REFUGE HOUSE, INC.

Child Placing Agency

SUBSTANCE USE SUPPORT SERVICES

COMPREHENSIVE ENHANCED SNAPSHOT

Umbrella Policy and Procedures with Embedded Cross-References

Policy Information	Details
POLICY NAME	Substance Use Support Services Policy
POLICY NUMBER	FC-SU-01
DOCUMENT TYPE	Comprehensive Enhanced Snapshot
ORIGINATED	December 2025
REVISION DATE	May 2026
LAST UPDATED	5/15/2026
LAST APPROVED	5/22/2026
APPROVED BY	Board of Directors
APPROVED ON	5/22/2026
EFFECTIVE DATE	5/22/2026
SECTION	FC-SU
DATE(S) OF REVISION	January 2026 - Added Section 5.9 Service Documentation and Cost Coverage February 2026 - Full reconciliation with umbrella policy; Added Sections 3.3-3.7, expanded Sections 14-15, updated training tables May 2026 - Strengthened §3.5 Dual Credentialing maintenance language; added Anticipated LOS to §4.1 (6-12 months — agency-set range under T3C Blueprint April 2026 Substance Use Support Services discretion); expanded §5.9 Family Engagement; added §5.12 STAR Health Coordination, §5.13 Substance Use-specific Foster Family Home Support Services, §5.14 Normalcy Activities; corrected §5.10 subsection numbering; May 2026 (v1.4) — Round 2 enhancement closeout for §5.2 (therapy frequency determination), §6.4 (24/7 CM-level coverage), and §8.1 (QA credential verification)

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

ABOUT THIS DOCUMENT

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

Document Convention: Content derived from other Refuge House policies and procedures is presented in bordered sections with clear source attribution:

📋 DERIVED FROM: [Source Document]

[Content from source document appears here]

This convention allows reviewers to:

See complete operational content in one document
Understand which foundational policies govern each area
Verify alignment with Refuge House's comprehensive policy infrastructure

Related Documents:

FC-SU-01 (Quick Reference): Lean cross-reference version for internal quick lookup
FC-SU-01 (Standard): Working template with cross-references to standalone policies

Shared Infrastructure Note: This Service Package shares significant infrastructure with Mental & Behavioral Health Support Services (FC-MH-01). Substance-use-specific elements are noted explicitly throughout.

POLICY SECTIONS

Purpose and Service Package Description
Governing Principles
Admission Criteria and Guidelines
Length of Service Parameters
Service Package Expectations
Staffing Requirements and Ratios
Foster Family Home Requirements
Quality Assurance and Continued Stay Guidelines
Aftercare Services (Mandatory)

PROCEDURE SECTIONS

Relationship Between Policy and Procedure
Admission and Placement Procedures (with embedded FC1-01.1, FC2-01.1, FC6-01)
Substance Use Assessment Procedures (with embedded FC-STAR-01.1)
Service Planning Procedures (with embedded FC3-01.1)
Drug Screening Procedures
Relapse Response Procedures (with embedded FC-04.1 Section 4)
Therapeutic Services Procedures
90-Day Continued Stay Review Procedures (with embedded FC-CSR-01.1)
Discharge and Aftercare Procedures (with embedded FC14-01, FC-AF-01)

TRAINING REQUIREMENTS

Staff and Caregiver Training (with embedded FC-16 Section 4.4)

TREATMENT MODEL AND CQI

Treatment Model Application
Continuous Quality Improvement

REFERENCE SECTIONS

Definitions
Regulatory References
Related Policies and Procedures
Forms and Attachments

POLICY SECTIONS

1. PURPOSE AND SERVICE PACKAGE DESCRIPTION

1.1 Service Package Definition

Substance Use Support Services provides trauma-informed foster care for children, youth, and young adults with substance use disorders, integrating recovery-focused treatment with the supportive environment of a foster family home.

1.2 Recovery Philosophy

CRITICAL PRINCIPLE: Refuge House recognizes that:

Recovery is possible for all youth
Relapse is addressed as an opportunity for treatment adjustment rather than failure
Trauma-informed care addresses root causes of substance use
All substance-related events are clinical matters, NOT behavioral infractions

1.3 Target Population

Children, youth, and young adults who:

Have a diagnosed substance use disorder or significant substance use history
Require specialized support for recovery
Can be safely served in a family setting with appropriate services
May have co-occurring mental health needs

1.4 Service Package Objectives

Provide stable, substance-free foster home environment
Coordinate comprehensive substance use treatment
Support recovery through trauma-informed care
Integrate family engagement in recovery process
Prepare youth for successful transition and sustained recovery

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 Substance Use Support Services, TBRI principles are enhanced with recovery-oriented approach:

Connecting Principles: Building trust and connection that supports recovery, recognizing that healthy relationships are protective factors against substance use.

Empowering Principles: Addressing physical regulation needs complicated by substance use, including nutrition, sleep, and sensory processing affected by substance use or withdrawal.

Correcting Principles: Non-punitive response philosophy recognizing that relapse is part of recovery process.

2.2 Non-Punitive Response Philosophy

CRITICAL: All substance-related behaviors are addressed as clinical matters requiring treatment adjustment, NOT as behavioral infractions requiring punishment.

3. ADMISSION CRITERIA AND GUIDELINES

3.1 Eligibility Criteria

T3C Blueprint Reference: Substance Use Support Services p.61 (October 2025)

Children, youth, and young adults are appropriate for Substance Use Support Services when they meet the following criteria:

Primary Admission Requirement - Substance Use Disorder or Significant Substance Use Concerns:

Current or recent substance use that impacts functioning
May or may not have formal DSM-5 Substance-Related and Addictive Disorder diagnosis
Substance use interferes with daily activities, relationships, or permanency planning
Risk factors present that could lead to substance use disorder if unaddressed

Substance Use May Include:

Alcohol
Marijuana/cannabis
Prescription medications (misuse)
Illicit drugs (methamphetamine, cocaine, opioids, etc.)
Inhalants
Synthetic substances
Polysubstance use

CANS 3.0 Assessment Alignment:

Once CANS 3.0 is administered, placement type and Service Package should align with the child's needs and strengths as demonstrated through the assessment results.

