 3 calendar days of placement in an accredited Texas public school (or written exception), with verification of enrollment within 5 calendar days (OCOK §6.13; Contracts §6100); written notice to the school district for children age 3+ placed in a residential facility (Texas Education Code §29.012; Contracts §6600); Education Portfolio initiated/updated at admission — birth certificate, SSN, immunizations, IEP, ARD notes, etc. (Contracts §6700–6820)
• Behavioral issues: safety plan — indication of need; high-risk behaviors — internal, external, and historical contributing factors (FC 2.02a)
• Child's criminal history or involvement with juvenile justice (§749.1133(c)(8))
• Recommended behavior-management plan — required for every admission, not only Mental & Behavioral Health (§749.1133(c)(13))
• CANS Assessment — review the CANS 3.0 if available; if none has been completed, schedule a CANS appointment with a STAR Health certified assessor within 30 days of entering DFPS conservatorship for children age 3–17 (Contracts §5330)
• Caregiver information-sharing (§749.1255) and the day-of-admission caregiver briefing (§749.1115) — see the procedure table above (Section 10)
• Youth rights review at admission (provide, review, and document): Form K-908-2530 Rights of Children and Youth in Foster Care / Child's Bill of Rights — reviewed with the child and signed; Texas Foster Care Handbook — provided to any youth age 10+; for youth age 16–22 — notice of the right to become their own Medical Consenter

Updated Admission Assessment — Routine: within 30 days · Emergency: within 15 days

Includes all Emergency and Full elements, plus:

• Biological family characteristics
• Biological family strengths
• Social history / family relationships — past and existing relationships with birth parents, siblings, extended family, and other significant adults/children, and the quality of those relationships, including sibling relationships (§749.1133(c)(1))
• Pre-removal home environment and family functioning — narrative description prior to removal (§749.1133(c)(2))
• Birth and neonatal history — prenatal exposure, NICU stay, birth complications (§749.1133(c)(3))
• Impact of biological-family needs

Kinship Foster Home Admissions (TAC §749.4443–§749.4449) — additional

For kinship foster home admissions, in addition to the elements above:

• Complete the kinship admission assessment within Refuge House's 14-day internal standard, which falls within the 40-day regulatory maximum established by §749.4449(b)
• Obtain initial admission information before verification or admission (§749.4445), including: current health status, chronic conditions, medications, high-risk behaviors, suicide screening if required, supervision needs, restraint contraindications, and safety plans
• Obtain a signed Placement Agreement (§749.4447): authorization to care, medical consent, reason for placement, and anticipated length in care
• Share the completed admission assessment (or DFPS CANS in its place) with the kinship foster parents (§749.4449(e))
• Document in the kinship child's record (§749.4443) the initial admission information, the admission assessment, the signed placement agreement, and post-placement contacts. The kinship admission assessment content mirrors §749.1133 as adapted by §749.4449(c); the DFPS needs-and-strengths assessment may be used in place of the admission assessment (§749.4449(d))

REGULATORY 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: Pages 67-75, Short-Term Assessment Support Services
• T3C Blueprint: Pages 136-147, T3C Treatment Foster Family Care Support Services
• T3C Blueprint: 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), §749.1255 / §749.1115 (caregiver information-sharing and day-of briefing)
• TAC §749.1253 (pre-placement discussion with the child), §749.1605–1609 (records to obtain at admission), §749.4443–§749.4449 (kinship foster home admissions)
• TAC Chapter 749, Subchapter H Division 2 (Admission Assessment) and Subchapter W Division 3 (Kinship)
• Texas Education Code §29.012 (school-district notice, residential placement)
• 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): Reviewed against the 2INgage Provider Manual Rev. 1.2026; aligned — no additional provider-specific provisions required. 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 — reviewed; aligned, no additional provider-specific provisions required. 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 — reviewed; aligned, 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) — 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 — reviewed; aligned, 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) — SFCS: SFCS Placement Provider Manual (July 2020, publicly-sourced — currency unconfirmed) / 2019 Affiliate Provider Agreement — reviewed; aligned, no additional provider-specific provisions required in this document. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

FORMS/ATTACHMENTS:

• Initial Intake Information 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
• Functional Behavior Assessment Form
• Sensory Profile Assessment
• Casey Life Skills Assessment (for youth 14+)
• 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
• Initial Health Screening Form
• DFPS Form 2087 / 2087ex (Common Application for Placement)
• DFPS Form 2085-B (Designation of Medical Consenter)
• DFPS Form 2085-FC (Placement Authorization — Foster Care)
• DFPS Form 2085-E (Education Decision-Maker)
• DFPS Form 2279 (Placement Summary)
• DFPS Form 2279b (Certification of Receipt of Child Sexual Abuse/Aggression Information)
• Attachment A (Child Sexual History Report)
• Form K-908-2530 (Rights of Children and Youth in Foster Care / Child's Bill of Rights)
• DFPS Form 4526 (Psychotropic Medication Treatment Consent)
• Texas Foster Care Handbook
• Kinship Placement Agreement (TAC §749.4447)

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

• Emergency vs. routine admission workflows
• TBRI®-informed assessment components
• Attachment history and trauma impact evaluation
• Sensory profile and regulation strategies
• Updated assessment functionality for returning children
• Special population considerations (multiple placements, aging out youth, kinship, pregnant/parenting)
• Mental & Behavioral Health clinical assessment modules
• IDD/Autism functional assessment components
• Substance Use screening and recovery support modules
• Short-Term Assessment coordination and tracking modules
• Treatment Foster Family Care clinical assessment and step-down planning modules

This procedure document operationalizes the principles established in the corresponding policy 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.