REFUGE HOUSE, INC.

1. PURPOSE

This policy establishes Refuge House's framework for conducting continued stay reviews to ensure children receive appropriate levels of care without unnecessary restriction in intensive placements. Continued stay reviews balance each child's need for specialized services with the principle of least restrictive environment, ensuring children do not remain in intensive placements longer than clinically necessary while verifying that ongoing service needs are met.

Relationship to the Service Plan Snapshot. The continued stay confirmation is the attestation layer of the Service Plan Snapshot — the certification event known in regulation as the Service Plan Review (26 TAC §749.1335). It is conducted within, not parallel to, the Snapshot: the Snapshot packages the evidence; the continued stay confirmation captures the signed professional judgment that the packaging cannot substitute for. See FC3-01 and the Service Plan Lexicon (cookbook: t3c-service-plan-lexicon).

2. GOVERNING PRINCIPLES

2.1 Least Restrictive Environment

Refuge House is committed to placing children in the least restrictive setting appropriate to meet their individualized needs. Continued stay reviews systematically evaluate whether children can safely transition to less intensive service packages or permanency placements.

2.2 Child-Centered Decision Making

All continued stay determinations are based on the child's current functioning, treatment progress, and ongoing service needs as documented through CANS 3.0 assessments and Service Plan reviews. Decisions prioritize child safety, well-being, and permanency.

2.3 Clinical Integrity

For specialized service packages, continued stay determinations require clinical justification supported by specific, measurable indicators. Generic statements are insufficient; documentation must demonstrate ongoing need for the current level of care.

2.4 Regulatory Compliance

Continued stay reviews comply with 26 TAC Chapter 749 Minimum Standards, T3C Blueprint requirements (April 2026 edition), RCC Contract obligations, and applicable state law including Texas Family Code §264.1073 for Treatment Foster Family Care.

3. REVIEW FREQUENCY BY SERVICE PACKAGE

3.1 Standard Review Cycles

¹ Decision (June 2026): Basic confirmations follow the same 90-day Snapshot cadence required by the RCC Contract, which supersedes the 6-month TAC baseline for as long as that contract term is in effect. A single cadence for all packages is simpler and safer to operate. ² The operational Snapshot reference additionally lists SSCC/DFPS affirmation at TFFC reviews. Verification against the April 2026 Blueprint TFFC section (pp.137-148) is pending; low priority while TFFC is not in Refuge House's credentialing process.

3.2 Treatment Foster Family Care - Enhanced Requirements

Per Texas Family Code §264.1073 and TAC §700.1335, Treatment Foster Family Care requires more frequent review (60 days) due to the intensive, time-limited nature of services (maximum 365-day length of stay). Both Program Director and Treatment Director must provide written confirmation at each review.

3.3 Short-Term Assessment Support Services - Not Applicable

Short-Term Assessment Support Services does NOT require continued stay reviews. This package is time-limited by design (30-45 days with possible 15-day extension) with the primary purpose of completing comprehensive assessments to determine appropriate ongoing Service Package placement. Children transition to receiving Service Packages upon assessment completion rather than remaining in continued stay.

Cross-Reference: FC-STASS-01 Short-Term Assessment Support Services Policy

4. WRITTEN CONFIRMATION REQUIREMENTS

4.1 Enhanced Service Packages (MH, IDD/Autism, SU, TFFC)

For specialized service packages, BOTH the Program Director AND Treatment Director must provide written confirmation addressing:

Treatment Director Confirmation:

• Child continues to meet clinical criteria for the Service Package
• Child is benefitting from the Evidence-Informed Treatment Model
• Specific clinical indicators supporting continued placement
• Explanation of why less-restrictive placement is insufficient

Program Director Confirmation:

• Child continues to meet admission criteria for the Service Package
• Less-restrictive placement type is not appropriate to meet child's individual needs
• Administrative and resource indicators supporting continued placement
• Placement stability and permanency planning progress

4.2 Documentation Standards

Written confirmations must include:

• Child's name and identifying information
• Date of review
• Current CANS 3.0 assessment reference
• Specific, measurable indicators (not generic statements)
• Both signatures with credentials and dates
• Clear statement regarding appropriateness of less-restrictive placement

4.3 Basic Foster Family Home

For T3C Basic Foster Family Home, the Program Director provides written confirmation at each 90-day Service Plan Snapshot that the child continues to meet admission criteria, that a less-restrictive placement is not appropriate, and that agency and home credentials are current. Dual signature is not required, and the Basic confirmation is not submitted to SSCC/DFPS; it is filed with the Snapshot in the child's record.

5. CONTINUED STAY CRITERIA

5.1 Universal Criteria (All Packages)

At each continued stay review, the following must be evaluated:

• Primary admission reason continues to require ongoing services, OR services have been added or replaced to address new needs that align with the credentialed Service Package
• Services continue to support the child's individual need for safety, well-being, developmental progress, and permanency
• Progress toward the child's individualized Service Plan goals is reviewed, including CANS 3.0 domain changes and documented clinical indicators, using the goal-type-appropriate scale (maintenance goals verified as sustained / at-risk; achievement goals on the progress scale — see FC3-01 Provision 8)
• Less-restrictive placement type is not appropriate to meet child's individual needs
• CPA and Foster Family Home continue to maintain required credential(s)
• Continued stay determinations — and the specific indicators supporting them — are documented in the case record (per §4.2)

Per T3C Blueprint (April 2026) and 26 TAC §749.1335.

