REFUGE HOUSE, INC.

Child Placing Agency

MENTAL & BEHAVIORAL HEALTH SUPPORT SERVICES

COMPREHENSIVE ENHANCED SNAPSHOT

Umbrella Policy and Procedures with Embedded Cross-References

ABOUT THIS DOCUMENT

Purpose: This Comprehensive Enhanced Snapshot is designed for external reviewers (e.g., DFPS credentialing analysts) who need a complete picture of Mental & Behavioral Health Support Services implementation without referring to separate policy and procedure documents.

Related Documents:

• FC-MH-01 (Quick Reference): Lean cross-reference version for internal quick lookup
• FC-MH-01 (Standard): Working template with cross-references to standalone policies
• FC-MH-01 Implementation Addendum: Interim Credential period operational details

Shared Infrastructure Note: This Service Package shares significant infrastructure with Substance Use Support Services (FC-SU-01). Mental health-specific elements are noted explicitly throughout.

TABLE OF CONTENTS

POLICY SECTIONS

1. Purpose and Service Package Description
2. Governing Principles
3. Admission Criteria and Guidelines
4. Length of Service Parameters
5. Service Package Expectations
6. Staffing Requirements and Ratios
7. Foster Family Home Requirements
8. Quality Assurance and Continued Stay Guidelines
9. Aftercare Services (Mandatory)

PROCEDURE SECTIONS

10-17. [Procedures integrated throughout]

TRAINING, TREATMENT MODEL, CQI, AND REFERENCES

10. Forms and Attachments
11. Regulatory References
12. Related Procedures and Policies
13. Document Control and Compliance Statement

POLICY SECTIONS

1. PURPOSE AND SERVICE PACKAGE DESCRIPTION

1.1 Service Package Definition

Mental & Behavioral Health Support Services provides trauma-informed foster care for children, youth, and young adults with mental health diagnoses who require specialized therapeutic support beyond Basic Foster Family Home services.

1.2 Target Population

Children, youth, and young adults who:

• Have a diagnosed mental health condition requiring specialized support
• Need therapeutic services coordinated through STAR Health
• Can be safely served in a family setting with appropriate services
• May have co-occurring needs (trauma history, behavioral challenges)

1.3 Dual Credentialing Requirement

In addition to maintaining the Mental & Behavioral Health Support Services Package credential, the Child Placing Agency and Foster Family Home Caregivers must be Credentialed to provide the T3C Basic Foster Family Home Support Service Package. This allows for step-down within the same foster family home when the child no longer requires Mental & Behavioral Health services.

Credential Maintenance: CPA and Foster Family Home Caregivers providing Mental & Behavioral Health Support Services maintain BOTH:

• T3C Basic Foster Family Home Support Services credential (foundational), AND
• Mental & Behavioral Health service package credential (specialized)

Loss or lapse of either credential suspends Mental & Behavioral Health service delivery until remediation is completed and both credentials are reinstated; service delivery cannot continue under the service package credential alone.

2. GOVERNING PRINCIPLES

2.1 TBRI® Integration

📋 DERIVED FROM: TBRI Treatment Model Executive Summary

Refuge House's Evidence-informed Treatment Model applies Trust-Based Relational Intervention (TBRI®) principles across all Service Packages. For Mental & Behavioral Health Support Services, TBRI principles are enhanced with clinical mental health interventions:

Connecting Principles: Building trust and connection that supports mental health recovery, recognizing that healthy relationships are foundational to healing.

Empowering Principles: Addressing physical regulation needs that impact mental health, including nutrition, sleep, and sensory processing.

Correcting Principles: Trauma-informed response philosophy recognizing that behaviors often stem from unmet needs and past experiences.

