# REFUGE HOUSE, INC.

| Policy Information | Details |
| :---- | :---- |
| **POLICY NAME** | Alternative and Substitute Care |
| **POLICY NUMBER** | FC18-01 |
| **ORIGINATED** | 6/04 |
| **APPROVED BY** | Board of Directors |
| **APPROVED ON** | 5/15/25 |
| **EFFECTIVE DATE** | 5/15/25 |
| **LAST UPDATED** | 5/15/2026 |
| **LAST APPROVED** | 5/22/2026 |
| **SECTION** | FC18 |
| **DATE(S) OF REVISION** | 6/04, 8/05, 7/06, 4/20/07, 5/26/07, 2/25/08, 8/5/08, 1/22/09, 8/29/09, 1/1/10, 3/23/10, 8/1/11, 1/16/12, 5/15/25, 6/16/26 |

| 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 that allows caregivers to utilize alternative and substitute care options while ensuring children and youth in care receive consistent, trauma-informed supervision that meets their individual needs and complies with all regulatory requirements.

## POLICY:

Refuge House recognizes that caregivers of foster/adoptive children need periodic breaks from the normal routine to allow time to recharge and refresh. Refuge House encourages caregivers to plan times when they can utilize these breaks to provide continued quality care to the children/young adults placed in their homes. Refuge House offers alternative and substitute care options while ensuring all RCCL minimum standards, DFPS/SSCC Contract terms, and T3C Blueprint requirements are followed according to the type of occurrence. All substitute care providers will be familiar with trauma-informed approaches and the basic TBRI principles to ensure continuity of care and minimize disruption for children in placement.

## PACKAGE-SPECIFIC REQUIREMENTS:

### CORE REQUIREMENTS

1. Refuge House offers several ways for a caregiver to take advantage of regular and routine breaks prior to becoming overwhelmed by their care giving duties. Refuge House develops and follows written policies for each of these provider types as required by **26 TAC §749.127**:  
     
   - **Babysitting** (up to 12 consecutive hours; no overnight)  
   - **Foster Child Serving as Babysitter** (a foster child or other minor age 16+, only where the conditions of **26 TAC §749.2599** are met)  
   - **Overnight Care Provider / In-Home Substitute Care** (planned in-home or out-of-home care that includes one or more nights and does **not** exceed 72 consecutive hours; replaces the former "Mini-Break" and "Weekender" categories)  
   - **Intermittent Alternative Care (IAC)** (planned 24-hour care of **more than 72 hours and up to 14 consecutive days**; the only form of substitute care permitted in response to an emergency or crisis)  
   - **Special Circumstances** (investigations, hospitalizations, emergency placements, primary medical needs, T3C TFFC)

   

2. All alternative and substitute care arrangements require verification that the provider can meet the child/young adult's needs while in their care, including consideration of:  
     
   - Medication regimen  
   - Medical, dental, psychological or psychiatric appointments  
   - Court ordered visitation  
   - Educational needs  
   - Recreational schedule  
   - Level of supervision required  
   - Daily routines and dietary issues  
   - Diagnosis and level of care  
   - History and potential trauma triggers  
   - Cultural, racial, ethnic, linguistic, religious, and sexual orientation considerations

   

3. A CPMS-qualified employee (Program Director / LCPAA) must approve the child/young adult's stay prior to **each** occurrence, ensuring compliance with child/caregiver capacity and ratio requirements and geographic proximity (preference for placement within **50 miles** of the child's primary placement when operationally feasible). A provider may never be out of **capacity**; if a provider will be out of **ratio** at any point, a justification for ratio is completed and approved.  
     
4. For a child/young adult associated with a tribe, Refuge House will contact the tribal representative for approvals of any substitute-care arrangement. A dedicated tribal liaison contact protocol and **ICWA-Compliant Placement Checklist** will be maintained and followed for all tribal youth.  
     
5. All substitute care providers must be screened for physical, emotional, and mental stability to provide safe, quality care for youth. Screening includes a **name-based criminal-history check** and a **DFPS Central Registry check on every household member age 14 or older**, and — for IAC providers — **FBI fingerprint-based checks** on the IAC household. If any red flags of physical, emotional, or mental instability are identified, the individual will not be used or licensed as a substitute-care provider.