CANS Indicators Supporting Substance Use Placement:

Substance Use domain scored 2 (actionable) or 3 (dangerous/disabling)
Multiple behavioral/emotional domains rated 2-3 that relate to substance use
Risk Behaviors domain showing substance-related concerns
Family/Caregiver domains showing substance use in home environment

Professional Judgment Consideration:

Admission may also be based on the knowledge and professional judgment of the child's Service Planning team, which includes:

The child, youth, or young adult (when age-appropriate)
Biological parents or family members
CPS or SSCC caseworker
Attorney ad-litem, guardian ad-litem, and/or CASA volunteer
STAR Health Service Coordinator
Relatives and subsequent caregivers
Other stakeholders as appropriate

3.2 Admission Screening

📋 DERIVED FROM: FC1-01.1 Admission Screening Procedure

Who How When Regulatory Reference

Intake Specialist 1. Receive referral information
2. Screen for substance use indicators
3. Gather substance use history
4. Forward to Treatment Director Within 2 hours of referral FC1-01.1

Treatment Director 1. Review substance use history and current status
2. Assess appropriateness for Substance Use package
3. Identify any higher level of care needs
4. Approve or redirect placement Within 4 hours of screening T3C Blueprint p.61 (October 2025)

Case Manager 1. Complete initial substance use screening tool
2. Document substances used, frequency, duration, last use
3. Identify immediate safety concerns Within 24 hours of placement FC2-01.1

Who	How	When	Regulatory Reference
Intake Specialist	1. Receive referral information 2. Screen for substance use indicators 3. Gather substance use history 4. Forward to Treatment Director	Within 2 hours of referral	FC1-01.1
Treatment Director	1. Review substance use history and current status 2. Assess appropriateness for Substance Use package 3. Identify any higher level of care needs 4. Approve or redirect placement	Within 4 hours of screening	T3C Blueprint p.61 (October 2025)
Case Manager	1. Complete initial substance use screening tool 2. Document substances used, frequency, duration, last use 3. Identify immediate safety concerns	Within 24 hours of placement	FC2-01.1

Documentation Requirements

At Admission, Case Manager documents:

Specific substance(s) used
Frequency and duration of use
Date of last use
Route of administration
History of overdose or medical complications
Previous substance use treatment
Current withdrawal risk
Motivation for treatment/recovery stage

3.3 Exclusion Criteria

Children are NOT appropriate for Substance Use Support Services when:

Higher Level of Care Needed:

Active withdrawal requiring medical detoxification
Severe substance use disorder requiring residential treatment
Co-occurring psychiatric condition requiring psychiatric hospitalization
Immediate safety risk to self or others due to substance-related impairment

Redirect to:

Medical facility for detoxification
Psychiatric hospital for stabilization
Residential substance use treatment facility
TFFC if meeting intensive treatment criteria

Lower Level Appropriate:

Substance experimentation without pattern of use
No current use and strong recovery supports already in place
Basic Foster Home with therapy adequate to address needs

3.4 Pre-Placement Visit Requirements

📋 DERIVED FROM: FC1-01.1 Admission Screening Procedure; TAC §749.1111

When applicable and appropriate, a pre-placement visit must be conducted and successful before admission to Substance Use Support Services.

Visit Components:

Youth meets foster family

Home environment reviewed for substance-free status

Foster parent understanding of recovery support needs confirmed

Youth expresses comfort with placement (if developmentally appropriate)

Any substance use triggers in home environment addressed

Documentation:

Pre-placement visit checklist completed

Youth feedback documented

Foster parent agreement to support recovery documented

Any concerns identified and resolved

3.5 Dual Credentialing Requirement

In addition to maintaining the Substance Use 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 Substance Use Support Services.

Credential Maintenance: CPA and Foster Family Home Caregivers providing Substance Use Support Services maintain BOTH:

T3C Basic Foster Family Home Support Services credential (foundational), AND
Substance Use Support Services package credential (specialized)

Loss or lapse of either credential suspends Substance Use Support Services delivery until remediation is completed and both credentials are reinstated; service delivery cannot continue under the service package credential alone.

Foster Family Home Requirements:

Foster home must hold credential for:

T3C Basic Foster Family Home Support Services (foundation)
AND have capacity to support substance use recovery

Caregiver Capabilities:

Understanding of adolescent substance use disorders
Commitment to substance-free home environment
Ability to support recovery without punitive approach
Willingness to participate in family therapy as needed
Capability to monitor without enabling

3.6 Capacity and Limitations

Maximum Capacity:

No specific capacity limitation beyond TAC §749 requirements
Foster home capacity determined by home's credential

Age Appropriateness:

Typically serves youth ages 12-21
Younger children may be served if substance exposure/use documented
Young adults in Extended Foster Care eligible if substance use needs present

3.7 Coordination with SSCC/DFPS

📋 DERIVED FROM: FC6-01 Admission Matching & Criteria Policy

Placement Approval Process:

Who Action Timeline

SSCC/DFPS Caseworker Determines Service Package need based on assessment and case planning Before placement

Treatment Director Reviews and confirms appropriateness Within 4 hours of referral

Case Manager Coordinates admission logistics Upon approval

Application for Placement Review:

If SSCC/DFPS refers placement that may not meet Substance Use criteria, Treatment Director reviews and may:

Accept placement if criteria met

Recommend alternative Service Package

Request additional clinical information

Decline if criteria not met and document rationale

Who	Action	Timeline
SSCC/DFPS Caseworker	Determines Service Package need based on assessment and case planning	Before placement
Treatment Director	Reviews and confirms appropriateness	Within 4 hours of referral
Case Manager	Coordinates admission logistics	Upon approval

4. LENGTH OF SERVICE PARAMETERS

4.1 Service Duration

Length of service is individualized based on:

Individual recovery progress
Treatment plan goals
CANS 3.0 assessment results
Continued Stay Guidelines as outlined in the T3C Blueprint
Clinical judgment of treatment team

Anticipated Length of Service: 6-12 months typical duration, customized based on individual recovery needs and Continued Stay Guidelines as outlined in the T3C Blueprint. Service length may extend based on the youth's recovery progress, treatment response, and Service Plan review outcomes, including ongoing clinical need for substance use-specific support and capacity-building toward sustained recovery.

4.2 Continued Stay Reviews

📋 DERIVED FROM: FC-CSR-01.1 Continued Stay Review Procedure

Continued Stay Reviews occur every 90 days to assess:

Continued need for specialized substance use services

Recovery progress and treatment engagement

Appropriateness of current placement level

Step-down readiness

4.3 Step-Down Criteria

Step-down to T3C Basic Foster Family Home may be appropriate when:

Sustained recovery progress demonstrated
Reduced need for specialized substance use monitoring
Youth demonstrates coping skills for recovery maintenance
Treatment team consensus on reduced support needs
CANS 3.0 scores support lower level of care

5. SERVICE PACKAGE EXPECTATIONS

5.1 Substance Use Assessment

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

Initial Screening:

Who How When Regulatory Reference

Case Manager 1. Complete substance use screening at admission
2. Document: substances used, frequency, duration, last use
3. Identify withdrawal risk
4. Identify immediate safety concerns Within 24 hours of admission T3C Blueprint

Comprehensive Assessment:

Who How When Regulatory Reference

Case Manager 1. Request authorization through STAR Health
2. Coordinate with qualified substance use assessor
3. Ensure assessment includes treatment level recommendation
4. Integrate results into Service Plan Within 30 days of admission T3C Blueprint; FC-STAR-01.1