3. ADMISSION CRITERIA AND GUIDELINES

3.1 Admission Guidelines

In addition to statutory and Minimum Standards Requirements:

• Placement type and Service Package align with child's needs and strengths as demonstrated through CANS 3.0 Assessment
• Pre-Placement visit conducted (when applicable and appropriate) and was successful
• CPA admissions staff have reviewed child's information and determined needs align with services offered
• CPA and Foster Family Home are Credentialed for Mental & Behavioral Health Support Services Package

3.2 Capacity

The T3C Blueprint (April 2026, pp.79-89) does not specify a Package-specific foster home capacity limit for the Mental & Behavioral Health Support Services Package. Standard TAC §749 base foster home capacity standards apply; refer to each foster home's verification for the approved capacity.

4. LENGTH OF SERVICE PARAMETERS

4.1 Length of Service

Length of service is individualized based on:

• Child's Treatment Model for providing Mental & Behavioral Health Support Services
• Admission Guidelines and Continued Stay Guidelines
• Child's CANS 3.0 Assessment
• Child's ability to make progress in accordance with the Service Plan

Anticipated Length of Service: 12-18 months typical duration, customized based on individual needs and Continued Stay Guidelines as outlined in the T3C Blueprint. Service length may extend based on the child's clinical progress, therapeutic response, and Service Plan review outcomes.

4.2 Service Plan Reviews

Service Plans are reviewed every 90 days to assess treatment progress, therapeutic effectiveness, step-down readiness, and continued service need.

5. SERVICE PACKAGE EXPECTATIONS

5.1 Therapeutic Services

Package-Specific Requirement: Weekly therapy minimum for children receiving this package.

Services include:

• Individual therapy (weekly minimum)
• Family therapy
• Group therapy
• Psychiatric services as clinically indicated

Foster Family Home Caregivers must support the child's participation in individual, family, and group therapy.

Provider Qualifications: Therapy services provided by Licensed Therapist specializing in providing therapy to children with DSM-5 diagnosis for serious mental, emotional, and/or behavioral disorder(s). Providers must be credentialed and contracted with STAR Health managed care organization.

5.2 Service Planning Requirements

5.3 24/7 Crisis Availability

📋 DERIVED FROM: FC-04 Crisis Management Policy; FC-04.1 Crisis Management Procedure Section 3

Availability: Crisis Management Staff available 24/7/365. On-call staff are case manager level or above.

Mental Health-Specific Crisis Protocols include:

• Psychiatric emergency response (active psychosis, severe mood episode)
• Suicidal ideation and self-harm assessment and response
• Severe behavioral escalation protocols
• Coordination with emergency behavioral health services when psychiatric hospitalization may be warranted
• Coordination with child's prescribing psychiatrist or psychiatric NP for medication-related crises

Response Timelines:

• Phone response to foster parent crisis call: within 15 minutes
• In-person dispatch if phone consultation is insufficient: within 1 hour
• Treatment Director consultation for complex clinical situations: available during and after business hours

Post-Crisis Documentation Requirements (per FC-04.1 §7):

• Case Manager completes crisis incident review within 3 business days
• Personal Safety Plan updated within 3 business days if new trigger information identified
• Treatment Director provides clinical recommendations within 3 business days for Mental Health package crises
• All notifications to RCCL Hotline and DFPS/SSCC caseworker completed per Incident Reporting Policy and Procedure timelines

Cross-Reference: FC-04.1 Crisis Management Procedure, Sections 2.2, 3.3, 7.2

5.4 Human Trafficking Prevention

📋 DERIVED FROM: FC-HT-01 Human Trafficking Prevention Policy

Universal Human Trafficking Prevention per FC-HT-01 and Human Trafficking Prevention Training Implementation Plan.

5.5 Family Engagement

📋 DERIVED FROM: FC7-01 Family Connections and Engagement Policy

Family engagement for Mental & Behavioral Health Support Services includes family education on supporting mental health recovery, family involvement in treatment planning, family therapy as clinically indicated, and support for family members affected by child's mental health needs.

5.6 Educational Coordination

This Service Package requires coordination and participation in school enrollment, including advocating for and ensuring various educational testing and plans are completed as necessary, and accommodations and/or supports are in place to aid in the child's educational success.

