REFUGE HOUSE, INC.
Child Placing Agency
T3C TREATMENT FOSTER FAMILY CARE SUPPORT SERVICES
COMPREHENSIVE ENHANCED SNAPSHOT
Umbrella Policy and Procedures with Embedded Cross-References
| Policy Information | Details |
|---|---|
| POLICY NAME | T3C Treatment Foster Family Care Support Services Policy |
| POLICY NUMBER | FC-TFFC-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-TFFC |
| DATE(S) OF REVISION | January 2026 - Added Section 5.6 Service Documentation and Cost Coverage February 2026 (E1) - Enhancement Round 1 responses: Expanded §5.2 (Service Plan content, who informs, progress documentation per p.139); Enhanced §5.2.3 (CANS 3.0 frequency per p.140 and results usage per p.139); Added §5.7 Educational Coordination per p.141-142; Added §5.8 Foster Family Home Caregiver Responsibilities (enhanced logistical support per p.141, multi-system navigation per p.141, caregiver participation in therapy per p.142); Expanded §3.5 Admission Guidelines per p.146; Expanded §4.2-4.4 (Anticipated Length of Service individualization, CPA policy requirement, Time-Limited Service, extensions per p.142-143) May 2026 (v2.1) — Round 2 enhancement: §5.5 (family engagement throughout placement + aftercare) and §8.1 (CSR 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 T3C Treatment Foster Family Care 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-TFFC-01 (Quick Reference): Lean cross-reference version for internal quick lookup
- FC-TFFC-01 (Standard): Working template with cross-references to standalone policies
TABLE OF CONTENTS
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 (60-Day Reviews)
- Aftercare Services (Mandatory)
PROCEDURE SECTIONS
- Relationship Between Policy and Procedure
- Admission and Placement Procedures (with embedded FC1-01.1, FC2-01.1, FC6-01)
- Service Planning Procedures (with embedded FC3-01.1)
- 60-Day Continued Stay Review Procedures (with embedded FC-CSR-01.1)
- Crisis Management Procedures (with embedded FC-04.1 Section 6)
- Therapeutic Services Procedures
- Discharge and Step-Down Procedures (with embedded FC14-01)
- Aftercare Services Procedures (with embedded FC-AF-01)
TRAINING REQUIREMENTS
- Staff and Caregiver Training (with embedded FC-16 Section 4.6)
TREATMENT MODEL AND CQI
- Treatment Model Application
- Continuous Quality Improvement
REFERENCE SECTIONS
- Definitions
- Regulatory References
- Forms and Attachments
POLICY SECTIONS
1. PURPOSE AND SERVICE PACKAGE DESCRIPTION
1.1 Service Package Definition
T3C Treatment Foster Family Care Support Services is the highest level of clinical intervention offered in a family setting, providing concentrated therapeutic services for children with serious mental, emotional, and/or behavioral challenges who require intensive, time-limited treatment.
1.2 Legal Framework
Services adhere to Texas Family Code Section 264.1073 and Texas Administrative Code Rule §700.1335.
1.3 Target Population
Children, youth, and young adults who:
- Have DSM-5 diagnosis for emotional, conduct, or behavioral disorder
- Meet two or more additional criteria (see Section 3)
- Require highest level of clinical intervention available in family setting
- Can be safely served with intensive foster home supports
1.4 Service Package Objectives
- Provide intensive, time-limited therapeutic intervention
- Achieve stabilization within defined timeframes (maximum 365 days)
- Support step-down to less restrictive placements
- Maintain highest clinical standards in family setting
2. GOVERNING PRINCIPLES
2.1 TBRI® Foundation with Intensive Clinical Enhancement
📋 DERIVED FROM: TBRI Treatment Model Executive Summary
Refuge House implements TBRI® as our Evidence-informed Treatment Model. For Treatment Foster Family Care, TBRI principles are enhanced with intensive clinical interventions:
Connecting Principles: Intensive relationship-building to address severe attachment disruptions and trust deficits resulting from complex trauma.
Empowering Principles: Comprehensive regulation support for children with severe emotional dysregulation, including crisis prevention and intensive behavioral support.