Who	How	When	Regulatory Reference
Case Manager	1. Complete substance use screening at admission 2. Document: substances used, frequency, duration, last use 3. Identify withdrawal risk 4. Identify immediate safety concerns	Within 24 hours of admission	T3C Blueprint

Who	How	When	Regulatory Reference
Case Manager	1. Request authorization through STAR Health 2. Coordinate with qualified substance use assessor 3. Ensure assessment includes treatment level recommendation 4. Integrate results into Service Plan	Within 30 days of admission	T3C Blueprint; FC-STAR-01.1

5.2 Therapeutic Services Requirements

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

Frequency Determination: Therapy type, frequency, and duration are determined by the Service Planning team in consultation with the Licensed Therapist, based on:

The youth's CANS 3.0 Assessment results
Clinical recommendation from the Licensed Therapist
Treatment Director consultation as needed
Individualized Service Plan goals and recovery progress
Continued Stay Guidelines as outlined in the T3C Blueprint

Frequency may be adjusted at any 90-day Service Plan review based on documented clinical justification.

Services include:

Individual therapy (weekly minimum)
Substance use treatment per clinical recommendation
Group therapy as clinically indicated
Family therapy as clinically indicated
Medication-assisted treatment (MAT) coordination if applicable

Provider Qualifications: Treatment provided by providers qualified in adolescent substance use treatment, coordinated through STAR Health. Therapy and substance use treatment providers must be credentialed and contracted with STAR Health managed care organizations (cross-reference §5.12 STAR Health Coordination).

Therapy Types Documentation:

Service Plan must document each type of therapy being provided:

Each type of therapy being provided
Frequency and duration of each therapy type
Clinical rationale for each therapy selection
Provider qualifications for each therapy type
How therapy types address CANS-identified needs
Coordination plan among multiple therapists if applicable

At Each 90-Day Service Plan Review:

Service Plan review must document:

Effectiveness of current therapy types
Any changes to therapy types with justification
Reasons for adding or discontinuing therapy types
Progress specific to each therapy modality
Ongoing clinical rationale for therapy configuration

5.3 Drug Screening

Drug screening is conducted as clinically indicated based on treatment team judgment:

Used as a clinical tool to inform treatment (NOT punitive)
Results inform Service Plan adjustments
Documented and shared with treatment team
Response to positive screens follows non-punitive protocol (Section 14)

5.4 Youth-Informed Service Planning

📋 DERIVED FROM: FC3-01.1 Individual Service Planning Procedure

Service Plan Requirements:

Service Plans must be:

Informed by the child (if appropriate), youth, or young adult

Developed in collaboration with the Service Planning team

Include customized goals

Include planned service(s) and support(s) to achieve goals

Service Plan Review Progress Documentation:

Service Plan Reviews must include documentation showing progress made toward achieving each goal.

CANS 3.0 Assessment Requirements:

For children over age 3:

CANS 3.0 administered every 90 days

Results used to inform Service Plan

Adjustments to type, frequency, and duration of services based on CANS results

CANS 3.0 Integration with Service Planning:

CANS results directly inform:

Service Plan goal development

Therapy type and frequency recommendations

Continued Stay determinations

Step-down readiness assessments

5.5 Continued Stay Review Requirements

📋 DERIVED FROM: FC-CSR-01.1 Continued Stay Review Procedure

90-Day Continued Stay Review Process:

At each 90-day Service Plan review, Case Manager in consultation with Treatment Director must:

Evaluate Continued Need: Document whether child continues to meet admission criteria or has developed other service needs aligned with this package

Assess Recovery Progress: Review treatment engagement, recovery milestones, and substance use treatment effectiveness

Confirm Service Appropriateness: Verify services continue to support safety, well-being, and permanency goals

Consider Less Restrictive Options: Document whether step-down to Basic Foster Home is appropriate

CANS-Based Justification: Use most recent CANS 3.0 assessment to support continued placement

Written Confirmation:

Written confirmation of Continued Stay evaluation must be documented in case record and copy provided to SSCC/DFPS within 15 business days of review.

Step-Down Process:

When step-down is appropriate:

Treatment Director recommends step-down with clinical justification

Service Planning Team reviews and confirms appropriateness

Transition plan developed (typically to Mental & Behavioral Health package or Basic)

30-day transition period with continued substance use support oversight

Written notification to SSCC/DFPS of planned transition

Warm handoff to receiving Case Manager with comprehensive recovery summary

5.6 24/7 Crisis Availability

📋 DERIVED FROM: FC-04 Crisis Management Policy; FC-04.1 Crisis Management Procedure Section 4

Substance-Related Crisis Response:

Crisis Type Response Protocol Timeline

Overdose Immediate 911; Narcan administration if trained; recovery position; do not leave youth alone Immediate

Severe Withdrawal Immediate 911; monitor for seizures; treat as medical emergency Immediate

Active Intoxication Safety monitoring; medical assessment as indicated; non-punitive response Immediate assessment

Relapse (Non-Emergency) Non-punitive clinical response; treatment adjustment; notify Treatment Director Within 2 hours

Key Principle: All substance-related crises are addressed as clinical events requiring treatment adjustment, NOT behavioral infractions warranting punitive response.

Crisis Type	Response Protocol	Timeline
Overdose	Immediate 911; Narcan administration if trained; recovery position; do not leave youth alone	Immediate
Severe Withdrawal	Immediate 911; monitor for seizures; treat as medical emergency	Immediate
Active Intoxication	Safety monitoring; medical assessment as indicated; non-punitive response	Immediate assessment
Relapse (Non-Emergency)	Non-punitive clinical response; treatment adjustment; notify Treatment Director	Within 2 hours

5.7 Human Trafficking Prevention

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

Youth with substance use disorders may have elevated trafficking risk. Enhanced screening and prevention measures include:

Universal HT screening at admission

Ongoing monitoring for trafficking indicators

Staff training on substance use/trafficking connections

Immediate response protocol if trafficking suspected

5.8 Foster Home Environment

Foster home must maintain substance-free environment with:

Medications and potentially abusable substances secured
Alcohol not accessible to youth
No tobacco/nicotine products accessible to youth
Environment supportive of recovery

5.9 Family Engagement

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

Family engagement for Substance Use Support Services is integrated into care coordination and Service Planning throughout the duration of placement and as part of Aftercare:

Family education on supporting recovery and the non-punitive response philosophy

Family involvement in Service Planning, treatment-team meetings, and 90-day Service Plan reviews

Family therapy as clinically indicated

Support for family members affected by the youth's substance use

Family outreach and engagement activities documented in the Service Plan

Continued family engagement during the mandatory 6-month Aftercare period (per FC-AF-01 Aftercare Services Policy), with family engagement efforts documented in Aftercare records

5.10 Service Documentation and Cost Coverage

T3C Blueprint Reference: Page 63 (October 2025)

5.10.1 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, the education system, and any other county, community, or state agency.