5.2 Package-Specific Criteria

Cross-Reference: Package-specific continued stay criteria are detailed in:

• FC-MH-01 Mental & Behavioral Health Support Services Policy (Section 8)
• FC-IDD-01 IDD/Autism Spectrum Disorder Support Services Policy (Section 6)
• FC-SU-01 Substance Use Support Services Policy (Section 16)
• FC-TFFC-01 Treatment Foster Family Care Support Services Policy (Section 8)

6. SSCC/DFPS SUBMISSION REQUIREMENTS

6.1 Submission Timeline

For Mental Health, IDD/Autism, Substance Use, and Treatment Foster Family Care packages, completed continued stay documentation must be submitted to SSCC/DFPS within 15 business days of the review date. T3C Basic confirmations are not submitted (§3.1, §4.3).

6.2 Submission Package Contents

The submission package includes:

• Enhanced Continued Stay Confirmation Form with both signatures
• Service Plan T3C Supplement (FC3-03)
• Current CANS 3.0 assessment summary
• Supporting documentation as applicable (crisis logs, therapy records, behavioral data)

6.3 Receipt Confirmation

Case Managers must confirm receipt of submission and document confirmation in the case record.

7. STEP-DOWN AND DISCHARGE PLANNING

7.1 Integration with Continued Stay Reviews

Each continued stay review must assess readiness for step-down to less intensive services or discharge to permanency. Reviews are not solely to justify continued placement but to actively plan for appropriate transitions.

7.2 Step-Down Determination

When continued stay review indicates child no longer requires current Service Package intensity:

• Initiate transition planning per FC14-01 Discharge and Permanency Planning Policy
• Coordinate with receiving placement or Service Package
• Begin the mandatory aftercare planning process per FC-AF-01 Aftercare Services Policy (for enhanced Service Packages)
• Complete transition within 30-60 days of determination

Cross-Reference: FC14-01 Discharge and Permanency Planning Policy; FC-AF-01 Aftercare Services Policy

8. EXTENDED STAY MONITORING

8.1 Expected Length of Stay Parameters

8.2 Extended Stay Review

For placements exceeding 150% of expected length of stay:

• Program Director provides written explanation to DFPS
• Action plan with timelines developed
• Case conference scheduled if needed
• System-level support requested as appropriate

Cross-Reference: T3C Blueprint p.86 (MH), p.135 (IDD) — April 2026 edition

9. QUALITY ASSURANCE

9.1 Compliance Monitoring

The QA Coordinator tracks continued stay review compliance including:

• Reviews completed within required timeframe
• Both signatures obtained (enhanced packages)
• Clinical justification adequacy
• SSCC/DFPS submission within 15-day deadline
• Documentation completeness

9.2 Reporting

Monthly compliance reports are provided to Program Director and Treatment Director for review and corrective action as needed.

Cross-Reference: FC-17 Continuous Quality Improvement Policy; CQI Plan

10. DEFINITIONS

Living Service Plan: The always-current Service Plan, continuously maintained as new information arises (see FC3-01).

Monthly Pulse: The monthly questionnaire-and-interview instrument that keeps the living plan current (FC3-01 Provision 7). The Pulse informs; it certifies nothing.

Service Plan Snapshot: The internal term for the Service Plan Review required by 26 TAC §749.1335 — a point-in-time, frozen, signed certification of the living Service Plan. The continued stay confirmation under this policy is the attestation layer within the Snapshot. Internal documents title this event "Service Plan Snapshot" (subtitle: Service Plan Review · 26 TAC §749.1335); external documents reverse the titles. The TAC citation appears in both orientations.

11. REGULATORY REFERENCES

• 26 TAC §749.1335 - Service Plan Reviews (TAC baseline 6 months; RCC Contract requires 90 days — see §3.1)
• 26 TAC §749.665 - Program Director Responsibilities
• 26 TAC §749.131 - Quality Assurance
• Texas Family Code §264.1073 - Treatment Foster Care
• TAC §700.1335 - Treatment Foster Care Standards
• T3C Blueprint (April 2026 edition) - p.86 (MH CSR), p.135 (IDD CSR), pp.137-148 (TFFC)
• DFPS 24-Hour RCC Requirements (FY26)

12. RELATED POLICIES AND PROCEDURES

• FC-CSR-01.1 Continued Stay Review Procedure
• FC3-01 Individual Service Planning Policy
• FC3-01.1 Individual Service Planning Procedure
• FC-REC-01 / FC-REC-01.1 Recorded Interview & Transcript Management Policy and Procedure
• FC14-01 Discharge and Permanency Planning Policy
• FC-MH-01 Mental & Behavioral Health Support Services Policy
• FC-IDD-01 IDD/Autism Spectrum Disorder Support Services Policy
• FC-SU-01 Substance Use Support Services Policy
• FC-TFFC-01 Treatment Foster Family Care Support Services Policy
• FC-STASS-01 Short-Term Assessment Support Services Policy

13. FORMS AND ATTACHMENTS

• Enhanced Continued Stay Confirmation Form (MH/IDD/SU - 90-Day)
• Enhanced Continued Stay Confirmation Form (TFFC - 60-Day)
• Basic Continued Stay Confirmation (within Snapshot; PD signature)
• Service Plan T3C Supplement (FC3-03)
• Continued Stay Review Tracking Calendar

DOCUMENT CONTROL

COMPLIANCE STATEMENT

This policy establishes Refuge House's continued stay review framework in compliance with 26 TAC Chapter 749 Minimum Standards, T3C Blueprint requirements (April 2026), Texas Family Code §264.1073, TAC §700.1335, and RCC Contract obligations. The corresponding procedure (FC-CSR-01.1) operationalizes these principles with specific implementation details.

This policy document establishes the governing principles for Continued Stay Reviews. The corresponding procedure document (FC-CSR-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.