REFUGE HOUSE, INC.

PURPOSE

This policy establishes Refuge House's comprehensive framework for preventing, responding to, and managing crisis situations involving children and youth in foster care. The policy integrates trauma-informed principles from Trust-Based Relational Intervention (TBRI®) with regulatory requirements to ensure child safety while supporting healing and maintaining therapeutic relationships. This framework supports all service packages, including T3C Basic Foster Family Home Support Services, Mental & Behavioral Health Support Services, Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder Support Services, Substance Use Support Services, Short-Term Assessment Support Services, and T3C Treatment Foster Family Care Support Services.

DEFINITIONS

Crisis: A situation in which a child's behavior endangers themselves or others, or when there is possible harm to significant property, requiring immediate intervention beyond typical de-escalation strategies.

Crisis Management Staff: Personnel trained in crisis intervention and de-escalation techniques who are available 24/7 to respond to behavioral emergencies, as required by the applicable T3C Service Package. (Specific staffing ratios are maintained in FC-04.1.)

Emergency Behavior Intervention: Techniques authorized under TAC §749.2051, including personal restraint used only when a child's behavior endangers themselves or others or when there is possible harm to significant property.

Personal Restraint: Any contact with a caregiver's body applied to restrict the movement of a child's body, as defined by TAC §749.43.

Personal Safety Plan: A written plan required per TAC §749.137 for children exhibiting high-risk behaviors that create immediate safety risks.

Feelings Thermometer: A five-level visual tool used to help children identify and communicate their emotional state (Level 1: Calm & Ready; Level 2: A Little Unsure; Level 3: Getting Big; Level 4: Very Upset; Level 5: Overwhelming).

Substance-Related Crisis: A crisis situation involving active intoxication, overdose, withdrawal symptoms, or behaviors directly related to substance use or recovery that requires immediate intervention.

Medical Emergency (Substance-Related): A potentially life-threatening situation involving overdose, severe withdrawal, or adverse reaction to substances requiring immediate medical intervention (911).

Relapse: Return to substance use after a period of abstinence; treated as a clinical event requiring supportive intervention, NOT as a behavioral crisis warranting punitive response.

Assessment Period Crisis: A crisis occurring during Short-Term Assessment placement where child's history, triggers, and effective interventions may be unknown or incomplete.

High-Acuity Behavioral Crisis: A crisis involving serious mental health or behavioral symptoms in a child receiving Treatment Foster Family Care services, potentially including psychiatric emergency, severe self-harm risk, or aggressive behaviors requiring intensive clinical intervention.

Psychiatric Emergency: A mental health crisis requiring immediate professional intervention, potentially including acute suicidal ideation, psychotic episode, or severe dissociation.

POLICY STATEMENTS

1. TBRI®-Informed Crisis Prevention

Refuge House prioritizes crisis prevention through trauma-informed relationship building, structured environments, and proactive identification of triggers and warning signs. All staff and foster parents are trained to recognize escalating behaviors using tools such as the Feelings Thermometer and to implement preventive strategies before situations reach crisis level.

2. 24/7 Crisis Response System

Refuge House maintains continuous crisis response capability through its established on-call system staffed by case-manager-level-or-above personnel (see FC-OC-01 On-Call Policy). Crisis Management Staff are available 24 hours a day, 7 days a week to provide consultation, support, and direct intervention as needed.

3. Service Package-Specific Crisis Response

Crisis response protocols are tailored to meet the specific needs of each T3C Service Package:

• Basic Foster Family Home Support Services: Standard crisis response using TBRI® principles and emergency behavior intervention when necessary

• Mental & Behavioral Health Support Services: Enhanced crisis response including mental health crisis recognition, coordination with behavioral health emergency services, and access to Treatment Director consultation

• IDD/Autism Spectrum Disorder Support Services: Specialized crisis response addressing sensory overload, communication barriers, and developmental considerations with access to Registered Nurse consultation

• Substance Use Support Services: Crisis response integrates understanding of addiction, recovery principles, and substance-related medical emergencies while maintaining a non-punitive, recovery-supportive approach. Relapse is addressed as a clinical event requiring enhanced support, not punishment.

• Short-Term Assessment Support Services: Crisis response recognizes that children's histories, triggers, and effective interventions may be unknown or incomplete at placement. Enhanced vigilance, careful documentation, and expedited safety planning are essential during this assessment period. All crisis information is documented for transition to the receiving Service Package.

• T3C Treatment Foster Family Care Support Services: Crisis response reflects the high-acuity population served and integrates intensive clinical oversight. The on-call Licensed Therapist must be available to provide consultation. Crisis patterns are reviewed at each 60-day Continued Stay Review and inform step-down planning.

4. Least Restrictive Intervention

Emergency behavior intervention techniques, including personal restraint, are used only as a last resort when less restrictive interventions have been attempted and failed, and only when necessary to prevent harm. Foster parents and staff must first attempt de-escalation strategies including relaxation techniques, quiet time, time out, and verbal interventions.

5. Regulatory Compliance

All crisis response activities comply with applicable regulations including TAC §749.2051–§749.2307 (Emergency Behavior Intervention), TAC §749.1951 and §749.1959 (disciplinary measures and restriction of a child's activities), TAC §749.137 (Personal Safety Plans; suicide prevention, intervention, and postvention), and T3C Service Package requirements.