### GENERAL GUIDELINES — ALL SUBSTITUTE CARE PROVIDERS

**Non-allowable while providing any form of substitute care:** no smoking in a vehicle or home while providing care; no intoxication by alcohol; no illegal drug use; and refraining from the use of profanity. (Refuge House strongly encourages providers to refrain from smoking and drinking entirely while caring for children/young adults.)

**Responsibilities while providing substitute care:** provide supervision according to each child's individual needs and service level; release a child/young adult only to Refuge House personnel or the child's caregiver (retaining responsibility until Refuge House personnel arrive if a person appears unfit to take the child); ensure uninterrupted continuation of the child's education; provide transportation to all appointments, scheduled activities, court-ordered visitation, and to and from the child's job; respect the child's culture, faith, age, gender, gender identity, sexual orientation, developmental delays, and medical needs; engage the child in age- and ability-appropriate activities consistent with **TBRI** principles; and follow all dietary requirements (food may never be withheld or used as discipline).

**24/7 availability and emergency information:** Refuge House provides 24/7 availability to all substitute-care providers. Prior to each occurrence, the provider is given and reviews a **fact sheet** with all emergency numbers (including the SSCC after-hours line where applicable) and serious-incident/emergency instructions per **26 TAC §749.2625** (cross-ref: Serious Incident Reporting Policy; DERPP). Before the provider assumes responsibility for the child, the provider reviews and signs **Form K-908-2279** (Placement Summary / Caregiver Certification), **Attachment A** (Child Sexual History Report), and **Form K-908-2279b** (Certification of Receipt of Child Sexual Abuse or Sexual Aggression Information).

### INTERMITTENT ALTERNATIVE CARE (IAC)

1. IAC is defined as out-of-home substitute care providing planned 24-hour alternative care lasting between 72 hours and 14 days whose purpose is to provide relief to primary caregivers.  
     
2. IAC is the only form of substitute care permitted in response to an emergency or crisis.  
     
3. Additional uses of IAC and length of stay permitted according to the DFPS Contract Attachment D include:  
     
   - Foster family emergency/crisis (14 days or less)  
   - Family out of town (longer than 72 hours up to 14 days)  
   - Investigations (extensions beyond 14 days only with written CPS-supervisor approval per RCC §2310)

   

4. IAC Provider Qualifications:  
     
   - Must be a verified Refuge House foster/adoptive care provider  
   - May or may not have children/young adults in the home  
   - Must be 21 years of age  
   - Must complete all required applications, background checks, and training  
   - Must demonstrate the ability to meet a child/young adult's needs in an age-appropriate and culturally sensitive manner  
   - Must follow child's service plan  
   - Must complete annual refresher training on:  
     - Trauma-informed care approaches  
     - Emergency behavior intervention techniques  
     - Medication administration  
     - TBRI principles

   

5. Payment for IAC:  
     
   - IAC is a paid form of substitute care  
   - The T3C rate methodology includes funding for 40 days of paid IAC per year  
   - Under T3C, with appropriate DFPS approval and documentation, the agency may pay both:  
     - The regular foster family their normal pass-through rate during IAC, AND  
     - The IAC provider the same pass-through rate for each day they provide care  
   - During investigations of the foster home, payment to the original foster home will be suspended unless specific DFPS/SSCC approval is documented  
   - Payment to the IAC provider is processed on the 15th and 30th of each month

   

6. Additional IAC Requirements:  
     
   - Each child/young adult placed in IAC must wait at least 10 days before returning to IAC (RCC §2310; no child-level exception — homes used exclusively for IAC remain available to *other* children)  
   - For each caregiver home providing IAC, the home must wait a minimum of 10 days between IAC placements  
   - A home may only provide IAC for a maximum of 60 days per year unless solely used for this purpose  
   - A child/young adult may be in IAC for 14 consecutive days, not to exceed 40 days per year  
   - IAC may not exceed 14 days: if care is needed beyond 14 days, contact the CPS Caseworker to secure a new placement; any extension requires **written approval from the CPS Caseworker's supervisor or designee** (RCC §2310)

### ☒ MENTAL & BEHAVIORAL HEALTH, ☒ SUBSTANCE USE SUPPORT SERVICES, ☒ SEXUAL AGGRESSION/SEX OFFENDER, ☒ HUMAN TRAFFICKING VICTIM/SURVIVOR

1. Substitute care providers for children/youth in these packages must receive additional training on managing behavioral issues and supporting youth with trauma histories related to these specific needs.  
     
