Procedure

Crisis Management Procedure

Refuge House, Inc.
Last updated: July 24, 2026 · Source: policies-procedures/Procedure/Crisis Management Procedure.md

REFUGE HOUSE, INC.

Procedure Information Details
PROCEDURE NUMBER FC-04.1
PROCEDURE TITLE Crisis Management Procedure
RELATED POLICY FC-04 Crisis Management Policy
EFFECTIVE DATE 5/22/2026
REVISION DATE 7/13/26 (pending approval)
LAST UPDATED 5/15/2026
LAST APPROVED 5/22/2026

PURPOSE AND OVERVIEW

This procedure operationalizes the Crisis Management Policy (FC-04) by providing detailed implementation steps for crisis prevention, assessment, response, and post-crisis management across all T3C Service Packages. The procedure integrates trauma-informed principles from Trust-Based Relational Intervention (TBRI®) with regulatory requirements to ensure child safety while supporting healing and maintaining therapeutic relationships.

RESPONSIBILITY

SECTION 1: CRISIS PREVENTION

1.1 Proactive Assessment and Planning

Who How When Regulatory Reference
Case Manager Complete comprehensive admission assessment including trauma history, triggers, behavioral patterns, and coping strategies; document findings in child's record Within 10 days of placement TAC §749.1133
Case Manager Develop Personal Safety Plan for children exhibiting high-risk behaviors (suicide attempt, suicidal ideations, suicidal thoughts, self-abuse, drug addiction, aggression causing bodily harm, sexual perpetration, fire setting, chronic running away) As needed based on assessment TAC §749.137
Case Manager Review and update safety plans based on mental health professional recommendations and documented behavioral changes As recommended; minimum every 90 days TAC §749.137
Treatment Director (Mental Health & IDD/ASD packages) Review safety plans and crisis prevention strategies for appropriateness and effectiveness Within 24 hours of plan development or update T3C Blueprint

1.2 Training Requirements

Who How When Regulatory Reference
All Staff Complete crisis intervention training including de-escalation techniques and trauma-informed approaches Pre-service and annually Agency Policy
Crisis Management Staff Complete emergency behavior intervention training per TAC §749.889, §749.947 Before assuming crisis response duties TAC §749.889, §749.947
Crisis Management Staff (Mental Health package) Complete mental health crisis recognition and response training Before first Mental Health placement T3C Blueprint
Crisis Management Staff (IDD/ASD package) Complete autism-specific crisis recognition, sensory overload response, and communication strategies training Before first IDD/ASD placement T3C Blueprint
Foster Parents Complete SAMA training including emergency behavior intervention techniques (short personal restraint, elbow-to-hip restraint, escort) Pre-service; annual refresher TAC §749.889; Agency Policy
Foster Parents Receive child-specific crisis prevention training based on Personal Safety Plan and documented triggers At placement and as plans are updated T3C Blueprint
Behavioral Support Specialist (Mental Health & IDD/ASD packages) Develop and implement behavior intervention plans focusing on skill-building and crisis prevention As needed based on assessment T3C Blueprint

Cross-Reference: All training requirements per FC-16 Staff and Caregiver Training Policy.

SECTION 2: CRISIS ASSESSMENT

2.1 Recognizing Crisis Levels

Level Indicators Appropriate Response
Level 1-2 (Calm & Ready / A Little Unsure) Child is regulated or showing early signs of discomfort; thinking is clear or mostly clear Regular check-ins; preventative strategies; emotional validation
Level 3 (Getting Big) Body tense, increased heart rate; thinking becoming scattered; child can still use coping skills with support Space and support person; sensory tools; gentle co-regulation; reduce demands
Level 4 (Very Upset) Very tense body, crying or yelling; difficulty focusing or reasoning Safe space; active co-regulation; minimal demands; crisis response notification if not de-escalating
Level 5 (Overwhelming) Out of control; survival mode activated; very limited ability to respond to intervention Crisis response activation; safety protocols; emergency behavior intervention if necessary to prevent harm

2.2 Service Package-Specific Assessment Considerations

Service Package Additional Assessment Factors
Mental & Behavioral Health Mental health diagnosis symptoms; medication effects; therapy progress; recent traumatic triggers; psychiatric stability
IDD/Autism Spectrum Disorder Sensory sensitivities; communication barriers; routine changes; developmental factors; medical conditions; seizure risk
Substance Use Signs of intoxication or withdrawal; substance-seeking behaviors; relapse triggers; recovery stage; medication-assisted treatment status; co-occurring mental health symptoms
Short-Term Assessment Unknown history requiring heightened vigilance; incomplete trigger identification; observe for patterns to inform assessment; document all behavioral observations
Treatment Foster Family Care Psychiatric symptom severity; medication compliance/effectiveness; therapy engagement; recent treatment changes; step-down readiness implications; pattern analysis

