# REFUGE HOUSE, INC.

| Procedure Information | Details |
| :---- | :---- |
| **PROCEDURE NAME** | Alternative and Substitute Care Procedure |
| **PROCEDURE NUMBER** | FC18-01.1 |
| **RELATED POLICY** | FC18-01 Alternative and Substitute Care Policy |
| **APPROVED BY** | Executive Director |
| **EFFECTIVE DATE** | 5/15/25 |
| **REVISION DATE** | 6/16/26 |
| **LAST UPDATED** | 5/15/2026 |
| **LAST APPROVED** | 5/22/2026 |

| APPLICABLE T3C PACKAGES: | APPLICABLE T3C ADD-ON SERVICES: |
| :---- | :---- |
| ☒ T3C Basic Foster Family Home | ☒ Transition Support Services for Youth & Young Adults |
| ☒ Substance Use Support Services | ☒ Kinship Caregiver Support Services |
| ☒ Short-Term Assessment | ☒ Pregnant & Parenting Youth or Young Adult |
| ☒ Mental & Behavioral Health |  |
| ☒ Sexual Aggression/Sex Offender |  |
| ☒ Complex Medical Needs or Medically Fragile |  |
| ☒ Human Trafficking Victim/Survivor |  |
| ☒ Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder |  |
| ☒ T3C Treatment Foster Family Care |  |

## PURPOSE:

To establish a standardized process for implementing alternative and substitute care options for children and youth in Refuge House foster homes, ensuring supervision that meets each child's individual needs while maintaining compliance with all regulatory requirements. Where an SSCC provider manual or the T3C System Blueprint imposes a stricter requirement than DFPS Minimum Standards, the **stricter requirement controls**.

## RESPONSIBILITY:

- Caregivers
- Case Specialists (formerly Case Manager)
- Case Manager Supervisors
- Program Directors / LCPAAs (CPMS-qualified approver)
- Treatment Director
- Intake / Home Development
- Quality Assurance / Quality Development
- Accounting

## PROCEDURE:

### 1. GENERAL SUBSTITUTE CARE REQUIREMENTS

#### Purpose and Overview

All forms of substitute care must prioritize the child's safety, well-being, and continuity of care. Substitute care providers are familiar with trauma-informed approaches and TBRI principles so children experience minimal disruption. These general requirements apply to all forms of substitute care, from brief babysitting to extended IAC. Refuge House maintains written policies for babysitters, overnight care providers, and respite care providers per **26 TAC §749.127**.

| Who | How | When | Where | Regulatory Reference |
| :---- | :---- | :---- | :---- | :---- |
| Case Specialist / Intake / Home Development | 1. Screen all potential substitute-care providers: name-based criminal-history check and DFPS Central Registry check on every household member age 14+; FBI fingerprint check on the IAC provider household; training completion; ability to meet the child's package-specific needs; understanding of TBRI. 2. Watch for physical, emotional, or mental instability; do not use a provider with unresolved red flags. 3. Document screening and maintain the approved-provider list. | Prior to any substitute care arrangement | Radius Provider Management | §749.127; §749.2627 |
| Substitute Care Provider | 1. Non-allowables: no smoking in vehicle/home while providing care; no alcohol intoxication; no illegal drug use; refrain from profanity. 2. Care standards: supervise per the child's needs/service level; release the child only to authorized Refuge House personnel or the caregiver; maintain educational continuity; provide required transportation (appointments, activities, court-ordered visitation, job); respect the child's culture/identity/needs; engage the child in TBRI-consistent activities; follow all dietary requirements (food never withheld or used as discipline). | Throughout substitute care period | Foster home or approved location | §749.2629 |
| On-Call Staff | 1. Maintain 24/7 availability. 2. Provide emergency support (behavior-management guidance, medical-emergency protocols, incident reporting, TBRI coaching). 3. Ensure the provider has received and reviewed the emergency fact sheet, including the SSCC after-hours line. 4. Document all contacts. | 24/7 during substitute care | Phone / Text support | §749.2625; RCC (FY26) §§2230, 2320 |

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

For a **2INgage** child placed into respite, notice is given to 2INgage **before** the respite occurs, and Refuge House **informs the child** of the plan for respite child-care services, including the intended time of stay. *(2INgage Provider Manual Rev. 1.2026 §4, p.20)*

**SSCC-2INGAGE — addition end**

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

For an **EMPOWER** child placed into respite, notice is given to EMPOWER **before** the respite occurs, and Refuge House **informs the child** of the plan for respite, including the intended time of stay *(EMPOWER Provider Manual Rev. 1.2026 §4, p.22)*.