Correcting Principles: Highly structured, therapeutic environment with immediate access to clinical intervention when behavioral escalation occurs.
2.2 Time-Limited Treatment Philosophy
This package recognizes that intensive intervention should achieve stabilization within defined timeframes, with step-down planning integrated from Day 1.
3. ADMISSION CRITERIA AND GUIDELINES
3.1 Admission Eligibility
Primary Requirement: DSM-5 diagnosis for emotional, conduct, or behavioral disorder
PLUS Two or More of the Following:
- Major self-injurious actions, including suicide attempt within last 12 months
- Difficulties presenting significant risk of harm to others, including frequent or unpredictable physical aggression
- Additional DSM-5 diagnosis of substance-related and/or addictive disorder with severe impairment
3.2 Admission Process
📋 DERIVED FROM: FC1-01.1 Admission Screening Procedure; FC2-01.1 Admission Assessment Procedure
Who How When Regulatory Reference Treatment Director 1. Review clinical documentation
2. Verify DSM-5 diagnosis
3. Confirm child meets 2+ additional criteria
4. Document clinical appropriatenessBefore placement T3C Blueprint p.142-143; FC2-01.1
3.3 Placement Matching
📋 DERIVED FROM: FC6-01 Admission Matching & Criteria Policy
CRITICAL Requirements:
- Child Placing Agency AND Foster Family Home must be Credentialed for Treatment Foster Family Care
- Dual credentialing verified (Treatment Foster Care AND Basic Foster Home)
- Home capacity verified (maximum 2 children)
- Pre-placement visit conducted when appropriate
3.4 Capacity Limitation
CRITICAL: Foster homes providing Treatment Foster Family Care may have no more than two (2) children in foster care at the same time due to the intensive nature of services.
3.5 Admission Guidelines
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.146 (October 2025)
In addition to, and/or consistent with Statutory, TAC Rule, and Minimum Standards Requirements, admission to the T3C Treatment Foster Family Care Support Services Package requires:
- CANS 3.0 Alignment: Placement type and Service Package aligns with the child's needs and strengths as demonstrated through the CANS 3.0 Assessment (if administered prior to need for admission), Application for Placement, and/or based on the knowledge and professional judgment of the child's Service Planning team
- Pre-Placement Visit: A Pre-Placement visit has been conducted (when applicable and appropriate) and was successful
- Admissions Staff Review: Child Placing Agency admissions staff have reviewed the child's information and determined that the child's needs align with services offered by the Child Placing Agency and selected Caregivers
- Dual Credentialing: The Child Placing Agency and Foster Family Home are Credentialed to provide the T3C Treatment Foster Family Care Support Services Package
4. LENGTH OF SERVICE PARAMETERS
4.1 Time-Limited Service
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.143 (October 2025)
| Parameter | Duration |
|---|---|
| Standard Treatment Period | Up to 274 days |
| Extension (if clinically necessary) | Up to 91 additional days |
| Maximum Total | 365 days |
CRITICAL: The T3C Treatment Foster Family Care Support Services Package is a Time-Limited Service lasting up to 274 days, with one extension of up to 91 days when necessary for the child to complete treatment. An individual child cannot be served under the T3C Treatment Foster Family Care Support Services Package for more than 365 days.
4.2 Anticipated Length of Service
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.143 (October 2025)
Length of service is individualized and based on the Child Placing Agency's Treatment Model for providing the T3C Treatment Foster Family Care Support Services Package, Guidelines for Admission, and Continued Stay Guidelines, as well as the child's CANS 3.0 Assessment, and the child's ability to make progress in accordance with the Service Plan.