2.3 Updated Service Package-Specific Assessment Summary

Service Package Additional Assessment Factors Key Crisis Types Clinical Involvement
T3C Basic Standard trauma-informed assessment Behavioral escalation Standard
Mental & Behavioral Health Psychiatric symptoms; medication effects; therapy progress Psychiatric crisis; behavioral escalation Treatment Director consultation
IDD/Autism Sensory sensitivities; communication; developmental factors Sensory overload; communication frustration RN consultation available
Substance Use Intoxication/withdrawal signs; relapse triggers; recovery stage Overdose; withdrawal; relapse Treatment Director + SU treatment provider
Short-Term Assessment Unknown history; limited safety plan; assessment documentation Various (unknown population) As indicated by observations
Treatment Foster Family Care Psychiatric severity; treatment engagement; step-down readiness Psychiatric emergency; high-acuity behavioral On-Call Licensed Therapist REQUIRED

SECTION 3: CRISIS RESPONSE (ALL PACKAGES)

3.1 Crisis Decision Tool

Refuge House provides an interactive Crisis Decision Support Tool to guide foster parents and staff through crisis assessment and response. This tool is available 24/7 at:

https://previewforms.refugehouse.org/forms/crisis-decision-tool

The Crisis Decision Tool integrates TBRI® principles and provides:

Foster parents and staff are trained on the Crisis Decision Tool during orientation and receive ongoing support in its use.

3.2 Initial Response

Who How When Regulatory Reference
Foster Parent Attempt de-escalation using TBRI® strategies: relaxation techniques, quiet time, time out, verbal interventions, offering choices, reducing demands Immediately when escalation identified TAC §749.2055
Foster Parent Move other children to safety if necessary As needed Safety Protocol
Foster Parent Contact Case Manager or On-Call Crisis Management Staff if situation not de-escalating or if child reaches Level 4-5 When de-escalation attempts unsuccessful Agency Policy
Foster Parent Use Feelings Thermometer to help child identify and communicate emotional state (when child able to engage) As appropriate during de-escalation Agency Policy

3.3 Crisis Management Staff Response

Who How When Regulatory Reference
On-Call Crisis Management Staff Answer crisis call within 15 minutes; assess situation through phone consultation with foster parent Immediately upon contact Agency Policy
On-Call Crisis Management Staff Provide phone coaching on de-escalation strategies specific to child's needs and triggers During initial contact Agency Policy
On-Call Crisis Management Staff Dispatch to home for in-person support if phone consultation insufficient Within 1 hour if needed Agency Policy
On-Call Crisis Management Staff Coordinate with Treatment Director (Mental Health/IDD packages) for clinical consultation As needed for complex situations T3C Blueprint
On-Call Crisis Management Staff (Mental Health package) Coordinate with emergency behavioral health services if psychiatric crisis As clinically indicated T3C Blueprint
On-Call Crisis Management Staff (IDD/ASD package) Coordinate with Registered Nurse for medical consultation if needed As needed for medical concerns T3C Blueprint
On-Call Crisis Management Staff Coordinate with emergency services (911) if imminent danger to child or others When immediate safety risk present Safety Protocol

3.4 Emergency Behavior Intervention

Authoritative source: the full EBI standards — permitted types, who may administer, written orders, monitoring, release, prohibited techniques, maximum duration, and documentation — are governed by FC-16.06 Emergency Behavior Intervention Policy and FC-16.06.1 Procedure (26 TAC §§749.2051–749.2307). The steps below address EBI only as it arises within a crisis response; EBI may never be used or threatened as discipline (see FC-16.07 Discipline Policy).

Who How When Regulatory Reference
Trained Foster Parent or Staff Use personal restraint (short personal restraint, elbow-to-hip restraint, or escort as trained in SAMA) only when child's behavior endangers themselves or others or when there is possible harm to significant property Only after other interventions attempted; only when necessary to prevent harm TAC §749.2051, §749.2059
Trained Foster Parent or Staff Perform restraint in manner appropriate to child's size using maximum caring and minimum force During restraint TAC §749.2061
Trained Foster Parent or Staff Monitor child continuously during restraint for signs of medical distress (difficulty breathing, decrease in alertness) Throughout restraint TAC §749.2201
Trained Foster Parent or Staff Release child from restraint as soon as child shows self-control and is no longer a danger Immediately when safe TAC §749.2153
Trained Foster Parent or Staff Release child immediately if any sign of emergency medical condition Immediately TAC §749.2153
Foster Parent or Staff Contact Case Manager or On-Call Staff during or immediately after restraint use Immediately Agency Policy

