# REFUGE HOUSE, INC.

| Policy Information | Details |
| :---- | :---- |
| **POLICY NAME** | Emergency Behavior Intervention Policy |
| **POLICY NUMBER** | FC-16.06 |
| **ORIGINATED** | 6/04 |
| **APPROVED BY** | Board of Directors |
| **EFFECTIVE DATE** | 5/15/25 |
| **REVISION DATE** | 6/15/26 |
| **LAST UPDATED** | 5/15/2026 |
| **LAST APPROVED** | 5/22/2026 |
| **RELATED PROCEDURE** | FC-16.06.1 Emergency Behavior Intervention Procedure |

| 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 the governing principles for the use of emergency behavior intervention (EBI), ensuring that any intervention promotes the safety and dignity of children, caregivers, and personnel, is used only in a genuine emergency and only as a last resort, and never as discipline.

## POLICY:

Refuge House uses behavior-intervention strategies that promote the safety and dignity of all children, foster/adoptive parents, caregivers, and personnel, in full compliance with **26 TAC Chapter 749, Subchapter L (§§749.2001–749.2383)**. Emergency behavior intervention may be used **only** in an emergency in which a child is at risk of imminent physical harm to self or others, and only after less-restrictive de-escalation measures have been attempted and proven ineffective. EBI may **never** be used or threatened as discipline (see FC-16.07 Discipline Policy), and its use within a crisis response is coordinated with FC-04 Crisis Management.

Consistent with TBRI®, caregivers prioritize **Connecting** and **Empowering** strategies — felt safety, co-regulation, addressing unmet physiological and sensory needs, and offering choices — to prevent escalation, so that any physical intervention is reserved for a genuine emergency and is itself delivered in a relationship-preserving, least-restrictive manner.

## AUTHORIZED FORMS OF EBI:

Refuge House permits only the following (**TAC §749.2051**): de-escalation; **short personal restraint** (no longer than one minute); and **personal restraint**, subject to all time, technique, and supervision limits below. These methods must not obstruct the child's airway, impair breathing, apply pressure to vital areas, obstruct the caregiver's view of the child's face, or interfere with the child's ability to communicate or vocalize distress. **Satori Alternatives to Managing Aggression (SAMA)** is the agency's authorized behavior-management program.

## PROHIBITED FORMS OF EBI:

Refuge House does **not** administer emergency medication, chemical restraint, mechanical restraint, or isolation/seclusion as behavior management; does not use aversive conditioning (including techniques designed or likely to cause physical pain, startling stimuli, or noxious sprays near the face) or pressure points; and prohibits **prone or supine restraint, including any prone or supine transitional hold** (a standard stricter than **TAC §749.2205**, which permits a one-minute transitional hold). Rebirthing therapy and hug/holding therapy are prohibited. Refuge House does not permit successive emergency behavior interventions, and no EBI technique used requires a physician's order.

## MAXIMUM LENGTH (any age):

- **Short personal restraint:** maximum **one (1) minute** — may not be exceeded.
- **Personal restraint:** maximum **thirty (30) minutes for a child of any age** — may not be exceeded under any circumstances (**TAC §749.2281, §749.2283**). *(This corrects prior language that referenced one hour for ages 9–17.)*
- Prone/supine transitional holds, emergency medication, chemical/mechanical restraint, and seclusion: **prohibited.**

## AUTHORIZED USE:

Personal restraint may be used only as an absolute last resort in an emergency to protect the child from imminent harm to self, imminent harm to others, or imminent harm to significant property, or as specifically approved in the child's service plan by the treatment team (**TAC §749.2059, §749.2061**). All de-escalation and less-restrictive techniques must be attempted and proven ineffective first. Only a Refuge House individual qualified in EBI may administer any form of EBI, **except** a short personal restraint. When a child's behavior cannot be safely managed by authorized techniques, when significant property damage is occurring, or when emergency medical care is required, caregivers are directed to call 9-1-1.

Personal restraint must never be used as punishment, retribution, or retaliation; to gain compliance or as a convenience; as a substitute for treatment; to demonstrate authority; or when a less-restrictive alternative is available (**TAC §749.2063**).

## MONITORING, RELEASE, AND DIGNITY:

A caregiver must continuously monitor the child during any restraint and release the child immediately when the child is no longer a danger or at any sign of an emergency medical condition (**TAC §749.2153, §749.2201**). The caregiver must use the minimum reasonable and necessary force, minimize the risk of discomfort or harm, and preserve the child's privacy and dignity.