Anticipated Length of Service for each child served under this package is determined based on:
- Treatment Model: TBRI®-informed clinical assessment of the child's needs and projected stabilization timeline
- Admission Guidelines: Severity and complexity of presenting issues at admission, including DSM-5 diagnosis and additional qualifying criteria
- Continued Stay Guidelines: Ongoing assessment of progress and continued need for TFFC-level intensity
- CANS 3.0 Assessment: Initial and ongoing CANS 3.0 results indicating functional levels across domains
- Service Plan Progress: The child's ability to make progress toward Service Plan goals and treatment objectives
4.3 CPA Policy Requirement
Although the maximum Length of Service guidelines for this Service Package have been established, Refuge House policy includes an anticipated Length of Service for each child, youth, and young adult served under the T3C Treatment Foster Family Care Support Services Package. This anticipated Length of Service is documented in the initial Service Plan and updated at each 60-day Service Plan review based on treatment progress and clinical assessment.
4.4 Step-Down Planning from Day 1
Due to the time-limited nature of this Service Package, step-down planning begins at admission with preliminary step-down goals included in the initial Service Plan.
5. SERVICE PACKAGE EXPECTATIONS
5.1 Therapeutic Services
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.138 (October 2025)
Child must receive regular and frequent therapeutic services:
- Individual therapy (weekly minimum, frequency per clinical need)
- Family therapy (as clinically indicated)
- Group therapy (as clinically indicated)
- Wraparound services (dependent on eligibility)
Therapy Authorization: Therapy services should be authorized and paid for through STAR Health (dependent on eligibility). The Service Planning team and Licensed Therapist will determine the frequency, customized to align with the child's individual needs. Authorization requests will be sent to STAR Health as needed for Medicaid-covered services.
Written Justification: Refuge House will ensure that written justification of assessed need (to include frequency of therapeutic services) is included in the Service Plan.
Therapist Qualifications: Therapy services should be provided by a Licensed Therapist that specializes in providing therapy to children with a DSM-5 diagnosis for serious mental, emotional, and/or behavioral disorder(s), unless the Service Planning team determines a different type of therapist is needed to meet the child's custom needs. If services are Medicaid-covered services, therapy providers must be credentialed and contracted with the STAR Health managed care organization.
Cross-Reference: Services coordinated through FC-STAR-01.1 STAR Health Coordination Procedure.
5.2 Service Planning Requirements
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.139 (October 2025)
Service Planning team meetings must occur in accordance with the provider's Treatment Model and based on the child's needs and permanency plan, but an initial Service Plan is due within 30 days of admission, and Service Plan reviews must occur every 60 days.
5.2.1 Service Plan Content and Development
As informed by the child (if appropriate), youth or young adult, and in collaboration with the Service Planning team, the Service Plan must include:
- Customized goals developed with meaningful input from the child/youth that reflect their strengths, needs, and intensive treatment priorities
- Planned services and supports specifically identified to help with achievement of each goal, including therapy type, frequency, and clinical rationale
- Documentation of who informed the Service Plan, including the child/youth (when age-appropriate), Service Planning team members, Foster Family Home Caregivers, SSCC/DFPS caseworker, biological family/support persons (when safe and appropriate), educational representatives, Licensed Therapist, and Treatment Director
- Step-down planning goals from Day 1, with preliminary targets for transition to less-restrictive placement
- Crisis prevention strategies tailored to the child's clinical profile
The Service Planning team incorporates input from all relevant parties to develop intensive treatment-focused goals that guide the child's stabilization and step-down process.
5.2.2 Service Plan Review - Progress Documentation
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.139 (October 2025)
Service Plan reviews must include documentation to show the progress made toward achieving each goal. For each goal identified in the Service Plan, the review documents:
- Current status of goal achievement (no progress, minimal progress, moderate progress, significant progress, goal achieved)
- Specific examples demonstrating current functioning related to the goal
- Effective interventions and supports that have promoted progress
- Barriers to progress and challenges encountered
- Adjustments needed to services, supports, or the goal itself
- Step-down readiness assessment specific to TFFC time-limited requirements
- Crisis pattern analysis documenting any crisis events and their impact on treatment progress
Review Frequency: Every 60 days for Treatment Foster Family Care (reflects intensive clinical intervention and time-limited nature of service).
Cross-Reference: FC3-01.1 Individual Service Planning Procedure Section 3 (Service Plan Reviews)
5.2.3 CANS 3.0 Assessment Requirements
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.139-140 (October 2025)
The child's CANS 3.0 Assessment must be administered in accordance with the requirements. Children over the age of 3, youth, and young adults receiving this Service Package must receive a CANS 3.0 Assessment every 90 days.