SECTION 4: SUBSTANCE USE SUPPORT SERVICES - CRISIS PROCEDURES

4.1 Substance-Related Crisis Types

Crisis Type Indicators Response Priority
Overdose (MEDICAL EMERGENCY) Unconsciousness, slow/stopped breathing, blue lips/fingertips, unresponsive IMMEDIATE 911
Severe Withdrawal Seizures, severe tremors, hallucinations, extreme agitation, vomiting IMMEDIATE 911
Active Intoxication Impaired coordination, slurred speech, altered consciousness, erratic behavior Medical assessment; safety monitoring
Relapse (Non-Emergency) Evidence of substance use without medical emergency Clinical response; treatment coordination
Substance-Seeking Behavior Attempts to obtain substances, leaving home to use, contact with using peers Enhanced supervision; clinical intervention

4.2 Overdose Response Protocol

Who How When Regulatory Reference
Foster Parent or Any Adult Present IMMEDIATELY:
  1. Call 911
  2. If available and trained, administer Narcan (naloxone)
  3. Place child in recovery position if unconscious but breathing
  4. Stay with child until emergency services arrive
  5. Do NOT leave child alone
 IMMEDIATE - This is a medical emergency Medical emergency protocol
Foster Parent
  1. Contact On-Call Staff immediately after calling 911
  2. Provide location and child's condition
  3. Follow emergency responder instructions
 Concurrent with 911 Agency Policy
On-Call Staff
  1. Respond to foster home or hospital
  2. Notify Treatment Director
  3. Coordinate with medical providers
  4. Notify DFPS/SSCC per FC-SIR-01 Serious Incident Reporting Policy
 Immediately upon notification T3C Blueprint; Incident Reporting
Treatment Director
  1. Consult on clinical response
  2. Coordinate with substance use treatment providers
  3. Review and adjust treatment plan
  4. Determine if placement continues to meet child's needs
 Within 4 hours FC-SU-01

4.3 Relapse Response (Non-Punitive Protocol)

CRITICAL: Relapse is a clinical event, NOT a behavioral infraction. Response must be supportive, not punitive.

Who How When Regulatory Reference
Foster Parent
  1. Ensure child's immediate safety
  2. Assess for medical emergency (if yes, follow overdose protocol)
  3. Provide calm, supportive response
  4. Do NOT lecture, punish, or express disappointment
  5. Contact Case Manager or On-Call Staff
 Upon discovery FC-SU-01; Recovery-supportive approach
Case Manager/On-Call
  1. Assess situation and child's current state
  2. Determine if medical evaluation needed
  3. Provide support to foster parent
  4. Contact Treatment Director for clinical guidance
  5. Coordinate with substance use treatment provider
 Within 2 hours T3C Blueprint
Treatment Director
  1. Review relapse circumstances
  2. Consult with substance use treatment provider
  3. Adjust treatment plan as indicated
  4. Determine appropriate level of care
  5. Document clinical assessment
 Within 24 hours FC-SU-01
Case Manager
  1. Update Service Plan with relapse information
  2. Increase monitoring and support as indicated
  3. Coordinate enhanced services if needed
  4. Document all interventions
  5. Ensure continued recovery-supportive environment
 Within 3 business days FC3-01

4.4 Substance Use Crisis Prevention

Who How When Regulatory Reference
Case Manager
  1. Identify relapse triggers during assessment
  2. Include trigger management in Service Plan
  3. Ensure foster parent understands triggers
  4. Coordinate with substance use treatment provider on prevention strategies
 At admission; ongoing FC-SU-01; FC3-01
Foster Parent
  1. Maintain substance-free home environment
  2. Secure all medications and potentially abusable substances
  3. Monitor for warning signs of relapse
  4. Support recovery activities and connections
  5. Report concerns promptly
 Ongoing FC-SU-01 Section 7.4

4.5 Staff Training - Substance Use Crisis

Cross-Reference: Training requirements per FC-16 Staff and Caregiver Training Policy, Section 4.4

Additional crisis-specific competencies:

SECTION 5: SHORT-TERM ASSESSMENT SUPPORT SERVICES - CRISIS PROCEDURES

5.1 Assessment Period Crisis Considerations

Children in Short-Term Assessment placements present unique crisis management challenges:

Challenge Implication Response Adaptation
Unknown trauma history Triggers may not be identified Heightened observation; assume trauma history
No established Personal Safety Plan Limited individualized guidance Use general TBRI® de-escalation; develop plan rapidly
Unknown effective interventions What works for this child is unclear Try multiple approaches; document effectiveness
Short placement duration Limited time to build relationship Prioritize felt safety and connection
Assessment purpose Crisis data informs package recommendation Thorough documentation essential

