Procedure

Continued Stay Review Procedure

Refuge House, Inc.
Last updated: July 24, 2026 · Source: policies-procedures/Procedure/Continued Stay Review Procedure.md

REFUGE HOUSE, INC.

Procedure Information Details
PROCEDURE NAME Continued Stay Review Procedure
PROCEDURE NUMBER FC-CSR-01.1
RELATED POLICY FC-CSR-01 Continued Stay Review Policy
ORIGINATED December 2025
APPROVED BY Executive Director
APPROVED ON 5/22/2026
EFFECTIVE DATE 5/22/2026
LAST UPDATED 5/15/2026
LAST APPROVED 5/22/2026
SECTION FC-CSR
DATE(S) OF REVISION May 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 (N/A - time-limited) ☒ 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

1. PURPOSE

This procedure establishes operational steps for conducting continued stay reviews across all applicable T3C Service Packages. It provides package-specific guidance for review preparation, documentation, approval processes, and SSCC/DFPS submission requirements.

2. CONTINUED STAY REVIEW SCHEDULE SUMMARY

Service Package Review Cycle Signature Requirements Submission Deadline
T3C Basic Foster Family Home 6 months Program Director Per Service Plan
Mental & Behavioral Health 90 days Both Directors 15 business days
IDD/Autism Spectrum Disorder 90 days Both Directors 15 business days
Substance Use Support Services 90 days Both Directors 15 business days
T3C Treatment Foster Family Care 60 days Both Directors 15 business days
Short-Term Assessment N/A N/A N/A

3. ☒ T3C BASIC FOSTER FAMILY HOME CONTINUED STAY REVIEW

Purpose and Overview

Standard continued stay reviews for T3C Basic Foster Family Home occur in conjunction with the 6-month service plan review per TAC §749.1335. These reviews ensure ongoing placement appropriateness and permanency progress.

3.1 Review Preparation

Who How When Where Regulatory Reference
Case Manager
  1. Schedule service plan review meeting
  2. Compile case documentation including CANS 3.0 results, placement progress, permanency status
  3. Prepare Service Plan T3C Supplement Form (FC3-03) with Continued Stay Evaluation section
  4. Notify treatment team members
 2 weeks before 6-month review date Office/Radius TAC §749.1335

3.2 Review Meeting

Who How When Where Regulatory Reference
Service Planning Team
  1. Review current CANS 3.0 scores and trends
  2. Assess progress on service plan goals
  3. Evaluate permanency timeline and progress
  4. Determine continued need for current placement
  5. Document findings in Service Plan T3C Supplement
 At 6-month review Meeting location per FC3-01.1 TAC §749.1335

3.3 Approval and Documentation

Who How When Where Regulatory Reference
Program Director
  1. Review continued stay justification
  2. Verify placement remains appropriate
  3. Sign and date approval
  4. Document any concerns or required actions
 Within 5 business days of review Radius approval system TAC §749.665
Case Manager
  1. Update Service Plan with continued stay determination
  2. File approved documentation in case record
  3. Distribute updated Service Plan per FC3-01.1
 Within 7 days of approval Radius case record TAC §749.1335

4. ☒ MENTAL & BEHAVIORAL HEALTH CONTINUED STAY REVIEW (90-Day)

Purpose and Overview

Mental & Behavioral Health Support Services requires enhanced 90-day continued stay reviews with dual Director signatures. Written confirmation must document ongoing clinical need and Treatment Model benefit, with submission to SSCC/DFPS within 15 business days.

4.1 Review Preparation

Who How When Where Regulatory Reference
Case Manager
  1. Schedule review meeting 2 weeks before 90-day date
  2. Ensure CANS 3.0 reassessment completed
  3. Compile clinical documentation: therapy notes, crisis incident log, medication compliance data, behavioral data
  4. Prepare Enhanced Continued Stay Confirmation Form
  5. Notify Treatment Director and Program Director
 14 days before 90-day review Office T3C Blueprint p.85
Case Manager 6. Verify dual credential status: confirm BOTH the T3C Mental & Behavioral Health Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for (a) Refuge House and (b) the placing foster home; document verification in the review record; if either has lapsed, flag immediately and initiate remediation per FC-MH-01 §1.3 — service delivery cannot continue until both credentials are reinstated 14 days before 90-day review Credentialing records; Radius FC-MH-01 §1.3

4.2 Clinical Review

Who How When Where Regulatory Reference
Treatment Director
  1. Review clinical progress indicators
  2. Assess current symptom severity and treatment response
  3. Evaluate crisis incidents in past 90 days
  4. Determine continued need for Mental Health package
  5. Assess step-down readiness
 At 90-day review meeting Clinical review T3C Blueprint p.85