Initial Assessment:
- Children ages 3-5: Within 21 days of placement
- Children ages 6 and older: Within 30 days of placement
Ongoing Assessments:
- Every 90 days thereafter for the duration of placement
Children Age 3 and Under:
- CANS 3.0 not required but may be completed if clinically indicated
Assessment Administration:
- Conducted by licensed clinical staff certified in CANS 3.0 administration (LMSW, LPC, LCSW, LPC-S, LMFT)
- Treatment Director or designee coordinates completion
- Case Manager ensures scheduling and follow-through
5.2.4 CANS 3.0 Results Usage
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.139 (October 2025)
Results of the CANS 3.0 Assessment must be used to inform the child's Service Plan, including adjustments to the type of, frequency, and duration of services. For Treatment Foster Family Care, CANS integration is critical for treatment effectiveness:
At Initial Service Plan Development (30 days):
- CANS 3.0 domains with actionable needs (ratings of 2-3) drive intensive goal development
- Therapy type selection matches CANS-identified needs (individual, family, group, specialized modalities)
- Therapy frequency determined by CANS severity and complexity (weekly minimum, may increase based on clinical need)
- Crisis risk domains inform safety planning and on-call therapist protocols
At Each 60-Day Service Plan Review:
- Compare current CANS 3.0 to previous assessment(s)
- Analyze CANS changes to evaluate intensive intervention effectiveness
- Adjust therapy type based on domain-specific progress or challenges
- Modify therapy frequency based on clinical response and CANS trajectory
- Assess step-down readiness using CANS improvement across multiple domains
CANS-Driven Service Adjustments:
- Increased therapy frequency: When CANS shows minimal improvement or regression despite current therapy
- Addition of specialized modalities: When CANS reveals specific needs requiring targeted intervention
- Family therapy intensification: When CANS indicates caregiver stress or family dysfunction hindering progress
- Step-down initiation: When CANS demonstrates sustained improvement allowing transition to less-restrictive package
- Continued TFFC justification: CANS data supports continued need for intensive services in Continued Stay reviews
| Requirement | Treatment Foster Care | Standard Reference |
|---|---|---|
| Service Plan Reviews | Every 60 days | Per FC3-01.1 |
| CANS 3.0 | Every 90 days (children over age 3) | T3C Blueprint p.140 |
| Step-Down Assessment | At each 60-day review | Package-specific |
5.3 24/7 Crisis Availability with On-Call Licensed Therapist
📋 DERIVED FROM: FC-04 Crisis Management Policy; FC-04.1 Crisis Management Procedure Section 6
CRITICAL REQUIREMENT (T3C Blueprint p.139): On-Call Licensed Therapist must be contacted for ALL crises involving Treatment Foster Family Care children.
Crisis Component Requirement Reference On-Call Licensed Therapist 24/7 availability; contact for ALL crises T3C Blueprint p.139; FC-04.1 Section 6.2 Psychiatric Emergency Specialized protocols for suicidal ideation, psychosis, severe dissociation FC-04.1 Section 6.4 60-Day Review Integration Crisis patterns documented and analyzed at each review FC-04.1 Section 6.5
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. Children, youth, and young adults must receive information related to the prevention of Human Trafficking in accordance with the Child Placing Agency's documented and planned method.
5.5 Family Engagement
📋 DERIVED FROM: FC7-01 Family Connections and Engagement Policy
Intensive family engagement for Treatment Foster Family Care is integrated into care coordination and Service Planning throughout the duration of placement and as part of Aftercare. The Child Placing Agency outreaches to, engages, and collaborates with the child, youth, or young adult, their biological parents, other relatives (including all siblings), potential Kinship (including fictive) Caregivers, adoptive Caregivers, and other supportive persons identified by the child or treatment team.