5.2 Initial 48-Hour Enhanced Monitoring

Who How When Regulatory Reference
Foster Parent
  1. Maintain enhanced supervision during initial 48 hours
  2. Observe and document behavioral patterns, triggers, calming strategies
  3. Note sleep patterns, eating behaviors, responses to transitions
  4. Report observations to Case Manager daily
 First 48 hours of placement T3C Blueprint; FC-STASS-01
Case Manager
  1. Check in with foster parent daily during first 48 hours
  2. Gather observations for Personal Safety Plan development
  3. Assess need for expedited clinical consultation
  4. Begin identifying potential crisis triggers
 First 48 hours FC-STASS-01

5.3 Expedited Personal Safety Plan Development

Who How When Regulatory Reference
Case Manager
  1. Develop preliminary Personal Safety Plan based on: - Available history from referral - Foster parent observations - Child's self-report (age-appropriate) - Clinical consultation if indicated
  2. Document known and suspected triggers
  3. Include general trauma-informed strategies
  4. Update as information becomes available
 Within 72 hours of placement (vs. standard timeframe) TAC §749.137; FC-STASS-01

5.4 Crisis Documentation for Transition

CRITICAL: All crisis information must be documented for transition to receiving Service Package.

Who How When Regulatory Reference
Case Manager
  1. Document all crisis incidents thoroughly including: - Antecedents and triggers identified - Behaviors observed - Interventions attempted and effectiveness - Duration and resolution - Child's response to different approaches
  2. Include crisis information in Transition Summary
  3. Communicate directly with receiving Case Manager
 Throughout placement; at transition FC-STASS-01; FC14-01
Foster Parent
  1. Complete detailed incident documentation
  2. Note what strategies were effective/ineffective
  3. Document child's own words about what helps
 After each incident FC-SIR-01 Serious Incident Reporting Policy

5.5 Crisis During Assessment Period

Who How When Regulatory Reference
Foster Parent
  1. Implement standard crisis response per FC-04
  2. Use TBRI® de-escalation strategies
  3. Contact On-Call Staff if unable to de-escalate
  4. Document thoroughly for assessment purposes
 During crisis FC-04; TAC §749.2055
On-Call/Crisis Management Staff
  1. Respond per standard protocol
  2. Note this is assessment placement with limited history
  3. Document all observations for assessment
  4. Consider whether crisis indicates need for specialized package
 During/after crisis FC-04
Case Manager
  1. Review crisis for assessment implications
  2. Determine if crisis pattern suggests specific Service Package need
  3. Include crisis analysis in package recommendation
  4. Ensure receiving package is aware of crisis history
 Within 24 hours; at package determination FC-STASS-01

5.6 Time-Limited Placement Considerations

Situation Response
Repeated crises suggesting higher-level need Document pattern; recommend appropriate specialized package
Crisis reveals previously unknown diagnosis/condition Coordinate expedited assessment; adjust package recommendation
Crisis approaching end of assessment period Ensure complete documentation; communicate with receiving placement
Crisis requires hospitalization Assessment timeline may need extension per FC-STASS-01

SECTION 6: T3C TREATMENT FOSTER FAMILY CARE - CRISIS PROCEDURES

6.1 High-Acuity Population Considerations

Children receiving Treatment Foster Family Care have serious mental, emotional, or behavioral challenges requiring intensive therapeutic intervention. Crisis frequency and intensity may be elevated compared to other packages.

Consideration Implication
High-acuity diagnoses Psychiatric symptoms may escalate rapidly
Complex trauma histories Multiple triggers; intense responses
Intensive therapeutic involvement Clinical team integral to crisis response
Step-down goal Crisis patterns affect readiness assessment
365-day maximum Crisis management must support progress toward step-down

6.2 On-Call Licensed Therapist Requirement

Per T3C Blueprint: The operation must ensure that an on-call Licensed Therapist is always available to provide consultation and respond in person if needed.

Who How When Regulatory Reference
On-Call Licensed Therapist
  1. Available 24/7 for phone/telehealth consultation
  2. Provide clinical guidance during crisis
  3. Consult on psychiatric emergency response
  4. Coordinate with treating therapist and psychiatrist
 24/7 availability T3C Blueprint p.138
Crisis Management Staff
  1. Contact On-Call Licensed Therapist for all TFFC crises
  2. Follow clinical guidance provided
  3. Document therapist consultation
 During all TFFC crises T3C Blueprint