## DOCUMENTATION AND REPORTING:

Each use of EBI is documented in the child's record within 24 hours, with a verbal report to Refuge House within 2 hours and written notice to the parent/managing conservator within 72 hours (**TAC §749.2301, §749.2303, §749.2307**). Serious-incident, SSCC, and DFPS reporting obligations apply (**TAC §§749.503, §749.511–§749.513**; DFPS 24-Hr RCC §1411), and any allegation of a prohibited or inappropriate EBI technique is reported to HHSC Child Care Regulation and the parent within 24 hours. Critical-incident reviews and quarterly reporting to HHSC are conducted per the procedure.

## TRAINING:

All caregivers and direct-care employees complete competency-based SAMA training (written and physical demonstration) before responsibility for children, per **TAC Chapter 749, Subchapter F (§§749.863, 749.864, 749.869, 749.887, 749.889, 749.911, 749.939)**, with at least 75% of pre-service hours on early identification and less-restrictive intervention. One foster parent must complete at least half of the required pre-service EBI hours before a child is placed; a caregiver may not administer any EBI other than a short personal restraint until all pre-service EBI hours are complete. Specific hour requirements by service level are maintained in FC-16.06.1 and FC-16.

## APPLICATION ACROSS SERVICE PACKAGES:

The EBI standards in this policy apply **uniformly to every child in care, regardless of Service Package** — the authorized forms, prohibitions, and maximum durations do not vary by package. Package-specific considerations are operationalized through FC-04 Crisis Management: **Mental & Behavioral Health** — coordination with psychiatric-emergency services; **IDD/Autism** — sensory-informed de-escalation, communication supports, and Registered Nurse consultation; **Substance Use** — recovery-supportive, non-punitive response; **Treatment Foster Family Care and other treatment services** — higher-acuity population served with on-call Licensed Therapist support and enhanced **16-hour** pre-service SAMA training (vs. 8 hours for child-care/programmatic services).

## NO RETALIATION AND GRIEVANCE:

Refuge House prohibits any discharge or retaliation against any person who, in good faith, reports the misuse of EBI or prohibited discipline, and provides a grievance and appeal process for such concerns.

## REFERENCES:

- TAC Chapter 749, Subchapter L: §§749.2001–749.2383 (Emergency Behavior Intervention — types, administration, restraint precautions, monitoring, release, maximum duration, documentation)
- TAC §749.2205 (transitional hold — RH standard is stricter), §749.2281, §749.2283 (maximum duration), §749.2301, §749.2303, §749.2307 (documentation/notice)
- TAC Chapter 749, Subchapter F: §749.863, §749.864, §749.869, §749.887, §749.889, §749.911, §749.939 (training)
- TAC §749.103, §749.115, §749.503, §749.511–§749.513, §749.1021 (policies, reporting, rights)
- DFPS 24-Hour Residential Child Care Requirements (FY26) §§1411, 4721; SSCC Provider Manuals (OCOK, 2INgage, EMPOWER, Belong, Saint Francis, 4Kids4Families)
- T3C System Blueprint 2026

## RELATED PROCEDURES:

- FC-16.06.1 Emergency Behavior Intervention Procedure
- FC-16.07 Discipline Policy (EBI is never discipline)
- FC-04 Crisis Management Policy (EBI within crisis response)
- FC-16 Staff and Caregiver Training Policy
- Incident Reporting Policy and Procedure

## DEFINITIONS:

**Emergency behavior intervention (EBI)**: an intervention used in an emergency to prevent imminent physical harm, limited to de-escalation, short personal restraint, and personal restraint.

**Short personal restraint**: a personal restraint of no more than one minute.

**Personal restraint**: bodily contact that restricts a child's free movement, limited to 30 minutes for a child of any age.

**Prone / supine restraint**: a face-down or face-up restraint; prohibited in any Refuge House home, including transitional holds.

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*This policy document establishes the governing principles for Emergency Behavior Intervention. The corresponding procedure document (FC-16.06.1) operationalizes these principles. While policies require Board approval and remain relatively stable, procedures may be updated by the Executive Director to adapt to regulatory changes or operational improvements without requiring Board approval, provided such changes maintain alignment with the policy's intent.*