Family engagement components include:
- Family therapy as clinically indicated
- Family involvement in Service Planning, treatment-team meetings, and 60-day Continued Stay Reviews
- Family education on TBRI® principles and trauma-informed parenting
- Support for family reunification when appropriate
- Step-down planning with family involvement from Day 1 (per §4.4 Step-Down Planning from Day 1)
- Identification of family members and other supportive persons (in collaboration with the child/youth/young adult), with this information shared with the SSCC or DFPS caseworker
- Continued family engagement during the mandatory 6-month Aftercare period (per FC-AF-01 Aftercare Services Policy)
Documentation Requirement: Family outreach and engagement efforts are documented as part of the Service Plan and in Aftercare Service documentation (if appropriate) in the child's case record maintained by the Child Placing Agency.
5.6 Service Documentation and Cost Coverage
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.141 (October 2025)
5.6.1 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.
5.6.2 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)
5.6.3 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.
5.6.4 Community Resource Pursuit
Refuge House shall seek community resources to obtain any needed services that are not covered through STAR Health.
5.6.5 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)
5.7 Educational Coordination
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.141-142 (October 2025)
This Service Package requires coordination and participation in school enrollment, including advocating for, and ensuring various educational testing and plans are completed, and accommodations and/or supports are in place to aid in the child's educational success.
Refuge House educational coordination for Treatment Foster Family Care includes:
- School Enrollment: Expedited enrollment in the appropriate school upon placement, including coordination with the school district's foster care liaison
- Educational Testing: Coordination of referrals for educational testing (academic, cognitive, behavioral) when indicated by the child's needs or when existing evaluations are outdated or unavailable
- IEP/504 Plans: Reviewing, requesting, and advocating for Individualized Education Programs (IEP) or Section 504 plans as indicated; ensuring the school has current plans and documentation
- Supports and Accommodations: Ensuring appropriate educational supports and accommodations are in place throughout the placement, including tutoring, supplemental services, and classroom modifications as needed
- Ongoing Monitoring: Monitoring educational progress throughout the time-limited treatment period and adjusting supports as needed based on the child's therapeutic progress and educational needs
Given the intensive therapeutic nature of this placement, emphasis is on maintaining educational stability while the child receives concentrated treatment services, with coordination between the educational system and the treatment team to ensure the child's academic needs are not disrupted by treatment demands.
📋 DERIVED FROM: FC-T3C-01 Section on Educational Services
The Education Liaison or Case Manager coordinates all educational services, working with the child's school, SSCC/DFPS caseworker, and foster family to ensure educational stability and support the child's academic success throughout the treatment period.
5.8 Foster Family Home Caregiver Responsibilities
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.141-142 (October 2025)
5.8.1 Enhanced Logistical Support
Foster Family Home Caregivers offer logistical support, transportation, coordination, and documentation/record keeping of services in accordance with the Service Plan. Given the intensive nature of Treatment Foster Family Care, this includes:
- Transportation to and from all therapy sessions (individual, family, group), psychiatric appointments, and wraparound services
- Coordination with multiple service providers regarding scheduling and follow-up
- Documentation and record keeping of all services received, including dates, providers, and key observations
- Daily observation and documentation of the child's behavioral patterns, therapeutic progress, and responses to interventions
- Communication of observations to the Service Planning team to inform treatment adjustments and crisis prevention
5.8.2 Enhanced Multi-System Navigation
Refuge House and Foster Family Home Caregivers must have enhanced skill in navigating multiple systems, and advocate for and provide coordination of services through:
- STAR Health — managed care services, intensive therapy authorization requests, and care coordination
- HHSC Behavioral Health Services — behavioral health referrals and services specific to children, youth, and young adults with serious emotional disturbance
- Early Childhood Intervention (ECI) — developmental services for children under 3 (if applicable)
- Child welfare systems — collaboration with SSCC/DFPS specific to children, youth, and young adults with serious emotional disturbance
- Education system — school enrollment, educational testing, IEP/504 coordination, and accommodation advocacy
- Other services as needed — including community-based resources, specialty providers, and psychiatric services
This multi-system navigation skill ensures comprehensive service coordination and advocacy for each child's individualized therapeutic and support needs throughout the time-limited treatment period.