5.10.2 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)

5.10.3 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.

5.10.4 Community Resource Pursuit

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

5.10.5 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)

5.11 Educational Coordination

📋 DERIVED FROM: FC-T3C-01 T3C Basic Foster Family Home Support Services Policy

Educational coordination includes:

Expedited school enrollment

Educational testing coordination as needed

IEP/504 plan support and advocacy

Educational accommodations monitoring

School liaison communication

5.12 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 youth'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 Substance Use Disorder services for youth with substance use disorders, including coordination of:

Substance use therapy services authorized through STAR Health

Medication-assisted treatment (MAT) coordination as clinically indicated

Specialty assessments (substance use evaluation, psychiatric evaluation)

Crisis response and stabilization services

Provider Credentialing through STAR Health: Therapy and substance use treatment providers serving youth under this Service Package must be credentialed and contracted with STAR Health managed care organizations. The Treatment Director verifies provider credentialing status during provider selection and ongoing service authorization.

5.13 Foster Family Home Support Services (Substance Use-Specific)

Foster Family Home Caregivers serving youth under the Substance Use 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 recovery-coordination, crisis-response, and treatment-engagement demands of this package.

Logistical Support:

Coordination of daily routines to accommodate weekly individual therapy, substance use treatment sessions, group therapy, family therapy, MAT appointments, and recovery support meetings
Integration of recovery-supportive routines, sober environment maintenance, and non-punitive response practices into daily caregiving
Preparation of the home environment to support recovery (secure storage of medications including MAT, removal of access to alcohol/tobacco/nicotine, crisis-response readiness for overdose/withdrawal events)

Transportation:

Provision and coordination of transportation to and from all scheduled therapy sessions, substance use treatment, MAT clinic visits, recovery support meetings, drug screening appointments, psychiatric appointments, and STAR Health coordination meetings
Coordination with public transit, Medicaid transportation (MTP), or other approved transportation supports when appropriate
Reliable transportation to emergency medical and crisis services for overdose, severe withdrawal, or active intoxication events

Service Coordination:

Active coordination with STAR Health, HHSC Substance Use Disorder services, school district personnel, community-based substance use treatment providers, MAT prescribers, and crisis response providers
Participation in Service Plan reviews, CFT (Child and Family Team) meetings, treatment team meetings, and 90-day Continued Stay Reviews
Communication with the Case Manager and Treatment Director regarding treatment engagement, MAT adherence, recovery progress, relapse events, and crisis response

Documentation and Record Keeping:

Maintenance of daily logs capturing behavioral observations, recovery-engagement progress, medication administration (including MAT), drug screening results, crisis events, and relapse incidents
Documentation of service delivery attendance, progress toward Service Plan recovery goals, and treatment-team recommendations
Maintenance of copies of substance use evaluations, therapy progress notes, MAT prescriptions, crisis response documentation, and drug screening results in the youth'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 Substance Use-specific support capacity (T3C Blueprint (April 2026); TAC §749.1335).

5.14 Normalcy Activities

Foster Family Home Caregivers serving youth under the Substance Use 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 recovery and developmental wellbeing. CPA staff coach and support Foster Family Home Caregivers in applying this standard to youth whose substance use disorders, recovery needs, and trauma histories may require individualized pacing or adaptation of Normalcy activities (e.g., careful selection of social settings to avoid recovery-disruptive environments).

6. STAFFING REQUIREMENTS AND RATIOS

6.1 Administrative Leadership

Position	Requirements
LCPAA	Full-time, dedicated to single CPA
Program Director	May serve as LCPAA; bachelor's degree OR 5 years residential childcare experience
Treatment Director	Must meet T3C Blueprint qualifications; responsible for clinical oversight of substance use services

6.2 Staff-to-Child Ratios

Position	Ratio	Notes
Case Manager	1:15	Per Mental Health pattern
Licensed Therapist	1:14	Per Mental Health pattern
Behavior Support Specialist/Mentor	1:15	Per Mental Health pattern
Crisis Management Staff	1:25	Standard T3C ratio
Aftercare Case Manager	1:25	Standard T3C ratio

6.3 Required Infrastructure Functions

📋 DERIVED FROM: FC-T3C-01 T3C Basic Foster Family Home Support Services Policy, Section 6

Infrastructure functions required for this package include:

Case Management

Intake/Placement

Staff Training and Workforce Development

Staff Recruitment and Retention

Crisis Management Staff

Foster Family Home Caregiver Recruitment and Retention

Licensed Therapist coordination

Education Liaison

Continuous Quality Assurance and Improvement Program

Billing, cost reporting, and claims administration

Cross-system coordination (STAR Health, substance use providers)

6.4 Hours of Operation

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

24/7 Case Manager-Level Coverage: Case Manager-level staff (or above) is available 24 hours per day, 7 days per week, 365 days per year, to respond to placement, clinical-coordination, and crisis-related needs for youth served under the Substance Use Support Services Package. After-hours coverage is provided through the on-call rotation, which routes to the on-call Case Manager (or designee at supervisor level or above), with escalation paths to the Treatment Director and Crisis Management Staff as required by the situation.

Refer to §5.6 24/7 Crisis Availability for substance-related crisis response protocols and FC-04.1 Crisis Management Procedure Section 4 for full crisis-response operational detail.

7. FOSTER FAMILY HOME REQUIREMENTS

7.1 Credentialing Requirements

📋 DERIVED FROM: FC-CRED-01.1 Foster Family Home Credentialing Procedure

Foster homes providing Substance Use Support Services must:

Hold current foster home verification

Complete Substance Use specific training (4 hours per FC-16 Section 4.4)

Demonstrate competency in recovery-supportive environment

Maintain substance-free home environment

7.2 Training Requirements

📋 DERIVED FROM: FC-16 Staff and Caregiver Training Policy, Section 4.4

Foster Parent Training - Substance Use:

Training Component Hours Content Timing

Initial Training 4 hours - Understanding substance use disorders
- Creating recovery-supportive home environment
- Non-punitive response to relapse
- Recognizing signs of use/intoxication/withdrawal
- Emergency response (overdose)
- Securing medications and substances
- Supporting MAT if applicable
- Working with treatment team Before first SU placement

Annual Refresher 2 hours - Updates and reinforcement
- Case discussion Annually

Training Component	Hours	Content	Timing
Initial Training	4 hours	- Understanding substance use disorders - Creating recovery-supportive home environment - Non-punitive response to relapse - Recognizing signs of use/intoxication/withdrawal - Emergency response (overdose) - Securing medications and substances - Supporting MAT if applicable - Working with treatment team	Before first SU placement
Annual Refresher	2 hours	- Updates and reinforcement - Case discussion	Annually

7.3 Foster Home Capacity

Maximum 4 children in foster care per home, unless necessary for sibling group placement.