4.3 Written Confirmation - Treatment Director

Who How When Where Regulatory Reference
Treatment Director Complete Treatment Director section of Enhanced Continued Stay Confirmation Form:
  1. State: "I confirm that [Child's Name] continues to require Mental & Behavioral Health Support Services based on the following clinical indicators:"
  2. Document specific clinical indicators: current diagnoses, behavioral symptoms (frequency/intensity), crisis incidents, medication management complexity, therapy engagement
  3. Document why less restrictive placement is insufficient: safety risks, 24/7 crisis availability need, therapeutic milieu requirements
  4. Confirm child is benefitting from Treatment Model
  5. Sign with credentials and date
 At 90-day review meeting Enhanced Continued Stay Confirmation Form CRITICAL: T3C Blueprint p.85

4.4 Written Confirmation - Program Director

Who How When Where Regulatory Reference
Program Director Complete Program Director section:
  1. State: "I confirm that [Child's Name] continues to meet admission criteria for Mental & Behavioral Health Support Services and that a less restrictive placement is not appropriate at this time."
  2. Document administrative indicators: placement stability, resource utilization, service availability, permanency progress
  3. Confirm child continues to benefit from Treatment Model
  4. Before signing: verify that BOTH the T3C Mental & Behavioral Health Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for Refuge House and the placing foster home (verified per §4.1); if either credential has lapsed, do not sign — initiate remediation per FC-MH-01 §1.3 before completing this confirmation
  5. Sign and date
 Within 24 hours of Treatment Director signature Same form CRITICAL: T3C Blueprint p.85; FC-MH-01 §1.3

4.5 SSCC/DFPS Submission

Who How When Where Regulatory Reference
Case Manager
  1. Compile submission package: Enhanced Continued Stay Confirmation Form with BOTH signatures, Service Plan T3C Supplement (FC3-03), CANS 3.0 assessment summary, crisis incident log, therapy attendance records
  2. Submit via IMPACT with cover memo
  3. Confirm SSCC/DFPS receipt
  4. Document submission in case record
 Within 15 business days of 90-day review IMPACT system CRITICAL DEADLINE

4.6 Clinical Indicators Reference

Domain Indicators Supporting Continued Stay Step-Down Readiness Indicators
Psychiatric Stability Active psychosis or severe mood symptoms; Medication adjustments in past 30 days; Psychiatric hospitalization in review period; CANS Mental Health items scored 2-3 Stable on medications 60+ days; No psychiatric symptoms interfering with functioning; CANS Mental Health items improving to 0-1
Crisis Incidents Self-harm attempts or gestures; Physical aggression requiring intervention; Police involvement for behavioral issues; Emergency psychotropic medication use No crisis interventions in 60 days; Using coping skills effectively; Managing triggers independently
Therapeutic Needs Requires intensive therapy (2+ weekly); Active trauma processing; High-risk behaviors present; Family therapy critical for stability Managing with weekly therapy; Trauma work stabilized; Risk behaviors resolved; Family engagement successful

5. ☒ IDD/AUTISM SPECTRUM DISORDER CONTINUED STAY REVIEW (90-Day)

Purpose and Overview

IDD/Autism Support Services requires 90-day continued stay reviews evaluating developmental progress, medical stability, and ongoing need for specialized supports. Dual Director signatures and RN consultation are required.

5.1 Review Preparation

Who How When Where Regulatory Reference
Case Manager
  1. Schedule review meeting 2 weeks before 90-day date
  2. Ensure CANS 3.0 reassessment completed
  3. Compile developmental and medical documentation
  4. Gather educational and therapy reports
  5. Request RN consultation summary
  6. Prepare Enhanced Continued Stay Confirmation Form
 14 days before 90-day review Office T3C Blueprint p.133
Case Manager 7. Verify dual credential status: confirm BOTH the T3C IDD/Autism Spectrum Disorder Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for (a) Refuge House and (b) the placing foster home; document verification in the review record; if either has lapsed, flag immediately and initiate remediation per FC-IDD-01 §1.4 — service delivery cannot continue until both credentials are reinstated 14 days before 90-day review Credentialing records; Radius FC-IDD-01 §1.4 (v1.2)

5.2 Clinical and Medical Review

Who How When Where Regulatory Reference
Treatment Director
  1. Review developmental progress indicators
  2. Assess adaptive functioning trends
  3. Evaluate behavior support plan effectiveness
  4. Determine continued need for IDD/Autism package
  5. Assess step-down readiness
 At 90-day review meeting Clinical review T3C Blueprint p.133
RN Consultant
  1. Provide medical status summary
  2. Document medical complexity factors
  3. Identify ongoing nursing needs
  4. Recommend continued stay or transition
  5. Sign RN consultation section
 Prior to 90-day review RN Consultation Form T3C Blueprint p.124