5.7 STAR Health Coordination

📋 DERIVED FROM: FC-STAR-01.1 STAR Health Coordination Procedure

CPA and Foster Family Home Caregiver are required to coordinate care with the child's medical consenter and participate in STAR Health Service Coordination. CPA and Foster Family Home Caregivers must have enhanced skill in advocating for and supporting coordination of services through STAR Health and HHSC Supports and Services for children with serious mental, emotional, and/or behavioral health disorders.

Mental & Behavioral Health-Specific STAR Health Coordination Requirements:

Service Area	Coordination Requirement
Psychiatric Services	Authorize and coordinate psychiatric evaluations, medication management appointments, and inpatient/partial hospitalization referrals through STAR Health managed care organization
Outpatient Therapy	Verify STAR Health authorization for individual, family, and group therapy; maintain records of authorization status; coordinate renewal before lapse
Medication-Assisted Treatment (MAT)	Where applicable for co-occurring substance use, coordinate MAT authorization and prescriber communication through STAR Health
HHSC Behavioral Health	Coordinate with HHSC Behavioral Health for services not covered by STAR Health, including Community Mental Health services and crisis stabilization resources
Service Denial Documentation	Document any STAR Health service request denial within case record, including date, service type, denial reason, and appeal status; notify SSCC/DFPS within 3 business days of denial (per §5.9)

Cross-Reference: FC-STAR-01.1 Section 9 (Managing Service Denials and Access Barriers)

5.8 Foster Home Environment

Foster home must maintain therapeutic environment with predictable routines and structure, calm regulated atmosphere, medications properly secured, and environment supportive of mental health recovery.

5.9 Service Documentation and Cost Coverage

T3C Blueprint Reference: Page 82 (April 2026)

5.9.1 Service Documentation Requirements

In collaboration with the Medical Consenter, Refuge House must document all services the child, youth, or young adult is receiving through STAR Health, HHSC Behavioral Health, Early Childhood Intervention (if applicable), the education system, and any other county, community, or state agency.

5.9.2 Service Request and Denial Documentation

Requests for specific services determined necessary as a part of the Service Plan or Service Plan review, and for which the child, youth, or young adult is referred, and the service is not readily available and/or it is determined that the child, youth, or young adult is ineligible for the service, must be documented in the case record. This documentation shall include:

• The date the service request, application, or referral was made
• The specific type of service being requested
• The status of the service request
• The reason provided for any denial (if applicable)
• The status of any service request appeals (if applicable)

5.9.3 SSCC/DFPS Notification

Refuge House shall notify the SSCC or DFPS caseworker of any challenges encountered with access to services and/or service referral denials within 3 business days.

5.9.4 Community Resource Pursuit

Refuge House shall seek community resources to obtain any needed services that are not covered through STAR Health.

5.9.5 Cost Coverage Commitment

If community resources are not available and/or STAR Health does not cover the needed service(s) consistent with this Service Package, and as outlined in the Service Plan or Service Plan review, Refuge House will ensure delivery of, and cover the cost of the needed service(s) and related supports.

Cross-Reference: FC-STAR-01.1 STAR Health Coordination Procedure Section 9 (Managing Service Denials and Access Barriers)

5.10 Foster Family Home Support Services (Mental & Behavioral Health-Specific)

Foster Family Home Caregivers serving children under the Mental & Behavioral Health Support Services Package are required to offer (a) logistical support, (b) transportation, (c) coordination, and (d) documentation/record keeping of services in accordance with court orders and the Service Plan. This package-specific support approach recognizes the heightened therapy-coordination and mental-health-crisis-response demands of this package.