7.4 Foster Home Environment

Foster home must:

Maintain substance-free environment
Secure all medications (prescription and over-the-counter)
Secure potentially abusable household substances
Restrict alcohol access
Restrict tobacco/nicotine product access for youth

8. QUALITY ASSURANCE AND CONTINUED STAY GUIDELINES

8.1 Continued Stay Review Requirements

📋 DERIVED FROM: FC-CSR-01.1 Continued Stay Review Procedure

Continued Stay Reviews for Substance Use Support Services follow the 90-day cycle (aligned with Mental & Behavioral Health):

Requirement Substance Use Package

Review Frequency Every 90 days

CANS 3.0 Update Required at each review

Recovery Progress Assessment Required component

Treatment Adjustment Review Required component

Credential Status Verification Required at each review (CPA + Foster Family Home)

SSCC/DFPS Submission Within 15 business days

Requirement	Substance Use Package
Review Frequency	Every 90 days
CANS 3.0 Update	Required at each review
Recovery Progress Assessment	Required component
Treatment Adjustment Review	Required component
Credential Status Verification	Required at each review (CPA + Foster Family Home)
SSCC/DFPS Submission	Within 15 business days

Credential Maintenance Verification: As part of the 90-day Continued Stay Review and the broader Quality Assurance process, the CPA verifies and documents that BOTH the Substance Use Support Services Package credential AND the T3C Basic Foster Family Home Support Services credential remain current and in good standing for:

The Child Placing Agency
The placing Foster Family Home

Credential lapses are flagged immediately and trigger the remediation process specified in §3.5 Dual Credentialing Requirement. Service delivery cannot continue if either credential is not in good standing; the QA process ensures this is detected at the earliest opportunity rather than at the next CSR cycle. Credential verification is documented in the CSR record and provided to SSCC/DFPS within 15 business days as part of the standard CSR submission.

8.2 Quality Metrics

Key quality indicators for Substance Use Support Services:

Metric	Target
Weekly therapy attendance	95%
Service Plan completion within 30 days	100%
90-day reviews completed on time	100%
Non-punitive relapse response documentation	100%
Recovery progress toward goals	Individualized

9. AFTERCARE SERVICES

9.1 Aftercare Requirements

📋 DERIVED FROM: FC-AF-01 Aftercare Services Policy

Mandatory 6-Month Aftercare:

Aftercare services are mandatory for all children discharged from Substance Use Support Services. Services continue for minimum 6 months following discharge.

Substance Use Aftercare Components:

Recovery stability monitoring

Continued substance use treatment coordination

MAT continuation support if applicable

Relapse prevention support

Connection to community recovery resources

Education on non-punitive relapse response for receiving caregivers

9.2 Aftercare Staffing

Position	Ratio	Responsibilities
Aftercare Case Manager	1:25	Recovery monitoring; treatment coordination; family support

PROCEDURE SECTIONS

10. RELATIONSHIP BETWEEN POLICY AND PROCEDURE

This Comprehensive Enhanced Snapshot integrates policy (governing principles) and procedure (operational implementation) to provide a complete picture for external reviewers.

Internal Operations: Staff should reference standalone policies and procedures for day-to-day operations, as these documents may be updated more frequently than this snapshot.

11. ADMISSION AND PLACEMENT PROCEDURES

11.1 Referral Receipt

📋 DERIVED FROM: FC1-01.1 Admission Screening Procedure

Who How When Regulatory Reference

Intake Specialist 1. Receive referral from SSCC/DFPS
2. Log referral in case management system
3. Review available documentation
4. Identify substance use history
5. Forward to Treatment Director for clinical review Within 2 hours of referral TAC §749.1251

Who	How	When	Regulatory Reference
Intake Specialist	1. Receive referral from SSCC/DFPS 2. Log referral in case management system 3. Review available documentation 4. Identify substance use history 5. Forward to Treatment Director for clinical review	Within 2 hours of referral	TAC §749.1251

11.2 Clinical Screening

Who	How	When	Regulatory Reference
Treatment Director	1. Review substance use documentation 2. Assess treatment needs and level of care 3. Determine if foster care appropriate setting 4. Identify any co-occurring needs 5. Approve for placement or recommend alternative	Within 4 hours of referral	T3C Blueprint

11.3 Placement Matching

📋 DERIVED FROM: FC6-01 Admission Matching & Criteria Policy

Who How When Regulatory Reference

Intake Specialist 1. Identify homes with Substance Use credential
2. Verify foster parent completed 4-hour SU training
3. Confirm substance-free environment
4. Match based on youth needs and home capabilities
5. Conduct pre-placement visit when appropriate Within 4 hours of approval T3C Blueprint; FC6-01

Who	How	When	Regulatory Reference
Intake Specialist	1. Identify homes with Substance Use credential 2. Verify foster parent completed 4-hour SU training 3. Confirm substance-free environment 4. Match based on youth needs and home capabilities 5. Conduct pre-placement visit when appropriate	Within 4 hours of approval	T3C Blueprint; FC6-01

11.4 Admission Documentation

📋 DERIVED FROM: FC2-01.1 Admission Assessment Procedure

Who How When Regulatory Reference

Case Manager 1. Complete admission assessment per FC2-01.1
2. Complete substance use screening (substances, frequency, last use)
3. Identify immediate safety concerns and withdrawal risk
4. Initiate STAR Health authorization for comprehensive assessment
5. Orient youth to recovery-supportive environment Within 24 hours of placement TAC §749.1301; FC2-01.1

Who	How	When	Regulatory Reference
Case Manager	1. Complete admission assessment per FC2-01.1 2. Complete substance use screening (substances, frequency, last use) 3. Identify immediate safety concerns and withdrawal risk 4. Initiate STAR Health authorization for comprehensive assessment 5. Orient youth to recovery-supportive environment	Within 24 hours of placement	TAC §749.1301; FC2-01.1

12. SUBSTANCE USE ASSESSMENT PROCEDURES

12.1 Initial Substance Use Screening

Who	How	When	Regulatory Reference
Case Manager	1. Complete substance use screening tool 2. Document: substances used, frequency, duration, last use 3. Identify withdrawal risk factors 4. Assess for immediate medical needs 5. Document in case record	Within 24 hours of admission	T3C Blueprint

12.2 Comprehensive Substance Use Assessment

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

Who How When Regulatory Reference

Case Manager 1. Request authorization through STAR Health
2. Identify qualified substance use assessor
3. Coordinate assessment appointment
4. Ensure assessment includes treatment level recommendation
5. Obtain assessment results
6. Integrate findings into Service Plan Within 30 days of admission T3C Blueprint; FC-STAR-01.1

Who	How	When	Regulatory Reference
Case Manager	1. Request authorization through STAR Health 2. Identify qualified substance use assessor 3. Coordinate assessment appointment 4. Ensure assessment includes treatment level recommendation 5. Obtain assessment results 6. Integrate findings into Service Plan	Within 30 days of admission	T3C Blueprint; FC-STAR-01.1