6. Proactive Runaway Prevention (DFPS 24-Hr RCC §4900)

Refuge House maintains proactive, trauma-informed runaway-prevention practices for every child in care — evaluation of behaviors indicating a higher likelihood of running away, treatment planning that documents prevention efforts for children with risk factors, strategies for working with the child to prevent runaway behaviors, and de-escalation skills for staff and foster parents — applying the reasonable and prudent parent standard. (DFPS 24-Hr RCC §4900)

A Runaway Prevention Plan (RPP) is developed for any child or youth who has a recent episode of running away or human trafficking victimization, or who has verbalized a serious desire to run away or whose behaviors have escalated indicating the need for intervention. (DFPS 24-Hr RCC §4900) The RPP:

• Is completed within 48 hours of identifying the child as at higher risk of running away (as indicated by a history of running away within the last 6 months, recent threats to run away, or human trafficking history) (DFPS 24-Hr RCC §4900);
• Is child-centered and strengths-based, includes the child's input, explores reasons for past runaway episodes and triggers, presents alternatives the child can use as an outlet for frustrations, plans for the child's safety and well-being, and plans proactively for if the child does run away (DFPS 24-Hr RCC §4900);
• Invites the CPS Caseworker to contribute — Refuge House may proceed if the caseworker cannot be reached or cannot attend (DFPS 24-Hr RCC §4900);
• Is transmitted, with written notice, to the child's assigned caseworker and supervisor within 24 hours of implementation, together with a copy of the plan (DFPS 24-Hr RCC §4900);
• Is evaluated monthly to ensure updates are made or to end the plan when the runaway risk has been mitigated (DFPS 24-Hr RCC §4900); and
• May be developed on the agency's own instrument or on DFPS Form 2882 (DFPS 24-Hr RCC §4900).

All staff and caregivers assigned to supervise the child are informed of the child's risk for running away, and de-escalation skill-building training is provided to staff and foster parents. (DFPS 24-Hr RCC §4900) The presence and currency of the RPP is verified at monthly home visits per home-monitoring checklist item HM-SAF-23. This proactive front end operates alongside — and does not replace — the post-runaway response and recovery requirements in FC-04.1 Section 12, which update the RPP after any runaway episode.

QUALITY ASSURANCE

Monitoring and Evaluation

The effectiveness of crisis management practices shall be evaluated through:

• Monthly review of all crisis incidents by Program Director and Treatment Director (when applicable)
• Quarterly analysis of crisis incident patterns, triggers, and outcomes
• Annual review of crisis prevention effectiveness and reduction in incident frequency
• Staff and foster parent feedback on crisis response support and training adequacy
• Evaluation of compliance with regulatory requirements and documentation standards
• Assessment of TBRI® fidelity in crisis prevention and response practices

Continuous Improvement

Based on quality assurance findings, Refuge House shall:

• Update crisis response protocols to reflect best practices and lessons learned
• Provide additional training to staff and foster parents as needed
• Modify environmental and programmatic factors that contribute to crisis situations
• Enhance crisis prevention strategies based on identified patterns
• Adjust staffing and support levels to meet demonstrated needs

REGULATORY ALIGNMENT

This policy supports compliance with:

• TAC §749.2051–§749.2307: Emergency Behavior Intervention (types, administration, restraint precautions, monitoring, release, maximum duration); §749.889, §749.947: EBI training curriculum
• TAC §749.1951, §749.1959: Disciplinary measures and restriction of a child's activities as a behavior-management tool (Restriction of Privileges)
• TAC §749.137: Personal Safety Plans (suicide prevention, intervention, and postvention); §749.501–§749.513: serious incidents and reporting
• T3C System Blueprint: Crisis Management Staff requirements for all T3C Service Packages
• T3C Blueprint: Substance Use Support Services requirements
• T3C Blueprint: Short-Term Assessment Support Services requirements (p.67-75)
• T3C Blueprint: Treatment Foster Family Care Support Services requirements (p.136-147), including on-call Licensed Therapist requirement (p.138)
• Texas Family Code §264.1073 (Treatment Foster Family Care)
• TAC §700.1335 (Treatment Foster Family Care)
• RCC Contract Requirements
• DFPS 24-Hour RCC Requirements (FY26) §4900: Runaway Prevention (proactive Runaway Prevention Plans)
• TBRI® Trauma-Informed Care Standards

RELATED POLICIES AND PROCEDURES

• FC-04.1 Crisis Management Procedure
• FC-SIR-01 Serious Incident Reporting Policy and Procedure
• FC-OC-01 On-Call Policy and Procedure
• Individual Service Planning Procedure (FC3-01)
• Admission Screening Procedure (FC1-01.1)
• Emergency Behavior Intervention Policy (referenced in Placement Documents)
• TBRI® Implementation Policy and Training Requirements
• FC-SU-01 Substance Use Support Services Policy
• FC-STASS-01 Short-Term Assessment Support Services Policy
• FC-TFFC-01 T3C Treatment Foster Family Care Support Services Policy
• FC-16 Staff and Caregiver Training Policy (crisis training requirements)
• FC-CSR-01 Continued Stay Review Policy (60-day review integration)

FORMS/ATTACHMENTS

Core Forms (All Packages):

• Crisis Assessment Tool
• Personal Safety Plan Template
• Emergency Behavior Intervention Documentation Form
• Crisis Response Debriefing Form
• Crisis Decision Support Tool (online at previewforms.refugehouse.org)
• Runaway Prevention Plan — agency instrument or DFPS Form 2882 (DFPS 24-Hr RCC §4900)

Package-Specific Forms:

Substance Use Support Services:

• Substance-Related Crisis Documentation Form
• Overdose Response Checklist
• Relapse Response Documentation (Non-Punitive)

Short-Term Assessment Support Services:

• Short-Term Assessment Crisis Observation Log
• STASS Crisis Transition Summary Template

T3C Treatment Foster Family Care:

• Treatment Foster Family Care Psychiatric Emergency Checklist
• TFFC 60-Day Crisis Pattern Analysis Template
• On-Call Licensed Therapist Consultation Log

This policy document establishes the governing principles for Crisis Management. The corresponding procedure document (FC-04.1) 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.