**SSCC-EMPOWER — addition end**

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

For **OCOK** Exceptional Care, Refuge House provides 24-hour crisis response, visits the caregiver home at least **every other week**, identifies and obtains approval of at least one **Alternative Care Provider** for single-parent homes (added to the service agreement), and ensures a respite option *(OCOK Network Management Operations Manual Rev. 7-1-2025 §6.24, pp.216–217)*.

**SSCC-OCOK — 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**, respite notice is given to the SFCS Child Case Manager by email at least **24 hours** prior (or **7 days** prior if the stay will exceed seven nights) *(SFCS Placement Provider Manual, July 2020 §2.10, p.20)*.

**SSCC-STFRANCIS — addition end**

### 2. BABYSITTING (≤ 12 consecutive hours; no overnight)

#### Purpose and Overview

A babysitter provides supervision in a Refuge House foster/adoptive home and **may not care for a child more than 12 consecutive hours** and **never overnight** (26 TAC §749.127; FC18-01). Arrangements including one or more nights use the Overnight Care Provider procedure (Section 4). The number of children a babysitter supervises may not exceed the home's verified capacity and child/caregiver ratio. Refuge House does **not** reimburse for babysitting.

| Who | How | When | Where | Regulatory Reference |
| :---- | :---- | :---- | :---- | :---- |
| Caregiver | 1. Verify the babysitter's qualifications are current and documented at Refuge House (call the Case Specialist to confirm): 18+ years (adult babysitter); prior child-care experience; current first-aid/CPR; cleared name-based criminal-history and DFPS Central Registry checks (FBI if necessary); two documented personal references; Refuge House orientation (confidentiality, mandated reporting, discipline, emergency procedures); valid driver's license and auto insurance if transporting; clear TB screening; required training complete. 2. Confirm the number of children does not exceed verified capacity/ratio. 3. Prepare the child using TBRI connecting principles and provide the information required by §749.2625 (emergency contacts, routine, preferences, dietary needs, behavioral strategies/Safety Plan, medication regimen, two-way contact method). 4. Review and have the babysitter sign Form K-908-2279, Attachment A (and K-908-2279b for respite/alternate providers) BEFORE the babysitter assumes responsibility. | Before each babysitting occurrence | Foster home | §749.127; §749.2625 |
| Case Specialist | 1. Provide verbal and e-mail verification to the caregiver; file the e-mail verification in the child's record. 2. Request the current Babysitter Information Form and confirm it is updated before the occurrence. 3. File the reviewed form in Radius. 4. Verify credentials annually and at re-verification; track usage for the 12-consecutive-hour maximum and no-overnight rule. | Each occurrence; credentials annually | Radius | §749.127; §749.2625 |
| Quality Assurance | 1. Lock down forms quarterly. 2. Review babysitting usage quarterly; identify patterns suggesting caregiver fatigue or over-reliance. 3. Address concerns with the Case Specialist and Program Director. | Quarterly | Radius Reports | T3C Blueprint FC 18.1 |

### 3. FOSTER CHILD SERVING AS BABYSITTER (26 TAC §749.2599)

#### Purpose and Overview

A foster child or other minor age **16 or older** may babysit children under 13 **only** when all of the §749.2599 conditions are met. CPMS approval and the documented duration/frequency limits are kept in the foster home record.

| Who | How | When | Where | Regulatory Reference |
| :---- | :---- | :---- | :---- | :---- |
| Case Specialist / CPMS | 1. Confirm ALL before approving: CPMS-qualified staff approval with specific duration/frequency limits; babysitter is 16+; babysitter holds current First Aid/CPR; **neither the babysitter nor any supervised child is receiving treatment services**. 2. Document approval, limits, and qualifications in the foster home record. 3. Limit any single occurrence to **8 hours** and **never overnight**. | Before each occurrence | Foster home record / Radius | §749.2599 |