12.3 Assessment Components

Comprehensive assessment should address:

Substance use history and patterns
Previous treatment attempts
Co-occurring mental health conditions
Trauma history
Family substance use history
Protective factors and strengths
Recommended level of care
Treatment recommendations

13. SERVICE PLANNING PROCEDURES

📋 DERIVED FROM: FC3-01.1 Individual Service Planning Procedure

Who How When Regulatory Reference

Case Manager 1. Complete CANS 3.0 assessment
2. Gather input from treatment team
3. Include recovery-specific goals
4. Integrate substance use treatment recommendations
5. Document weekly therapy requirement
6. Include relapse prevention strategies
7. Submit to SSCC/DFPS Within 30 days of placement TAC §749.1301; T3C Blueprint

Who	How	When	Regulatory Reference
Case Manager	1. Complete CANS 3.0 assessment 2. Gather input from treatment team 3. Include recovery-specific goals 4. Integrate substance use treatment recommendations 5. Document weekly therapy requirement 6. Include relapse prevention strategies 7. Submit to SSCC/DFPS	Within 30 days of placement	TAC §749.1301; T3C Blueprint

14. DRUG SCREENING PROCEDURES

14.1 Clinical Purpose

📋 DERIVED FROM: FC-SU-01 Umbrella Policy Section 14

Drug screening is conducted as clinically indicated and serves as a clinical tool, NOT a punitive measure.

Purpose of Screening:

Monitor treatment effectiveness

Inform clinical decision-making

Identify need for treatment adjustments

Support youth in recovery accountability

CRITICAL: Results are NEVER used for:

Punishment or consequences

Placement disruption decisions (unless safety-related)

Negative documentation without clinical context

14.2 Screening Protocol

Who	How	When	Regulatory Reference
Case Manager / Foster Parent	1. Conduct screening per treatment team guidance 2. Document results 3. Report to treatment team 4. Implement clinical response	As clinically indicated	T3C Blueprint; FC-SU-01
Treatment Director	1. Review screening results 2. Determine treatment adjustments 3. Guide clinical response 4. Document in case record	Upon receipt of results	T3C Blueprint

14.3 Response to Positive Screens

Non-Punitive Clinical Response Protocol:

Immediate Safety Assessment: Ensure youth is safe and not in medical distress
Clinical Notification: Notify Treatment Director within 2 hours
Treatment Team Consultation: Convene treatment team to assess
Treatment Adjustment: Modify Service Plan as clinically indicated
Supportive Response: Engage youth in recovery-supportive conversation
Documentation: Record as clinical event with treatment response

PROHIBITED RESPONSES:

Grounding or loss of privileges as punishment for positive screen
Threats regarding placement
Shame-based interventions
Reporting to DFPS as behavioral incident (unless safety concern)

15. RELAPSE RESPONSE PROCEDURES

📋 DERIVED FROM: FC-04.1 Crisis Management Procedure Section 4

15.1 Relapse Philosophy

CRITICAL PRINCIPLE: Relapse is addressed as an opportunity for treatment adjustment, NOT as failure or behavioral infraction.

15.2 Non-Emergency Relapse Response

Who How When Regulatory Reference

Foster Parent 1. Ensure youth safety
2. Provide supportive, non-judgmental response
3. Notify Case Manager
4. Document observations Immediately upon awareness FC-04.1 Section 4.4

Case Manager 1. Assess situation
2. Notify Treatment Director
3. Convene treatment team
4. Adjust Service Plan as needed Within 2 hours FC-04.1 Section 4.4

Treatment Director 1. Review clinical situation
2. Recommend treatment adjustments
3. Determine if higher level of care needed
4. Guide clinical response Within 4 hours T3C Blueprint

15.3 Emergency Relapse Situations

For overdose, severe intoxication, or withdrawal emergencies, follow FC-04.1 Section 4.2 (Substance-Related Medical Emergencies):

Crisis Type Immediate Response

Overdose Call 911; Administer Narcan if trained; Recovery position; Do not leave youth alone

Severe Withdrawal Call 911; Monitor for seizures; Treat as medical emergency

Severe Intoxication Safety monitoring; Medical assessment; Recovery position if unconscious

Who	How	When	Regulatory Reference
Foster Parent	1. Ensure youth safety 2. Provide supportive, non-judgmental response 3. Notify Case Manager 4. Document observations	Immediately upon awareness	FC-04.1 Section 4.4
Case Manager	1. Assess situation 2. Notify Treatment Director 3. Convene treatment team 4. Adjust Service Plan as needed	Within 2 hours	FC-04.1 Section 4.4
Treatment Director	1. Review clinical situation 2. Recommend treatment adjustments 3. Determine if higher level of care needed 4. Guide clinical response	Within 4 hours	T3C Blueprint

Crisis Type	Immediate Response
Overdose	Call 911; Administer Narcan if trained; Recovery position; Do not leave youth alone
Severe Withdrawal	Call 911; Monitor for seizures; Treat as medical emergency
Severe Intoxication	Safety monitoring; Medical assessment; Recovery position if unconscious

16. THERAPEUTIC SERVICES PROCEDURES

Who	How	When	Regulatory Reference
Case Manager	1. Coordinate weekly therapy appointments 2. Ensure provider qualified in adolescent substance use 3. Track therapy attendance 4. Integrate therapy recommendations into Service Plan 5. Coordinate additional services as needed	Ongoing; weekly minimum	T3C Blueprint; FC-STAR-01.1

17. 90-DAY CONTINUED STAY REVIEW PROCEDURES

📋 DERIVED FROM: FC-CSR-01.1 Continued Stay Review Procedure

Who How When Regulatory Reference

Case Manager 1. Update CANS 3.0 assessment
2. Document recovery progress
3. Review treatment effectiveness
4. Assess step-down readiness
5. Complete Enhanced Continued Stay Confirmation Form
6. Submit to SSCC/DFPS Every 90 days TAC §749.1335; T3C Blueprint

Who	How	When	Regulatory Reference
Case Manager	1. Update CANS 3.0 assessment 2. Document recovery progress 3. Review treatment effectiveness 4. Assess step-down readiness 5. Complete Enhanced Continued Stay Confirmation Form 6. Submit to SSCC/DFPS	Every 90 days	TAC §749.1335; T3C Blueprint

18. DISCHARGE AND AFTERCARE PROCEDURES

18.1 Discharge Planning

📋 DERIVED FROM: FC14-01 Discharge and Permanency Planning Policy

Who How When Regulatory Reference

Case Manager 1. Assess recovery stability
2. Verify receiving placement maintains recovery-supportive environment
3. Coordinate continued substance use treatment
4. Prepare transition summary
5. Transfer to Aftercare Case Manager Before discharge TAC §749.1361; FC14-01