6.3 Psychiatric Emergency Response

Who How When Regulatory Reference
Foster Parent Recognize psychiatric emergency indicators: - Active suicidal ideation with plan/means - Suicide attempt - Psychotic episode (hallucinations, delusions) - Severe dissociation - Complete loss of reality contact Response:
  1. Ensure immediate safety
  2. Call 911 if imminent danger
  3. Contact On-Call Staff immediately
  4. Do not leave child alone
  5. Remove access to means of harm
 Upon recognition Medical/Psychiatric Emergency Protocol
On-Call Staff
  1. Contact On-Call Licensed Therapist immediately
  2. Assess need for psychiatric hospitalization
  3. Coordinate with emergency services
  4. Notify Treatment Director
  5. Support foster parent through crisis
 Immediately T3C Blueprint
On-Call Licensed Therapist
  1. Provide clinical assessment via phone/telehealth
  2. Guide decision on hospitalization vs. stabilization
  3. Coordinate with child's treating therapist/psychiatrist
  4. Document clinical recommendations
 During crisis T3C Blueprint p.138
Treatment Director
  1. Oversee clinical response
  2. Coordinate with psychiatric providers
  3. Review for 60-day implications
  4. Determine if placement remains appropriate
  5. Update treatment plan
 Within 24 hours FC-TFFC-01

6.4 Crisis Response Integration with Treatment

Who How When Regulatory Reference
Case Manager
  1. Notify child's treating therapist of crisis within 24 hours
  2. Coordinate crisis follow-up with therapy schedule
  3. Ensure crisis addressed in next therapy session
  4. Update Service Plan with crisis information
 Within 24 hours T3C Blueprint
Licensed Therapist (Treating)
  1. Review crisis incident
  2. Adjust treatment approach as indicated
  3. Process crisis with child therapeutically
  4. Provide guidance to foster parent
  5. Document treatment implications
 Next scheduled session or sooner Clinical practice
Treatment Director
  1. Review crisis for treatment model alignment
  2. Ensure therapeutic response coordinated
  3. Assess whether current treatment intensity sufficient
  4. Recommend adjustments as needed
 Within 3 business days FC-TFFC-01

6.5 60-Day Review Crisis Integration

CRITICAL: Per FC-TFFC-01, crisis patterns must be reviewed at each 60-day Continued Stay Review.

Who How When Regulatory Reference
Case Manager
  1. Compile crisis incident summary for review period
  2. Analyze patterns (frequency, triggers, intensity, interventions)
  3. Include crisis data in 60-day review documentation
  4. Note progress or regression in crisis management
 At each 60-day review FC-TFFC-01; FC-CSR-01
Treatment Director
  1. Review crisis patterns in clinical context
  2. Assess whether crises indicate: - Treatment progress (decreasing) - Need for treatment adjustment (stable/increasing) - Step-down readiness (significant reduction) - Potential need for higher level of care (escalating)
  3. Document crisis analysis in 60-day confirmation
 At each 60-day review FC-TFFC-01
Program Director
  1. Consider crisis patterns in continued stay determination
  2. Ensure crisis management supports permanency goal
  3. Confirm continued appropriateness of TFFC placement
 At each 60-day review FC-TFFC-01

6.6 Step-Down Readiness and Crisis History

Crisis Pattern Step-Down Implication
Significant reduction in frequency and intensity May indicate readiness for step-down consideration
Stable pattern without improvement Treatment adjustment may be needed before step-down
Increasing frequency or intensity Step-down not appropriate; treatment intensification needed
Crisis-free for extended period Strong indicator of potential step-down readiness

6.7 Staff Training - Treatment Foster Family Care Crisis

Cross-Reference: Training requirements per FC-16 Staff and Caregiver Training Policy, Section 4.6

Additional crisis-specific competencies (within 20-hour specialized training):

SECTION 7: POST-CRISIS RESPONSE

7.1 Immediate Follow-Up

Who How When Regulatory Reference
Foster Parent or Staff Ensure child's physical and emotional safety; provide comfort and reassurance using TBRI® principles Immediately after crisis resolved Agency Policy
Foster Parent or Staff Check in with other children in home who may have been affected Within 1 hour Agency Policy
Foster Parent or Staff Complete incident documentation per FC-SIR-01 Serious Incident Reporting Policy and Procedure See FC-SIR-01 Serious Incident Reporting Policy for timeframes See FC-SIR-01 Serious Incident Reporting Policy
Case Manager or Crisis Management Staff Conduct debriefing with child (when appropriate) to process experience and identify learning opportunities Within 24 hours Agency Policy
Case Manager or Crisis Management Staff Conduct debriefing with foster parents to process experience, assess support needs, and identify prevention strategies Within 24 hours Agency Policy

7.2 Assessment and Planning

Who How When Regulatory Reference
Case Manager Review crisis incident and identify any patterns, triggers, or gaps in current interventions Within 3 business days Agency Policy
Case Manager Update Personal Safety Plan if incident reveals new information about triggers, warning signs, or effective interventions Within 3 business days of crisis TAC §749.137
Treatment Director (Mental Health/IDD packages) Review crisis incident and provide clinical recommendations for plan modifications Within 3 business days T3C Blueprint
Case Manager Coordinate additional supports as needed (increased therapy frequency, medication evaluation, respite care, additional training for foster parents) Within 1 week T3C Blueprint
Case Manager Document all post-crisis actions and plan modifications in child's record Within 3 business days Agency Policy

7.3 Notification Requirements

All notifications following crisis incidents shall be completed in accordance with the timeframes and procedures specified in the FC-SIR-01 Serious Incident Reporting Policy and Procedure, including:

Refer to FC-SIR-01 Serious Incident Reporting Policy and Procedure for complete notification requirements, timeframes, and documentation protocols.