Logistical Support:

• Coordination of daily routines to accommodate weekly individual therapy, family therapy, group therapy, and psychiatric appointments
• Integration of therapeutic recommendations and safety plans into daily caregiving
• Preparation of the home environment to support trauma-informed, therapeutic routines (including secure medication storage and crisis response readiness)

Transportation:

• Provision and coordination of transportation to and from all scheduled therapy sessions, psychiatric appointments, STAR Health coordination meetings, and educational/IEP meetings
• Coordination with public transit, Medicaid transportation (MTP), or other approved transportation supports when appropriate
• Reliable transportation to emergency behavioral health and crisis services when needed

Service Coordination:

• Active coordination with STAR Health, HHSC Behavioral Health, school district personnel, community-based therapists, psychiatrists, and crisis response providers
• Participation in Service Plan reviews, CFT (Child and Family Team) meetings, treatment team meetings, and educational/IEP meetings
• Communication with the Case Manager and Treatment Director regarding therapy engagement, medication adherence, behavioral health status, and crisis events

Documentation and Record Keeping:

• Maintenance of daily logs capturing behavioral observations, mood/affect changes, medication administration, crisis events, and therapy-engagement progress
• Documentation of service delivery attendance, progress toward Service Plan goals, and therapy-related recommendations
• Maintenance of copies of psychiatric evaluations, therapy progress notes, safety plans, and medication lists in the child's health file
• Timely documentation sufficient to support CSR submission within 15 business days and SSCC/DFPS caseworker reporting

CPA staff provide training, supervision, and direct support to Foster Family Home Caregivers to build and sustain this Mental & Behavioral Health-specific support capacity (T3C Blueprint (April 2026); TAC §749.1335).

5.11 Normalcy Activities

Foster Family Home Caregivers serving children under the Mental & Behavioral Health Support Services Package must support Normalcy activities — including, but not limited to, clothing, hygiene products, hair care, birthdays, holidays, graduations, extracurricular, social, cultural, enrichment, and employment activities that are age-appropriate and consistent with the Service Plan. These activities are provided in accordance with the Reasonable and Prudent Parent Standard (Texas Family Code §264.125; Human Resources Code §42.042; TAC §749.2605) and are essential to mental health recovery and developmental wellbeing. CPA staff coach and support Foster Family Home Caregivers in applying this standard to children whose trauma histories and mental health needs may require individualized pacing or adaptation of Normalcy activities.

6. STAFFING REQUIREMENTS AND RATIOS

6.1 Administrative Leadership

6.2 Staff-to-Child Ratios

6.3 Hours of Operation

Admissions and placement staff on-call/available 365 days per year, 24 hours per day.

7. FOSTER FAMILY HOME REQUIREMENTS

7.1 Credentialing Requirements

Foster homes providing Mental & Behavioral Health Support Services must:

• Hold current foster home verification
• Complete Mental & Behavioral Health specific training (4 hours per FC-16 Section 4.3)
• Demonstrate competency in therapeutic environment maintenance
• Be credentialed for BOTH Mental & Behavioral Health AND Basic Foster Family Home packages

7.2 Training Requirements

📋 DERIVED FROM: FC-16 Staff and Caregiver Training Policy, Section 4.3

Foster Parent Training - Mental & Behavioral Health:

Training Component	Hours	Content	Timing
Initial Training	4 hours	Understanding mental health diagnoses in youth; Creating therapeutic home environment; Trauma-informed response to behaviors; Recognizing signs of mental health crisis; Crisis response and de-escalation; Medication management and safety; Working with treatment team; Supporting therapy engagement	Before first MH placement
Annual Refresher	2 hours	Updates and reinforcement; Case discussion	Annually

7.3 Foster Home Capacity

The T3C Blueprint (April 2026, pp.79-89) does not specify a Package-specific foster home capacity limit for the Mental & Behavioral Health Support Services Package. Standard TAC §749 base foster home capacity standards apply; refer to each foster home's verification for the approved capacity.

8. QUALITY ASSURANCE AND CONTINUED STAY GUIDELINES

8.1 Continued Stay Review Requirements

Continued Stay Reviews for Mental & Behavioral Health Support Services follow the 90-day cycle:

Dual Director Written Confirmation (CRITICAL — T3C Blueprint p.87):

Each 90-day review requires written confirmation from BOTH the Treatment Director AND the Program Director before submission to SSCC/DFPS. One signature alone is insufficient.