### 4. OVERNIGHT CARE PROVIDER / IN-HOME SUBSTITUTE CARE (one or more nights, ≤ 72 consecutive hours)

#### Purpose and Overview

An Overnight Care Provider delivers planned in-home or out-of-home care that includes one or more nights and does **not** exceed 72 consecutive hours (and therefore is not respite/IAC under §749.2621). Care exceeding 72 consecutive hours falls under the IAC procedure (Section 5). This category replaces the former "Mini-Break" and "Weekender" sub-categories. Refuge House may place a child for babysitting, overnight, or respite care in a home **not** regulated by Licensing only when the provider is not subject to Licensing regulation and meets Refuge House requirements developed under §749.127 (§749.2635). Refuge House does not pay for standard overnight care that does not qualify as paid IAC.

| Who | How | When | Where | Regulatory Reference |
| :---- | :---- | :---- | :---- | :---- |
| Caregiver | 1. Determine the correct category (Babysitting ≤12 hrs; Overnight ≤72 hrs; IAC >72 hrs). 2. Submit the request with advance notice: **at least 24 hours** prior for any out-of-home occurrence; **at least 7 days** prior when the stay will exceed 7 nights. Identify the proposed provider, dates, and duration. | 24 hrs / 7 days advance | Written notice to Refuge House | §749.2635 |
| Case Specialist / Home Development / Intake | 1. Verify the provider meets category requirements: 18+ (in-home) or 21+ (outside the home); all background checks clear (criminal history + Central Registry on every household member 14+); required training (trauma-informed care, TBRI, EBI, medication administration, Universal Human Trafficking Prevention, CSA/Remedial Order 4 as applicable); ability to meet package-specific needs. 2. Confirm the provider is in good standing before seeking approvals. | Within the notice window | Radius | §749.2635; §749.2629 |
| Case Specialist → CPMS / Treatment Director | 1. Complete the justification form to CPMS (Program Director/LCPAA) and Treatment Director confirming: quality match in good standing; child/adult ratios met (a provider may NEVER be out of capacity; a ratio justification is completed if out of ratio); supervision plan; appropriate sleeping arrangements for age/gender/special needs; ICWA / ICWA-Compliant Placement Checklist for tribal youth; and a conflict-of-care determination for other children in the receiving home. | Before approval | Radius | §749.2627; §749.2629 |
| Case Specialist | 1. E-mail/fax the request to the CPS worker / SSCC Permanency Case Manager (and Tribal Representative if applicable); follow up by phone daily (excluding weekends). 2. If no approval within 3 days, escalate to the CPS Supervisor / SSCC chain of command; after another 3 days, escalate to the unit Program Director; if local and still unreturned, go in person. 3. File the approval/denial in the child's Radius record. 4. Send the caregiver written authorization (or denial) BEFORE care; for tribal youth, do not authorize until the tribal representative responds. The authorization to an active foster family states: "From the point of this approval your home may not receive new placements. Once the substitute care has ended, placements may resume," and copies Intake. **Without written authorization, substitute care may not occur.** | Until approvals returned; before care | Radius / e-mail | §749.2627; §749.2635 |
| Case Specialist | 1. Within 48 hours of care, complete the In-Home Substitute Care Fact Sheet / Information-Sharing Checklist required under **§749.2625** with all emergency contacts (family "away" contact; physician; DFPS / SSCC after-hours line; school; Refuge House on-call). 2. Attach required blank forms: Form K-908-2279, Attachment A, and K-908-2279b (signed before the provider assumes responsibility); medication logs for the length of stay; Medical Consent Letter (caregiver-signed); and Radius login for the provider to enter caregiver notes, the recreation calendar, and the Safety Plan if applicable. 3. Enter the substitute care into Radius. | Within 48 hrs of care | Radius | §749.2625 |
| Caregiver | 1. Ensure the provider understands all requirements and receives all paperwork: medications and directions, med logs, Medicaid card, DFPS placement authorization, signed Medical Consent Letter, the Fact Sheet (verbally reviewed), supervision requirements and Safety Plan. 2. On completion, provide Refuge House the med logs and ensure caregiver notes and recreation calendars are completed in Radius; document the occurrence in caregiver notes and the recreation calendar. | Before and after care | Foster home / Radius | §749.2625; §749.2629 |
| Case Specialist | 1. Review all paperwork; scan medication logs into Radius. 2. Document the substitute care in the quarterly home-monitoring report in the caregiver record and upload to OneCase or IMPACT where required by the SSCC by the next business day. 3. Close the substitute care in Radius. | At completion | Radius | §749.2629 |