Who	How	When	Regulatory Reference
Case Manager	1. Assess recovery stability 2. Verify receiving placement maintains recovery-supportive environment 3. Coordinate continued substance use treatment 4. Prepare transition summary 5. Transfer to Aftercare Case Manager	Before discharge	TAC §749.1361; FC14-01

18.2 Aftercare Services

📋 DERIVED FROM: FC-AF-01 Aftercare Services Policy

Who How When Regulatory Reference

Aftercare Case Manager 1. Monitor recovery stability
2. Verify receiving placement maintains recovery-supportive environment
3. Coordinate continued substance use treatment
4. Provide education on non-punitive relapse response to receiving caregivers
5. Support MAT continuation if applicable
6. Document monthly contacts Minimum 6 months post-discharge T3C Blueprint; FC-AF-01

Monthly Reporting:

Who How When Regulatory Reference

Aftercare Case Manager 1. Complete Monthly Aftercare Report
2. Document recovery stability indicators
3. Submit to SSCC/DFPS Monthly during aftercare period T3C Blueprint

Who	How	When	Regulatory Reference
Aftercare Case Manager	1. Monitor recovery stability 2. Verify receiving placement maintains recovery-supportive environment 3. Coordinate continued substance use treatment 4. Provide education on non-punitive relapse response to receiving caregivers 5. Support MAT continuation if applicable 6. Document monthly contacts	Minimum 6 months post-discharge	T3C Blueprint; FC-AF-01

Who	How	When	Regulatory Reference
Aftercare Case Manager	1. Complete Monthly Aftercare Report 2. Document recovery stability indicators 3. Submit to SSCC/DFPS	Monthly during aftercare period	T3C Blueprint

TRAINING REQUIREMENTS

19. STAFF AND CAREGIVER TRAINING

19.1 Staff Training Requirements

📋 DERIVED FROM: FC-16 Staff and Caregiver Training Policy, Section 4.4

Substance Use Support Services Training - Staff:

Training Component Duration Content Completion

Initial SU Training 4 hours - Understanding substance use disorders in youth
- Non-punitive, recovery-supportive approach
- Drug screening as clinical tool
- Relapse response protocols
- Overdose recognition and Narcan administration
- STAR Health substance use treatment coordination
- MAT support basics
- Trauma-substance use connections Before first SU assignment

Annual Refresher 2 hours - Updates on best practices
- Case review and discussion
- Reinforcement of non-punitive approach Annually

Staff Who Must Complete Training:

Case Managers assigned SU children

Crisis Management Staff serving SU population

Intake/Placement Coordinators handling SU referrals

Aftercare Case Managers serving SU discharges

Treatment Director (may have equivalent qualification)

Behavior Support Specialists serving SU children

Training Component	Duration	Content	Completion
Initial SU Training	4 hours	- Understanding substance use disorders in youth - Non-punitive, recovery-supportive approach - Drug screening as clinical tool - Relapse response protocols - Overdose recognition and Narcan administration - STAR Health substance use treatment coordination - MAT support basics - Trauma-substance use connections	Before first SU assignment
Annual Refresher	2 hours	- Updates on best practices - Case review and discussion - Reinforcement of non-punitive approach	Annually

19.2 Foster Parent Training Requirements

📋 DERIVED FROM: FC-16 Staff and Caregiver Training Policy, Section 4.4

Substance Use Support Services Training - Foster Parents:

Training Component Hours Content Timing

Initial Training 4 hours - Understanding substance use disorders
- Creating recovery-supportive home environment
- Non-punitive response to relapse
- Recognizing signs of use/intoxication/withdrawal
- Emergency response (overdose)
- Securing medications and substances
- Supporting MAT if applicable
- Working with treatment team Before first SU placement

Annual Refresher 2 hours - Updates and reinforcement
- Case discussion Annually

Training Component	Hours	Content	Timing
Initial Training	4 hours	- Understanding substance use disorders - Creating recovery-supportive home environment - Non-punitive response to relapse - Recognizing signs of use/intoxication/withdrawal - Emergency response (overdose) - Securing medications and substances - Supporting MAT if applicable - Working with treatment team	Before first SU placement
Annual Refresher	2 hours	- Updates and reinforcement - Case discussion	Annually

19.3 Training Tracking

Who	How	When	Regulatory Reference
Training Coordinator	1. Track all SU training completion 2. Maintain training records 3. Monitor annual refresher due dates 4. Ensure training completed before SU assignments	Ongoing	FC-16; T3C Blueprint

TREATMENT MODEL AND CQI

20. TREATMENT MODEL APPLICATION

20.1 Evidence-Informed Treatment Model

📋 DERIVED FROM: TBRI Treatment Model Executive Summary

Refuge House's Evidence-informed Treatment Model applies TBRI® principles to Substance Use Support Services:

Connecting Principles:

Build trusting relationships that support recovery

Recognize substance use often stems from attachment disruption and trauma

Use relationship as foundation for recovery support

Empowering Principles:

Address physical needs that may trigger substance use

Ensure proper nutrition, sleep, and sensory regulation

Create predictable, safe environment supporting recovery

Correcting Principles:

Respond to substance-related behaviors with understanding

Use TBRI® de-escalation during substance-related crises

Frame relapse as opportunity for treatment adjustment

Avoid punitive responses that damage trust

20.2 Recovery-Focused Integration

The treatment model integrates recovery principles:

Recovery is possible for all youth
Multiple pathways to recovery
Recovery is non-linear
Peer support enhances recovery
Family involvement supports recovery
Addressing trauma supports recovery

21. CONTINUOUS QUALITY IMPROVEMENT

21.1 CQI Integration

📋 DERIVED FROM: FC-17 Continuous Quality Improvement Policy; CQI Plan

Substance Use Support Services quality improvement includes:

Metric Target Frequency

Weekly therapy completion 95% Monthly review

Service Plans completed within 30 days 100% Monthly review

90-day reviews completed on time 100% Monthly review

Non-punitive relapse documentation 100% Quarterly audit

Foster parent training completion 100% Prior to placement

Aftercare contact completion 95% Monthly review

Recovery progress toward goals Individualized 90-day reviews

Metric	Target	Frequency
Weekly therapy completion	95%	Monthly review
Service Plans completed within 30 days	100%	Monthly review
90-day reviews completed on time	100%	Monthly review
Non-punitive relapse documentation	100%	Quarterly audit
Foster parent training completion	100%	Prior to placement
Aftercare contact completion	95%	Monthly review
Recovery progress toward goals	Individualized	90-day reviews

21.2 Quality Review Process

Who	How	When	Regulatory Reference
CQI Coordinator	1. Collect SU-specific metrics 2. Analyze trends 3. Identify improvement opportunities 4. Report to leadership	Monthly	FC-17; T3C Blueprint
Program Director	1. Review CQI findings 2. Implement improvements 3. Monitor effectiveness	Quarterly	FC-17

REFERENCE SECTIONS

22. DEFINITIONS

Drug Screening: Testing to detect presence of substances; used as clinical tool to inform treatment, not as punishment.