5.3 Written Confirmation - Treatment Director

Who How When Where Regulatory Reference
Treatment Director Complete Treatment Director section:
  1. State: "I confirm that [Child's Name] continues to require IDD/Autism Support Services based on the following developmental and medical indicators:"
  2. Document specific indicators: adaptive functioning deficits, communication challenges, behavioral manifestations, medical complexity, sensory/environmental needs
  3. Document specialized support requirements: daily living skill support level, behavior plan needs, medical protocols, environmental modifications
  4. Sign with credentials and date
 At 90-day review meeting Enhanced Continued Stay Confirmation Form CRITICAL: T3C Blueprint p.133-134

5.4 Written Confirmation - Program Director

Who How When Where Regulatory Reference
Program Director Complete Program Director section:
  1. Confirm child continues to meet admission criteria
  2. Document administrative and resource indicators
  3. Confirm less restrictive placement is not appropriate
  4. Before signing: verify that BOTH the T3C IDD/Autism Spectrum Disorder Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for Refuge House and the placing foster home (verified per §5.1); if either credential has lapsed, do not sign — initiate remediation per FC-IDD-01 §1.4 before completing this confirmation
  5. Sign and date
 Within 24 hours of Treatment Director signature Same form CRITICAL: T3C Blueprint p.133; FC-IDD-01 §1.4 (v1.2)

5.5 SSCC/DFPS Submission

Who How When Where Regulatory Reference
Case Manager
  1. Compile submission package: Enhanced Continued Stay Confirmation Form with BOTH signatures and RN input, Service Plan T3C Supplement (FC3-03), developmental assessment data, behavior data graphs (3-month trend), communication progress documentation, medical stability indicators
  2. Submit via IMPACT
  3. Confirm receipt
 Within 15 business days of 90-day review IMPACT system CRITICAL DEADLINE

5.6 Developmental Indicators Reference

Domain Indicators Supporting Continued Stay Step-Down Readiness Indicators
Adaptive Functioning Requires full assistance with ADLs; Cannot communicate basic needs; No safety awareness; Requires 24/7 specialized supervision Increasing independence in ADLs; Functional communication established; Basic safety skills demonstrated; Standard supervision sufficient
Medical/Nursing Complex medical conditions requiring RN oversight; Multiple daily medications; Specialized medical equipment; Frequent medical crises Medical conditions stable; Simplified medication regimen; Standard medical needs; Rare medical incidents
Behavioral Support Severe self-injurious behaviors; Aggressive behaviors requiring specialized intervention; Property destruction patterns; Elopement risk requiring environmental modifications Behaviors manageable with standard approaches; Minimal behavioral incidents; No specialized interventions needed; Safe in standard environment

6. ☒ SUBSTANCE USE SUPPORT SERVICES CONTINUED STAY REVIEW (90-Day)

Purpose and Overview

Substance Use Support Services follows the Mental & Behavioral Health 90-day continued stay review pattern with additional recovery progress indicators. Dual Director signatures and submission to SSCC/DFPS within 15 business days are required.

6.1 Review Preparation

Who How When Where Regulatory Reference
Case Manager
  1. Compile review documentation per Mental Health pattern (Section 4.1)
  2. Include recovery progress indicators
  3. Include substance use treatment progress
  4. Schedule review meeting
 14 days before 90-day review Office T3C Blueprint; FC-SU-01
Case Manager 5. Verify dual credential status: confirm BOTH the T3C Substance Use Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for (a) Refuge House and (b) the placing foster home; document verification in the review record; if either has lapsed, flag immediately and initiate remediation per FC-SU-01 §3.5 — service delivery cannot continue until both credentials are reinstated 14 days before 90-day review Credentialing records; Radius FC-SU-01 §8.1 (v1.4)

6.2 Clinical Review

Who How When Where Regulatory Reference
Treatment Director
  1. Review clinical and recovery progress
  2. Assess substance use treatment engagement
  3. Evaluate recovery stability
  4. Assess relapse history and risk factors
  5. Determine continued need for specialized services
  6. Recommend continued stay or step-down
 At 90-day review Clinical review T3C Blueprint

6.3 Written Confirmation Process

Who How When Where Regulatory Reference
Treatment Director Complete Treatment Director section per Section 4.3 with additional recovery-specific indicators: substance use treatment engagement, recovery support involvement, relapse prevention progress At 90-day review meeting Enhanced Continued Stay Confirmation Form T3C Blueprint
Program Director Complete Program Director section per Section 4.4 Within 24 hours Same form T3C Blueprint