### 5. INTERMITTENT ALTERNATIVE CARE (IAC) (> 72 hours to 14 consecutive days)

#### Purpose and Overview

IAC is our most comprehensive substitute-care option — planned 24-hour care by fully verified foster families lasting between 72 hours and 14 days. Per policy, "IAC is the only form of substitute care permitted in response to an emergency or crisis." The T3C funding model includes **40 days of paid IAC annually**.

| Who | How | When | Where | Regulatory Reference |
| :---- | :---- | :---- | :---- | :---- |
| Caregiver | 1. Submit the IAC request: reason; preferred dates; preferred IAC provider if known; current needs/behaviors. 2. For tribal youth, note tribal affiliation. | At least 24 hrs prior (planned); immediately for emergencies | Radius or email to Case Specialist | §749.2627 |
| Case Specialist | 1. Review against the child's service plan, prior IAC usage (10-day gap rule), annual limits, and provider suitability. 2. For tribal youth: contact the tribal representative, document input, follow ICWA. 3. Match the child to an appropriate IAC provider. 4. Verify provider home compliance: current verification; capacity availability; 10-day gap since last IAC; annual 60-day limit. | Within 48 hours of request | Radius IAC Module | §749.2627; §749.2633; ICWA |
| Program Director / CPMS | 1. Review and approve the IAC placement considering geographic proximity, the provider's ability to meet needs, capacity/ratios, and special circumstances. 2. Document approval rationale. 3. For investigations: determine payment continuation per DFPS guidance. | Within 1 business day of Case Specialist review | Radius | §749.2631; §749.2635 |
| Case Specialist | 1. Prepare the IAC Fact Sheet / information-sharing checklist required under **§749.2625** (routine, preferences, medical info and medications, educational requirements, TBRI behavioral strategies, emergency contacts, court-ordered visits, cultural considerations). 2. Coordinate the handoff between families. 3. Ensure medication transfer with logs. 4. Document the placement in Radius. | 48 hours before IAC start | Radius and direct communication | §749.2625 |
| IAC Provider | 1. Review the child's information thoroughly. 2. Maintain all routines and appointments. 3. Implement TBRI strategies consistently. 4. Document daily activities and behaviors. 5. Administer medications per directions. 6. Maintain communication with the primary caregiver, Case Specialist, and on-call support. 7. Complete daily logs. | Throughout IAC placement | IAC provider home | §749.2629 |
| Accounting (coding by Intake Coordinator; verified by Program Director) | 1. Process IAC payments per policy: the regular family continues receiving its pass-through rate AND the IAC provider receives the same pass-through rate per day, with documented DFPS/SSCC approval. 2. Pay both on the **15th and 30th** of each month. 3. Track against the 40-day annual funding. 4. For investigations: suspend the regular family's payment unless DFPS/SSCC approval is documented; document the determination; continue IAC-provider payment. | Per semi-monthly schedule | Radius Financial Module / QuickBooks | T3C Blueprint (IAC funding); RCC (FY26) §2310 |

### 6. SPECIAL CIRCUMSTANCES

#### Purpose and Overview

Certain situations require modifications while maintaining safety and regulatory compliance — extended investigations, hospitalizations, and emergency placements.