Medication-Assisted Treatment (MAT): FDA-approved medications combined with counseling for treatment of substance use disorders.

Recovery: Process through which individuals improve health and wellness, live self-directed lives, and strive to reach full potential.

Relapse: Return to substance use; treated as treatment issue requiring adjustment, not as failure.

23. REGULATORY REFERENCES

T3C Blueprint Standards: Pages 59-67, Substance Use Support Services (April 2026)
TAC Chapter 749: Minimum Standards for Child Placing Agencies
TAC §749.1251: Screening requirements
TAC §749.1301: Service Plan requirements
TAC §749.1111: Pre-placement visits
TAC §749.1361: Discharge Planning
DFPS 24-Hour RCC Requirements (FY26)
STAR Health Guidelines: Substance use treatment authorization

24. RELATED POLICIES AND PROCEDURES

Core T3C Framework:

FC-T3C-01 T3C Basic Foster Family Home Support Services Policy
FC-T3C-01 T3C Basic Foster Family Home Support Services (Comprehensive Snapshot — canonical)

Clinical Framework:

FC-MH-01 Mental & Behavioral Health Support Services Policy (substantial infrastructure overlap)

Admission and Assessment:

FC1-01.1 Admission Screening Procedure
FC2-01.1 Admission Assessment Procedure
FC6-01 Admission Matching & Criteria Policy

Service Planning:

FC3-01.1 Individual Service Planning Procedure

Continued Stay Reviews:

FC-CSR-01.1 Continued Stay Review Procedure

Health and STAR Health:

FC10-01 Physical and Mental Health Care Policy
FC-STAR-01.1 STAR Health Coordination Procedure

Discharge and Aftercare:

FC14-01 Discharge and Permanency Planning Policy
FC-AF-01 Aftercare Services Policy

Credentialing and Training:

FC-CRED-01.1 Foster Family Home Credentialing Procedure
FC-16 Caregiver Training Policy (Section 4.4: Substance Use Training)

Quality and Compliance:

FC-17 Continuous Quality Improvement Policy
CQI Plan

Crisis Management:

FC-04 Crisis Management Policy
FC-04.1 Crisis Management Procedure (Section 4: Substance Use)

Other:

FC-HT-01 Human Trafficking Prevention Policy
TBRI Treatment Model Executive Summary

25. FORMS AND ATTACHMENTS

Core Forms:

Substance Use Admission Screening Tool
Comprehensive Substance Use Assessment Authorization Request
Service Plan - Substance Use Supplement
Enhanced Continued Stay Confirmation Form - Substance Use Version
Recovery Progress Tracking Log
Aftercare Services Plan Template
Monthly Aftercare Report Template

Drug Screening Forms:

Drug Screening Protocol Form
Drug Screening Results Documentation

Crisis/Relapse Forms:

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

Training Documentation:

Substance Use Training Completion Record (4-hour)
Foster Parent SU Training Verification
Annual Refresher Tracking Log

DOCUMENT CONTROL

Version	Date	Author	Changes
1.0	December 2025	Refuge House Leadership	Initial comprehensive enhanced snapshot
1.1	January 2026	Refuge House Leadership	Added Section 5.9 Service Documentation and Cost Coverage per T3C Blueprint p.63 requirements
1.2	February 2026	Refuge House Leadership	Full reconciliation with umbrella policy; Added Sections 3.3-3.7 (Exclusion Criteria, Pre-Placement Visit, Dual Credentialing, Capacity, SSCC/DFPS Coordination); Expanded Sections 14-15 (Drug Screening and Relapse Response); Updated training tables; Added Section 5.11 Educational Coordination; Updated regulatory references to October 2025 Blueprint pages 58-66
1.3	May 2026	Refuge House Leadership	Strengthened §3.5 Dual Credentialing language to include credential-maintenance and lapse-suspends-service-delivery clause; added Anticipated Length of Service to §4.1 (6-12 months — agency-set range; the T3C Blueprint April 2026 Substance Use Support Services section requires the CPA's policy to include an anticipated Length of Service but leaves the specific range to CPA discretion, customized in accordance with the operation's Continued Stay Guidelines); expanded §5.9 Family Engagement to include throughout-placement and aftercare framing; added §5.12 STAR Health Coordination; added §5.13 Substance Use-specific Foster Family Home Support Services; added §5.14 Normalcy Activities; corrected §5.10 subsection numbering
1.4	May 2026	Refuge House Leadership	Round 2 enhancement closeout: §5.2 clarified that therapy type/frequency/duration are determined by the Service Planning team in consultation with the Licensed Therapist, with cross-reference to §5.12 for STAR Health provider credentialing requirements; §6.4 added explicit 24/7 Case Manager-level coverage statement and on-call rotation/escalation language; §8.1 added credential-status verification as a required QA + CSR component, with explicit credential-lapse remediation language tying back to §3.5

COMPLIANCE STATEMENT

This Comprehensive Enhanced Snapshot demonstrates Refuge House's compliance with T3C Blueprint (April 2026) for Substance Use Support Services. This document integrates content from the following Refuge House policies and procedures to provide a complete operational picture:

Source Document	Sections Incorporated
FC-04 Crisis Management Policy	Substance-related crisis principles
FC-04.1 Crisis Management Procedure	Section 4: Substance Use crisis protocols
FC-16 Staff and Caregiver Training Policy	Section 4.4: Substance Use training (4-hour requirement)
FC-AF-01 Aftercare Services Policy	Mandatory 6-month aftercare with recovery monitoring
FC-CSR-01.1 Continued Stay Review Procedure	90-day review process
FC1-01.1 Admission Screening Procedure	Admission process
FC2-01.1 Admission Assessment Procedure	Assessment process
FC3-01.1 Individual Service Planning Procedure	Service planning with recovery components
FC6-01 Admission Matching & Criteria Policy	Placement matching
FC7-01 Family Connections and Engagement Policy	Family engagement in recovery
FC10-01 Physical and Mental Health Care Policy	Health care coordination
FC14-01 Discharge and Permanency Planning Policy	Discharge process
FC-HT-01 Human Trafficking Prevention Policy	Enhanced trafficking screening
FC-STAR-01.1 STAR Health Coordination Procedure	Substance use treatment authorization; Service Documentation and Cost Coverage
FC-CRED-01.1 Foster Family Home Credentialing Procedure	Foster home credentialing
FC-MH-01 Mental & Behavioral Health Support Services Policy	Shared infrastructure framework
TBRI Treatment Model Executive Summary	Treatment model application
CQI Plan	Quality improvement

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.

FC-SU-01 SUBSTANCE USE SUPPORT SERVICES - Comprehensive Enhanced Snapshot