6.4 SSCC/DFPS Submission

Who How When Where Regulatory Reference
Case Manager
  1. Compile submission per Section 4.5 with recovery progress documentation
  2. Submit to SSCC/DFPS
  3. Confirm receipt
 Within 15 business days IMPACT system CRITICAL DEADLINE

7. ☒ T3C TREATMENT FOSTER FAMILY CARE CONTINUED STAY REVIEW (60-Day)

Purpose and Overview

T3C Treatment Foster Family Care requires enhanced 60-day continued stay reviews (not 90-day) with dual Director signatures. This accelerated review cycle reflects the time-limited, intensive nature of this highest-level family-based Service Package (maximum 365 days). Step-down evaluation is integral to each review.

7.1 Review Preparation

Who How When Where Regulatory Reference
Case Manager
  1. Compile review documentation: therapy notes, behavioral data, crisis incident log, CANS 3.0 results, step-down progress indicators
  2. Gather treatment progress indicators
  3. Obtain current CANS 3.0 results
  4. Schedule review meeting
  5. Prepare Enhanced Continued Stay Confirmation Form (60-Day)
 7 days before 60-day review date Office T3C Blueprint p.145
Case Manager 6. Verify dual credential status: confirm BOTH the T3C Treatment Foster Family Care Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for (a) Refuge House and (b) the placing foster home; document verification in the review record; if either has lapsed, flag immediately and initiate remediation per FC-TFFC-01 §7.1 — service delivery cannot continue until both credentials are reinstated 7 days before 60-day review date Credentialing records; Radius FC-TFFC-01 §8.1 (v2.1)

7.2 Clinical Review with Step-Down Assessment

Who How When Where Regulatory Reference
Treatment Director
  1. Review treatment progress indicators
  2. Assess behavioral stability and crisis frequency
  3. Evaluate therapy engagement and response
  4. Determine continued need for Treatment Foster Family Care
  5. Assess step-down readiness (required at each review)
  6. If step-down indicated, initiate transition planning per FC14-01
 At 60-day review meeting Clinical review T3C Blueprint p.145-146

7.3 Written Confirmation - Treatment Director

Who How When Where Regulatory Reference
Treatment Director Complete Treatment Director section:
  1. State: "I confirm that [Child's Name] continues to require T3C Treatment Foster Family Care based on the following clinical indicators:"
  2. Document specific clinical indicators supporting continued intensive care
  3. State: "[Child's Name] is benefitting from the Treatment Model"
  4. Document why less restrictive placement (including Basic in same home if dually credentialed) is insufficient
  5. Sign with credentials and date
 At 60-day review meeting Enhanced Continued Stay Confirmation Form (60-Day) CRITICAL: T3C Blueprint p.145

7.4 Written Confirmation - Program Director

Who How When Where Regulatory Reference
Program Director Complete Program Director section:
  1. State: "I confirm that [Child's Name] continues to meet criteria for T3C Treatment Foster Family Care and that a less restrictive placement is not appropriate at this time."
  2. Document administrative indicators
  3. Confirm that BOTH the T3C Treatment Foster Family Care Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for both Refuge House and the placing foster home (verified per §7.1); if either has lapsed, do not sign — initiate remediation per FC-TFFC-01 §7.1 before completing this confirmation
  4. Sign and date
 Within 24 hours of Treatment Director signature Same form CRITICAL: T3C Blueprint p.145

7.5 SSCC/DFPS Submission

Who How When Where Regulatory Reference
Case Manager
  1. Compile complete submission package with BOTH Director signatures
  2. Include Service Plan T3C Supplement
  3. Include step-down assessment documentation
  4. Submit to SSCC/DFPS
  5. Document submission in case record
  6. Confirm receipt
 Within 15 business days of 60-day review IMPACT system CRITICAL DEADLINE: T3C Blueprint p.145

7.6 Step-Down Options

At each 60-day review, assess whether child can transition to:

Step-Down Option Requirements
Same home - Basic Package Home dually credentialed for BOTH Treatment Foster Care AND Basic; Child clinically stable; Foster family willing to continue
Different home - Basic Package Appropriate Basic home identified; Transition planning completed per FC14-01
Different home - Other Package Alternative Service Package appropriate; Transition coordinated
Permanency placement Permanency resource identified; Preparation completed

8. ☐ SHORT-TERM ASSESSMENT SUPPORT SERVICES

8.1 No Continued Stay Review Required

Short-Term Assessment Support Services is excluded from continued stay review requirements. This time-limited Service Package is designed exclusively for assessment purposes with the following parameters:

Parameter Requirement
Standard Duration 30 days (children ≥5) or 45 days (children 6+)
Maximum Extension Single 15-day extension
Maximum Total Duration 60 days
Purpose Assessment and Service Package determination
Transition To appropriate ongoing Service Package upon assessment completion

Cross-Reference: Assessment completion and transition follow FC-STASS-01 Short-Term Assessment Support Services Policy and FC14-01 Discharge and Permanency Planning Policy.