5.8.3 Caregiver Participation in Therapy and Services
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.142 (October 2025)
Caregivers must participate in therapy and other services with the child as needed and must have the ability to attend multiple meetings per week, and respond immediately when there is a need, or the child is in crisis. This participation includes:
- Attending family therapy sessions as directed by the treatment team
- Participating in treatment team meetings and Service Planning conferences
- Engaging in TBRI®-informed therapeutic activities within the home
- Responding immediately to crisis situations and coordinating with the On-Call Licensed Therapist
- Implementing therapeutic recommendations in daily caregiving practices
5.8.4 STAR Health Coordination
Refuge House and Foster Family Home Caregivers are required to coordinate care with the child or youth's medical consenter and are required to participate in STAR Health Service Coordination (dependent and based on child, youth, or young adult's individual eligibility).
📋 DERIVED FROM: FC-STAR-01.1 STAR Health Coordination Procedure
STAR Health coordination for Treatment Foster Family Care includes intensive therapy authorization, psychiatric services coordination, and wraparound service access, with emphasis on maintaining continuity of intensive therapeutic services throughout the time-limited treatment period.
5.8.5 Normalcy Activities
Foster Family Home Caregivers must support Normalcy activities to include, but not limited to, clothing, hygiene products, hair care, birthdays, holidays, graduations, and other Normalcy activities that are age appropriate and in accordance with the Service Plan.
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 (psychiatrist, psychologist, LCSW, LPC, LMFT with required experience); responsible for supervision of Licensed Therapists |
6.2 Staff-to-Child Ratios
| Position | Ratio | Notes |
|---|---|---|
| Case Manager | 1:6 | Intensive ratio for high-acuity |
| Licensed Therapist | 1:11 | For intensive therapy services |
| Behavior Support Specialist/Mentor | 1:6 | Intensive behavioral support |
| Crisis Management Staff | 1:25 | With On-Call Licensed Therapist requirement |
| Aftercare Case Manager | 1:25 | Standard T3C ratio |
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 Dual Credentialing Requirement
CRITICAL: Foster homes must be credentialed for BOTH:
- T3C Treatment Foster Family Care Support Services
- T3C Basic Foster Family Home Support Services
This dual credentialing allows step-down within same home when appropriate.
7.2 Training Requirements
📋 DERIVED FROM: FC-16 Staff and Caregiver Training Policy, Section 4.6 and TAC §749.863(c)
Treatment Foster Family Care Training - Foster Parents:
Training Component Duration Content Completion Initial Specialized Training 20 hours - Managing high-acuity behaviors
- Implementing intensive behavior support plans
- Crisis intervention and de-escalation
- Supporting concentrated therapeutic treatment
- Recognizing and responding to psychiatric emergencies
- On-Call Licensed Therapist coordination
- Treatment team participation expectations
- Step-down transition supportBefore first TFFC placement Annual Specialized Training 8 hours - Advanced behavior management
- Updates on best practices
- Case reviewAnnually
7.3 Capacity Limitation
Maximum 2 children in foster care per home due to intensive nature of services.
7.4 Specialized Paid Intermittent Alternative Care Program
Refuge House maintains a Specialized Paid Intermittent Alternative Care Program with one (1) skilled Intermittent Alternative Care Caregiver available for every twenty (20) children receiving the T3C Treatment Foster Family Care Support Services Package. This program ensures that, subject to certain exceptions, the Caregiver taking Intermittent Alternative Care receives the same daily rate as the Caregiver offering Intermittent Alternative Care for the same days of care.
7.5 Awake Night Supervision
Awake night supervision in foster home that aligns with plan necessary to keep all children safe in the home. Mandatory if there are 7 or more children in the home. Please note that a variance issued by HHSC-CCR is required for foster homes with more than 6 children.