2. IAC providers are required to be fully licensed caregivers with the ability to meet a child/young adult's needs in an age-appropriate and culturally sensitive fashion.  
     
3. Fully licensed and experienced caregivers have the needed skills to help a child/young adult process any trauma related to the emergency/crisis that resulted in the need for IAC.  
     
4. IAC providers must demonstrate understanding of the importance of following the child/young adult's service plan and using TBRI principles to provide support in key areas including behavioral, developmental, social, educational, spiritual, daily living, and life-skills domains.

### ☒ COMPLEX MEDICAL NEEDS OR MEDICALLY FRAGILE

1. Substitute care providers for children/youth in this package must demonstrate competence in meeting the specific medical needs of the child/youth, including medication administration and any specialized care procedures.  
     
2. IAC providers must receive specific training on the child's medical needs before caring for children in this package.  
     
3. An individualized health plan must be developed for each child with complex medical needs or who is medically fragile, and this plan must be shared with and followed by all substitute care providers.

### ☒ INTELLECTUAL OR DEVELOPMENTAL DISABILITY (IDD)/AUTISM SPECTRUM DISORDER

1. Substitute care providers for children/youth in this package must demonstrate understanding of the child's unique communication, sensory, and behavioral needs.  
     
2. The provider must be able to maintain the child's routine and structure to minimize disruption and distress.

## DEFINITIONS:

- **Respite**: A licensing term which encompasses IAC and other forms of planned 24-hour substitute care  
- **Caregiver**: A person counted in the child/caregiver ratio, including employees, foster parents, contract service providers, and volunteers, whose duties include direct care, supervision, guidance, and protection of a child in care  
- **Intermittent Alternative Care (IAC) Provider**: A certified foster care provider who may or may not have children/young adults in the home, providing planned 24-hour care for more than 72 hours and up to 14 days, as a subset of respite services  
- **Overnight Care Provider / In-Home Substitute Care**: A person providing planned in-home or out-of-home care that includes one or more nights and does **not** exceed 72 consecutive hours (and therefore does not constitute respite/IAC under §749.2621); replaces the former "Mini-Break" and "Weekender" categories  
- **Babysitter**: A person who provides supervision in a Refuge House foster/adoptive home for no more than **12 consecutive hours** and no overnight; not considered a caregiver unless the babysitter is a verified foster/adoptive parent, licensed caregiver, or Refuge House employee (26 TAC §749.127; §749.2625)  
- **Foster Child Serving as Babysitter**: A foster child or other minor age **16 or older** who may babysit children under 13 only when all conditions of 26 TAC §749.2599 are met (CPMS approval with documented duration/frequency limits; current First Aid/CPR; neither the babysitter nor any supervised child receiving treatment services; single occurrence ≤ 8 hours; never overnight)  
- **Safety Plan**: When a child/young adult presents a risk of harm to self or others, Refuge House will develop a written Safety Plan, which may include continuous observation until the danger has subsided and the child/young adult's condition is stabilized, with mandatory upload to CCRMS within 24 hours

## REFERENCES:

- T3C Blueprint Standards: FC 18.1, FC 18.2, FC 18.3, FC 18.04, FC 18.5, FC 18.6, FC 18.7  
- DFPS Chapter 749 Minimum Standards: **§749.127** (policies for babysitters/overnight/respite providers), **§749.2599** (child serving 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 (placement in a home Licensing does not regulate)  
- DFPS 24-Hour RCC Requirements (FY26) §§2230–2330 (Respite and Intermittent Alternate Care); T3C System Blueprint (Apr 2026); applicable SSCC Network Provider requirements  
- Indian Child Welfare Act (ICWA) and ICWA-Compliant Placement Checklist

## RELATED PROCEDURES:

- FC18-01.1 Alternative and Substitute Care Procedure  
- RH Home Study Policy  
- RH Recruitment and Retention of Foster Families Policy  
- RH Serious Incident Reporting Policy  
- RH Disaster Plan

## FORMS/ATTACHMENTS:

- Forms and documentation to be determined