9. COMPLIANCE MONITORING PROCEDURES

9.1 Review Tracking

Who How When Where Regulatory Reference
CQI Coordinator
  1. Track all continued stay reviews on master calendar by Service Package
  2. Send alerts to Case Managers: 30 days before review, 7 days before review, Day of review, 10 business days post-review, 14 business days (DEADLINE WARNING)
 Ongoing Compliance tracking system RCC (FY26) §4230; T3C Blueprint Continued Stay

9.2 Documentation Audit

Who How When Where Regulatory Reference
QA Coordinator
  1. Audit all enhanced continued stay submissions for: Both Director signatures present, Clinical justification adequate, All supporting documents included, Submission within deadline
  2. Report compliance rates monthly
 Monthly QA dashboard TAC §749.131

9.3 Corrective Action

Who How When Where Regulatory Reference
Program Director
  1. Review any late or incomplete submissions
  2. Implement corrective action for missed deadlines
  3. Report patterns to Executive Director
  4. Provide additional training as needed
 As needed Leadership reports T3C Blueprint

10. EXTENDED STAY PROCEDURES

10.1 Extended Stay Monitoring

Who How When Where Regulatory Reference
QA Coordinator Track all placements exceeding expected Service Package timeframes Monthly QA tracking system T3C Blueprint p.47-55
Treatment Director Review all extended stays to identify: patterns requiring intervention, training needs, resource gaps, permanency barriers Monthly Leadership review meeting TAC §749.673

10.2 Action at 150% of Expected Length of Stay

Who How When Where Regulatory Reference
Program Director
  1. Provide written explanation to DFPS
  2. Develop action plan with timelines
  3. Request system-level support if needed
  4. Schedule case conference
 At 150% threshold Written communication T3C Blueprint p.85, p.134

11. REGULATORY REFERENCES

12. RELATED POLICIES AND PROCEDURES

13. FORMS AND ATTACHMENTS

DOCUMENT CONTROL

Version Date Author Changes
1.0 December 2025 Refuge House Leadership Initial document creation
1.1 May 2026 Refuge House Leadership Added dual credential verification requirements to Sections 7.1 and 7.4 per FC-TFFC-01 v2.1 §8.1
1.2 May 2026 Refuge House Leadership Added dual credential verification requirement to Section 6.1 Review Preparation for Substance Use Support Services per FC-SU-01 §8.1 (v1.4)
1.3 May 2026 Refuge House Leadership Added dual credential verification requirements to Sections 5.1 and 5.4 for IDD/Autism Spectrum Disorder Support Services per FC-IDD-01 §1.4 (v1.2)
1.4 May 2026 Refuge House Leadership Added dual credential verification requirements to Sections 4.1 and 4.4 for Mental & Behavioral Health Support Services per FC-MH-01 §1.3

CRITICAL REMINDERS

15 BUSINESS DAY DEADLINE: All Enhanced Continued Stay Confirmations for specialized packages MUST be submitted to SSCC/DFPS within 15 business days of review. Missing this deadline is a compliance violation.

BOTH SIGNATURES REQUIRED: For Mental Health, IDD/Autism, Substance Use, and Treatment Foster Family Care packages, the Enhanced Continued Stay Confirmation Form requires BOTH Program Director AND Treatment Director signatures. One signature alone is insufficient.

60-DAY CYCLE FOR TFFC: Treatment Foster Family Care uses a 60-day review cycle, NOT the 90-day cycle used by other specialized packages.

NO CONTINUED STAY FOR STASS: Short-Term Assessment Support Services does NOT require continued stay reviews - it is time-limited with assessment transition, not ongoing placement.

CLINICAL JUSTIFICATION: Generic statements are insufficient. Specific, measurable clinical indicators must support continued stay determinations.

This procedure document operationalizes FC-CSR-01 Continued Stay Review Policy. Procedures may be updated by the Executive Director to adapt to regulatory changes or operational improvements without requiring Board approval, provided changes maintain alignment with policy intent.

© 2026 Refuge House, Inc. · This is a controlled document. Always refer to the current version.