8. QUALITY ASSURANCE AND CONTINUED STAY GUIDELINES
8.1 60-Day Continued Stay Review Requirements
📋 DERIVED FROM: FC-CSR-01.1 Continued Stay Review Procedure
Requirement Treatment Foster Family Care Review Frequency Every 60 days CANS 3.0 Update Every 90 days Step-Down Assessment Required at each 60-day review Credential Status Verification Required at each review (CPA + Foster Family Home) Dual Signature BOTH SSCC/DFPS AND CPA signatures required SSCC/DFPS Submission Within 15 business days
Credential Maintenance Verification: As part of each 60-day Continued Stay Review and the broader Quality Assurance process, the CPA verifies and documents that BOTH the T3C Treatment Foster Family Care 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 §7.1 Dual Credentialing Requirement. Service delivery under this Service Package cannot continue if either credential is not in good standing; because TFFC operates on a 60-day CSR cadence (more frequent than the 90-day cadence used for other packages), credential issues are surfaced quickly. 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 Continued Stay Evaluation Criteria
T3C Blueprint Reference: Treatment Foster Family Care Support Services p.146-147 (October 2025)
Quality Assurance and Continued Stay Guidelines include:
- Ongoing CANS-based Review: On-going review and adjustment of services based on subsequent CANS 3.0 Assessment and on the Service Plan
- Admission Criteria Continuity: The primary reason the child met the Admission Guidelines continues to require on-going services or are replaced with other service needs that align to the Credentialed Service Package offered and meet Admission Guidelines
- Service Appropriateness: The services continue to support the child's individual need for safety, improved well-being, and permanency in accordance with the child and family Service Plans
- Less-Restrictive Consideration: A less-restrictive placement type/Service Package is not appropriate to meet the child's individual needs
8.3 Dual Signature Requirement
CRITICAL: Considering the most recent CANS 3.0 Assessment, and in conjunction with each 60-day Service Plan review, the Child Placing Agency's Program Director and the Treatment Director responsible for the T3C Treatment Foster Family Care Support Services Package must review the child's goals and services to ensure they align with child's custom strengths, needs, and permanency plan.
The Program Director and Treatment Director must provide written confirmation that:
- The child, youth, or young adult continues to meet criteria for and is benefitting from the Evidence-informed Treatment Model offered through the program
- The less-restrictive T3C Basic Foster Home Service Package is not appropriate to meet the child's custom needs
Written confirmation should be documented in the Child Placing Agency's case record for the child, and a copy should be provided to the SSCC or DFPS caseworker within 15 business days of review and confirmation.
Enhanced Continued Stay Confirmation Form requires signatures from BOTH:
- SSCC or DFPS caseworker
- Refuge House representative (Case Manager or supervisor)
8.4 Time-Limited Service Reminder
This Service Package is Time-Limited, and an individual child cannot be served under the T3C Treatment Foster Family Care Support Services Package for more than 365 days.
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 Treatment Foster Family Care. Services continue for minimum 6 months following discharge.
Treatment Foster Care Aftercare Components:
- Clinical stability monitoring
- Continued therapy coordination
- Step-down adjustment support
- Crisis prevention planning
- Family support continuation
Upon discharge (both successful and unsuccessful), the child, youth, or young adult will exit placement with a robust Aftercare Services plan that at a minimum includes:
- Name and contact information for the STAR Health Service Coordinator (if assigned) and the Child Placing Agency's Aftercare Services Case Manager
- Education Portfolio
- Referrals for continued services
- Initial appointments set (if transition is needed)
- Plan with times and dates set for weekly, transitioning to twice a month, follow-up calls and/or meetings for a period of 6 months
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.