• Treatment Director Written Confirmation: Documents specific clinical indicators supporting continued stay, including current diagnoses, symptom severity, crisis incidents in the review period, medication management complexity, therapy engagement, and reason why a less restrictive placement is insufficient. The Treatment Director must also confirm the child is benefitting from the Treatment Model.

• Program Director Written Confirmation: Documents administrative indicators including placement stability, resource utilization, service availability, and permanency progress. Before signing, the Program Director must 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. If either credential has lapsed, the Program Director does not sign — remediation is initiated per §1.3 before the confirmation is completed.

Cross-Reference: FC-CSR-01.1 Continued Stay Review Procedure, Sections 4.3 and 4.4 (full procedure steps for each Director's confirmation)

8.2 Desired Individual Outcomes

Child Placing Agency must have clearly articulated child-level outcome expectations that tie directly to the Mental & Behavioral Health Support Services Treatment Model, supporting at a minimum:

• Child Safety
• Child's Permanency Goal
• Child's Well-Being

8.3 Outcome Tracking

CPA must have infrastructure in place to collect, track, and evaluate/analyze child outcomes (both during placement and as a part of Aftercare Services), including being able to analyze outcomes based on individual foster family homes.

9. AFTERCARE SERVICES

9.1 Aftercare Requirements

📋 DERIVED FROM: FC-AF-01 Aftercare Services Policy; FC-AF-01.1 Aftercare Services Procedure §2.2 and §3.1

Mandatory 6-Month Aftercare:

Aftercare services are mandatory for ALL children discharged from Mental & Behavioral Health Support Services. Services continue for a minimum of 6 months following discharge, regardless of discharge reason.

Contact Frequency (CRITICAL — T3C Blueprint p.88):

• Minimum twice-monthly contact with the youth throughout the 6-month aftercare period
• First month post-discharge: in-person contact preferred
• 24/7 crisis availability for aftercare youth is maintained throughout the 6-month period

Mental Health Aftercare Components:

• Mental health stability monitoring (therapy attendance, psychiatric stability, medication compliance)
• Continued therapy coordination and STAR Health authorization support
• Medication management support (monitoring, prescriber coordination if applicable)
• Crisis prevention support (updated safety plan, 24/7 crisis line access)
• Connection to community mental health resources

9.2 Family and Caregiver Engagement During Aftercare

📋 DERIVED FROM: FC-AF-01.1 §2.2; FC7-01 Family Connections and Engagement Policy

• Minimum twice-monthly contact with family/caregivers in the receiving placement throughout the 6-month aftercare period
• Aftercare Case Manager consults with caregivers on mental health-informed responses to youth behaviors and crisis triggers
• Verify implementation of therapeutic coping strategies in the home environment
• Identify caregiver support gaps and arrange targeted coaching or training
• Connect families to community mental health family support resources and peer family groups
• Document all family engagement contacts in the Family Engagement Log

9.3 Aftercare Staffing

9.4 Aftercare Completion and Extension

At the 5-month mark, the Aftercare Case Manager and Treatment Team conduct a completion assessment reviewing clinical stability, service engagement, natural support strength, and caregiver competency. The Program Director approves service completion, extension (with clinical justification), or transfer to adult services before the 6-month deadline. Cross-Reference: FC-AF-01.1 §6.1

10. FORMS AND ATTACHMENTS

All forms available at previewforms.refugehouse.org and in Radius.

11. REGULATORY REFERENCES

12. RELATED PROCEDURES AND POLICIES

13. DOCUMENT CONTROL AND COMPLIANCE STATEMENT

Document Control

Compliance Statement

This Comprehensive Enhanced Snapshot demonstrates Refuge House's compliance with T3C Blueprint (April 2026) for Mental & Behavioral Health Support Services. This document integrates content from the following Refuge House policies and procedures:

This Comprehensive Enhanced Snapshot is designed for external review purposes. For day-to-day operations, staff should reference the standalone policies and procedures, which may be updated more frequently than this snapshot document.