SECTION 8: RESTRICTIONS OF PRIVILEGES

Authoritative source: restriction of privileges is a discipline measure governed by FC-16.07 Discipline Policy and FC-16.07.1 Procedure (26 TAC §749.1959, §749.1951). The steps below restate the key thresholds for use during/after a crisis; the Discipline Policy controls.

8.1 Standard Restrictions

Who How When Regulatory Reference
Foster Parent May restrict activities as behavior management tool within reason, not to exceed 10 days duration As appropriate TAC §749.1959
Foster Parent Ensure restrictions do not interfere with structure and/or unstructured activities required by child's individual service plan During restriction period TAC §749.1959
Foster Parent Inform child and Managing Conservator or DFPS/SSCC caseworker of restriction and reason At time of restriction TAC §749.1959
Foster Parent Document restriction including justification, communication to child/caseworker in child's record Within 24 hours TAC §749.1959

8.2 Extended Restrictions (>10 Days)

Who How When Regulatory Reference
Foster Parent Submit restriction for review and approval by Case Manager, Administrator, or Treatment Director Before restriction exceeds 10 days TAC §749.1959, §749.1951
Case Manager/Administrator/Treatment Director Review restriction request and approve or deny based on appropriateness and necessity Within 24 hours of restriction being imposed TAC §749.1959, §749.1951
Foster Parent Document approval in child's record Within 24 hours of approval TAC §749.1959

8.3 Area Restrictions (>24 Hours)

Who How When Regulatory Reference
Foster Parent Submit restriction to particular area (room or building) for review by treatment team, professional service provider, or Treatment Director Prior to imposing restriction over 24 hours OR within 24 hours of imposing restriction TAC §749.1959
Treatment Team/Professional Service Provider/Treatment Director Review and approve or deny area restriction request Prior to or within 24 hours of restriction being imposed TAC §749.1959
Foster Parent Document approval and all details of restriction in child's record Within 24 hours TAC §749.1959

SECTION 9: CRISIS MANAGEMENT STAFFING FOR T3C SERVICE PACKAGES

9.1 Current Crisis Coverage System

Refuge House maintains 24/7 crisis response capability through its established on-call system (see FC-OC-01 On-Call Policy and Procedure):

9.2 Crisis Management Credentialing Plan

For T3C Mental & Behavioral Health Support Services, IDD/Autism Spectrum Disorder Support Services, Substance Use Support Services, and Treatment Foster Family Care credentials, Refuge House implements enhanced crisis management capabilities:

Staffing Model:

Training Enhancements:

Implementation:

SECTION 10: STAFF TRAINING SUMMARY BY PACKAGE

Training Module Requirements

Cross-Reference: All training requirements per FC-16 Staff and Caregiver Training Policy

Module Duration Content Completion Timing
Module 3: Substance Use Crisis Response 2 hours (included in 4-hour SU training) Overdose recognition, Narcan administration overview, withdrawal symptoms, non-punitive relapse response, recovery-supportive crisis intervention Before first Substance Use placement
Module 4: Short-Term Assessment Crisis Response 1 hour (included in 4-hour STASS training) Unknown history considerations, expedited safety planning, crisis documentation for transition, observation and pattern identification Before first Short-Term Assessment placement
Module 5: Treatment Foster Family Care Crisis Response 4 hours (included in 20-hour TFFC training) Psychiatric emergency response, high-acuity de-escalation, clinical team coordination, 60-day review integration, step-down implications Before first TFFC placement

SECTION 11: SUICIDE PREVENTION, INTERVENTION, AND POSTVENTION

Purpose and Overview

Suicide risk is screened, responded to, and followed up on per TAC §749.137, integrated with the child's Personal Safety Plan.

Who How When Regulatory Reference
Child Placement Staff Screen for suicide risk using a validated tool (e.g., C-SSRS) at admission and on the required re-screening cadence; document the screening and the screener's training At admission; 90-day cadence for children age 10+ TAC §749.137(c), §749.137(d)
Child Placement Staff High risk: immediately refer the child to a mental-health professional for a comprehensive suicide-risk assessment; do not leave the child alone until assessed; remove access to means; alert all caregivers; follow all mental-health recommendations; update the Personal Safety Plan Immediately CRITICAL: TAC §749.137(e)(1)
Child Placement Staff Potential risk: refer to a mental-health professional within 24 hours; maintain close monitoring; remove access to means; alert caregivers; update the Personal Safety Plan. Do not discuss, list, or describe specific methods during safety conversations Within 24 hours TAC §749.137(e)(2)
Case Manager / Crisis Mgmt Staff Post-hospitalization & postvention: meet with the returning child in the home within 24 hours to review transition, safety, and risk-reduction. Following any suicide attempt or death, activate postvention — debriefing/referral for affected staff, caregivers, and children, and a blame-free lessons-learned review Within 24 hours of return; after any attempt/death TAC §749.137(b)(1), §749.137(f)(1)