| Who | How | When | Where | Regulatory Reference |
| :---- | :---- | :---- | :---- | :---- |
| Program Director | **Investigations:** 1. Coordinate placement with DFPS. 2. Payment structure: IAC provider always paid; regular family payment per DFPS. 3. Document decisions. 4. If IAC is needed beyond 14 days, contact the CPS Caseworker to secure a new placement or obtain **written approval from the CPS Caseworker's supervisor or designee** for the extension (RCC §2310). | Upon investigation notice | Radius and DFPS communication | §749.2631; §749.2633; RCC §2310 |
| Case Specialist | **Hospitalizations:** 1. Arrange appropriate supervision. 2. Consider medical needs. 3. Coordinate with the medical team. 4. Document arrangements. 5. Update the Safety Plan if needed. | Immediately upon admission | Hospital and Radius | Medical consent requirements |
| On-Call Supervisor | **Emergency placements:** 1. Identify an available IAC provider. 2. Gather essential information. 3. Approve the emergency placement. 4. Notify the Case Specialist. 5. Complete documentation within 24 hours. | Immediately upon emergency | Phone and Radius | §749.2621; §749.2627 |

### 7. QUALITY ASSURANCE AND COMPLIANCE

| Who | How | When | Where | Regulatory Reference |
| :---- | :---- | :---- | :---- | :---- |
| Quality Assurance / Quality Development | 1. Monitor compliance: babysitting limits (12-hr/no-overnight), IAC day gaps and annual limits, provider verification status, documentation completeness, payment accuracy. 2. Generate compliance reports. 3. Assign a QA worker to review and lock down substitute-care records. | Monthly and quarterly | Radius Reports | T3C Blueprint monitoring |
| Treatment Director | 1. Review substitute-care usage patterns and support needs. 2. Recommend additional resources. 3. Ensure TBRI implementation. 4. For paid IAC/in-home care: review the payment request, obtain ED/CEO signature approval for payment, scan the approved request to each child's Radius record, e-mail accounting, and notify Quality Development. | Quarterly; per payment | Case reviews / Radius | CQI requirements |
| Accounting | 1. Enter substitute-care payments into QuickBooks and schedule payment on the 15th and 30th. 2. Reconcile payments against T3C allocations. 3. Identify discrepancies and maintain the audit trail. | Monthly / semi-monthly | Financial reports | Financial compliance |

## REGULATORY REFERENCES:

- T3C Blueprint: FC 18.1, FC 18.2, FC 18.3, FC 18.04, FC 18.5, FC 18.6, FC 18.7 (IAC funding)
- 26 TAC **§749.127** (provider policies), **§749.2599** (child as babysitter), §749.2621 (respite services), **§749.2625** (information shared with provider), §749.2627 (before accepting respite), §749.2629 (additional respite requirements), §749.2631 (duration), §749.2633 (frequency), §749.2635 (non-Licensing-regulated home)
- DFPS 24-Hour RCC Requirements (FY26) §§2230–2330 (Respite and Intermittent Alternate Care); T3C System Blueprint (Apr 2026); SSCC Network Provider requirements (if applicable)
- Indian Child Welfare Act (ICWA) and ICWA-Compliant Placement Checklist

**SSCC alignment (FY-26):** 2INgage Provider Manual Rev. 1.2026 — §4 (p.20 respite notice / inform child). 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 — §4 (p.22 respite/inform child). 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 — §6.24 (pp.216–217 Exceptional Care duties). 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 — Manual §2.10 (respite notice). Confirm against the current SFCS provider manual. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

## FORMS/ATTACHMENTS:

- Babysitter Information Form
- Form K-908-2279 (Placement Summary / Caregiver Certification); Attachment A (Child Sexual History Report); Form K-908-2279b (Certification of Receipt of CSA/Sexual Aggression Information)
- IAC Request Form; IAC Fact Sheet; IAC Justification and Approval Letter
- In-Home Substitute Care Request, Justification, Approval Letter, Fact Sheet, and Request Payment Form
- Justification Form for Ratio
- Medical Consent Letter

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*This procedure operationalizes FC18-01 Alternative and Substitute Care Policy and may be updated by the Executive Director to reflect regulatory or operational changes, provided alignment with the policy's intent is maintained.*