SECTION 12: MISSING CHILD, RUNAWAY, AND TRAFFICKING RESPONSE

Purpose and Overview

When a child is missing, Refuge House follows age-tiered law-enforcement notification (the strictest applicable standard controls), concurrent reporting, and screens every recovered child for trafficking victimization.

Who How When Regulatory Reference
Foster Parent / Case Manager Age-tiered law-enforcement notification: under 6 — immediately upon determining the child is not on the premises; ages 6–12 — within 2 hours; ages 13+ — within 6 hours (immediately if there is trafficking history, suspected abduction, or reason to believe the child will not return) Per age tier CRITICAL: TAC §749.503(8)–(10)
Case Manager / Crisis Mgmt Staff Concurrent notifications: NCMEC (1-800-THE-LOST) immediately, no later than 8 hours; DFPS Special Investigations and the Regional Missing Children Coordinator within 8 hours; SSCC on-call, CPS caseworker, and chain of command within 8 hours; HHSC CCR per the age-tiered timeframe; parents per the LE notification timeframe Within 8 hours TAC §749.503; FC-04
Case Manager Recovery and debriefing: interview the child to determine the reasons for the absence; screen for crime or trafficking victimization; if trafficking or abuse/neglect is identified or suspected, notify DFPS Statewide Intake (1-800-252-5400) and local law enforcement immediately, no later than 8 hours. Update the Personal Safety Plan and Runaway Prevention Plan Upon recovery 42 U.S.C. §671(a)(34)(A); TAC §749.503

SECTION 12A: PROACTIVE RUNAWAY PREVENTION (RUNAWAY PREVENTION PLAN)

Purpose and Overview

Per FC-04 Policy Statement 6 and DFPS 24-Hr RCC §4900, Refuge House operates a proactive Runaway Prevention Plan (RPP) regime — the front end that precedes any runaway episode. Section 12 above governs the response after a child goes missing and updates the RPP upon recovery; this section governs identifying elevated risk and putting the plan in place before a runaway occurs.

Who How When Regulatory Reference
Case Manager / Foster Parent / Crisis Mgmt Staff Identify elevated runaway risk: evaluate behaviors indicating a higher likelihood of running away at admission assessment and on an ongoing basis. RPP triggers: a recent episode of running away (history within the last 6 months) or human trafficking victimization; a verbalized serious desire to run away; recent threats to run away; or escalating behaviors indicating the need for intervention At admission; ongoing; immediately upon any trigger DFPS 24-Hr RCC §4900
Case Manager Develop the Runaway Prevention Plan within 48 hours of identifying the child as at higher risk. Use DFPS Form 2882 or the agency RPP instrument. The plan must be child-centered, strengths-based, and include the child's input; explore reasons for past runaway episodes and triggers; present alternatives for the child to use as an outlet for frustrations; plan for the child's safety and well-being; and plan proactively for if the child does run away Within 48 hours of risk identification DFPS 24-Hr RCC §4900
Case Manager Invite the CPS Caseworker to contribute to the plan; document the invitation and any contribution. Proceed without the caseworker if the caseworker cannot be reached or cannot attend, documenting the attempts During plan development DFPS 24-Hr RCC §4900
Case Manager Provide written notice and a copy of the RPP to the child's assigned caseworker and supervisor within 24 hours of implementing the plan; document the transmission in the child's record Within 24 hours of implementation DFPS 24-Hr RCC §4900
Case Manager / Foster Parent Inform all caregivers and staff assigned to supervise the child of the child's risk for running away and the plan's de-escalation strategies At implementation and on each update DFPS 24-Hr RCC §4900
Case Manager Evaluate the RPP monthly: update the plan as needed, or end the plan when the runaway risk has been mitigated; document each monthly evaluation Monthly while the plan is active DFPS 24-Hr RCC §4900
Case Manager / Home Development Verify at monthly home visits (home-monitoring checklist item HM-SAF-23) that the RPP is present and current for any child at elevated runaway risk, that the caregiver can describe the child's risk factors and de-escalation strategies, and that the caseworker was provided a copy within 24 hours Monthly home visit DFPS 24-Hr RCC §4900; HM-SAF-23
Training Coordinator Provide staff and foster parents training that builds skills in de-escalation for children with runaway risk factors (see FC-16 Staff and Caregiver Training Policy) Pre-service and ongoing DFPS 24-Hr RCC §4900

Implementation guidance: the 48-hour development clock, the 24-hour caseworker/supervisor transmission, and the monthly evaluation cadence for active RPPs are tracked through case-management tickler/cadence reminders (Pulse cadence tracking for RPP due dates is planned); until automated, the Case Manager tracks these dates manually and the monthly home-visit check (HM-SAF-23) serves as the verification backstop.

SECTION 13: DISASTER AND EMERGENCY RESPONSE (DERPP)

Purpose and Overview

A written Disaster and Emergency Response Preparedness Plan (DERPP) is maintained for every certified home; see the Disaster and Emergency Response Preparedness Plan (DERPP) Policy.

Who How When Regulatory Reference
Program Director / All Staff & Caregivers Maintain a written DERPP for every certified home covering evacuation, severe weather, transportation emergencies, pandemic, and chemical/hazardous/terrorism threats, with special procedures for children under 24 months and those with limited mobility or sensory/cognitive/medical needs; submit each home-specific DERPP to SSCC partners within 30 days of the Provider Services Agreement and review annually Within 30 days; reviewed annually TAC §§749.2907–§749.2908
Foster Parent / Caregiver Complete annual fire drills demonstrating a 3-minute exit and documented annual severe-weather drills; complete annual DERPP training with signed acknowledgement; maintain at least two current emergency contacts per child Annually TAC §§749.2907–§749.2908

SECTION 14: INCIDENT DOCUMENTATION, REPORTING, AND ESCALATION

Purpose and Overview

The strictest applicable reporting timeframe controls, and reporting through one channel does not eliminate the obligation to report to others. See the FC-SIR-01 Serious Incident Reporting Policy and Procedure for full requirements; TAC §749.501–§749.513 govern serious incidents.

Quick-reference reporting:

Incident Notify Timeframe
Abuse / neglect / exploitation (suspected) DFPS Statewide Intake (1-800-252-5400) Immediately
Death All parties (DFPS/SSCC, HHSC CCR, parents) Immediately
Suicide attempt SSCC/DFPS; written report ASAP; written within 24 hours
Substantial injury SSCC on-call (verbal); written Verbal 12 hours; written 24 hours
Missing child — under 6 / 6–12 / 13+ Law enforcement Immediately / within 2 hours / within 6 hours
Trafficking Local law enforcement; DFPS Immediately, no later than 8 hours
Emergency behavior intervention / PRN Document; written notice to parent Document 24 hours; parent within 72 hours
Communicable disease SSCC and DFPS No later than 24 hours
Disaster SSCC / DFPS ASAP, no later than 24 hours
Psychiatric admission All parties; written Immediately; written within 24 hours
Who How When Regulatory Reference
All Staff / Crisis Mgmt Staff File the verbal Serious Incident report to the SSCC on-call and the written Serious Incident Report (Texas Provider Gateway or the SSCC partner's designated channel); report to the CPS caseworker, supervisor, and chain of command; report any suspicion of abuse, neglect, or exploitation to DFPS Statewide Intake immediately Verbal 12 hours; written 24 hours; abuse/neglect immediately TAC §749.501–§749.513; DFPS RCC §1410–§1411
Program Director / Designee Report communicable-disease incidents and any child arrest/indictment/warrant to SSCC and DFPS no later than 24 hours; report any allegation of a prohibited or inappropriate EBI technique to HHSC CCR and the parent within 24 hours; hold a Critical Incident Review before placement resumes from any hold No later than 24 hours TAC §749.501; 25 TAC Chapter 97

PACKAGE-SPECIFIC CRISIS MANAGEMENT COMPARISON

Element Substance Use Short-Term Assessment Treatment Foster Care
Primary Crisis Types Overdose; withdrawal; relapse Various (unknown) Psychiatric emergency; high-acuity behavioral
Medical Emergency Protocol Overdose/withdrawal → 911 Standard Psychiatric emergency → 911
Clinical Involvement Treatment Director + SU provider As indicated On-Call Licensed Therapist REQUIRED
Unique Consideration Non-punitive relapse response Unknown history; document for transition 60-day review integration
Personal Safety Plan Include relapse prevention Expedited (72 hrs) Intensive; clinically informed
Training Module 2 hours (in 4-hr SU training) 1 hour (in 4-hr STASS training) 4 hours (in 20-hr TFFC training)
Step-Down Implications Recovery stability N/A (assessment only) Crisis pattern analysis

REGULATORY REFERENCES

FORMS/ATTACHMENTS

Core Forms (All Packages):

Package-Specific Forms:

Substance Use Support Services:

Short-Term Assessment Support Services:

T3C Treatment Foster Family Care:

This procedure document operationalizes the principles established in the corresponding policy 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.

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