11. ADMISSION AND PLACEMENT PROCEDURES
11.1 Clinical Review
| Who | How | When | Regulatory Reference |
|---|---|---|---|
| Treatment Director | 1. Review clinical documentation 2. Verify DSM-5 diagnosis for emotional/conduct/behavioral disorder 3. Confirm child meets 2+ additional criteria 4. Document clinical appropriateness for TFFC 5. Approve for placement |
Before placement | T3C Blueprint p.142-143 |
11.2 Placement Matching
| Who | How | When | Regulatory Reference |
|---|---|---|---|
| Intake Specialist | 1. Identify TFFC-credentialed homes 2. Verify dual credentialing (TFFC + Basic) 3. Confirm capacity (max 2 children) 4. Verify foster parent completed 20-hour training 5. Conduct pre-placement visit |
Before placement | T3C Blueprint p.146 |
12. 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. Develop intensive Service Plan informed by child/youth, Service Planning team, and Treatment Director
3. Include customized goals and planned services/supports
4. Include step-down planning from Day 1
5. Document weekly therapy requirement with written justification
6. Include crisis prevention strategies
7. Document who informed the Service Plan
8. Submit to SSCC/DFPSWithin 30 days of placement TAC §749.1301; T3C Blueprint p.139
13. 60-DAY CONTINUED STAY REVIEW PROCEDURES
📋 DERIVED FROM: FC-CSR-01.1 Continued Stay Review Procedure
Who How When Regulatory Reference Case Manager 1. Prepare Continued Stay documentation including CANS 3.0 analysis
2. Document progress toward each Service Plan goal
3. Complete step-down readiness assessment
4. Include crisis pattern analysis
5. Obtain dual signatures (SSCC/DFPS AND CPA)Every 60 days T3C Blueprint p.146-147 Program Director & Treatment Director 1. Review child's goals and services for alignment with strengths, needs, and permanency plan
2. Provide written confirmation child continues to meet criteria and benefit from Treatment Model
3. Confirm less-restrictive T3C Basic Foster Home not appropriate
4. Document in case recordAt each 60-day review T3C Blueprint p.146-147 Case Manager 1. Provide copy to SSCC/DFPS caseworker Within 15 business days of review T3C Blueprint p.147
14. CRISIS MANAGEMENT PROCEDURES
📋 DERIVED FROM: FC-04 Crisis Management Policy; FC-04.1 Crisis Management Procedure Section 6
Who How When Regulatory Reference On-Call Staff 1. Assess crisis severity
2. Contact On-Call Licensed Therapist for ALL crises
3. Implement psychiatric emergency protocols if needed
4. Document crisis and responseImmediately upon crisis T3C Blueprint p.139; FC-04.1 Section 6
15. THERAPEUTIC SERVICES PROCEDURES
| Who | How | When | Regulatory Reference |
|---|---|---|---|
| Licensed Therapist | 1. Provide individual therapy (weekly minimum) 2. Provide family therapy as clinically indicated 3. Provide group therapy as clinically indicated 4. Document therapy frequency justification in Service Plan 5. Coordinate with treatment team |
Per Service Plan; weekly minimum | T3C Blueprint p.138; FC-STAR-01.1 |
16. DISCHARGE AND STEP-DOWN PROCEDURES
📋 DERIVED FROM: FC14-01 Discharge and Permanency Planning Policy
Who How When Regulatory Reference Treatment Team 1. Assess step-down readiness based on CANS improvement
2. Develop step-down plan
3. Coordinate transition to less-restrictive placement
4. Ensure service continuity
5. Transfer to AftercarePer step-down readiness T3C Blueprint p.147
17. AFTERCARE SERVICES PROCEDURES
📋 DERIVED FROM: FC-AF-01 Aftercare Services Policy
Who How When Regulatory Reference Aftercare Case Manager 1. Monitor clinical stability
2. Coordinate continued therapy
3. Support step-down adjustment
4. Provide crisis prevention support
5. Document weekly transitioning to twice monthly contactsMinimum 6 months T3C Blueprint p.147-148
TRAINING REQUIREMENTS
18. STAFF AND CAREGIVER TRAINING
18.1 Staff Training Requirements
📋 DERIVED FROM: FC-16 Staff and Caregiver Training Policy, Section 4.6
Treatment Foster Family Care Training - Staff:
Training Component Duration Content Completion Initial TFFC Training Clinical components (varies) - High-acuity population management
- 60-day review processes
- Dual signature requirements
- Step-down planning and coordination
- Psychiatric emergency response
- On-Call Licensed Therapist coordination
- Intensive treatment team participationBefore first TFFC assignment Annual Refresher Per role requirements - Updates on best practices
- Case review
- Advanced clinical techniquesAnnually
18.2 Foster Parent Training Requirements
📋 DERIVED FROM: FC-16 Staff and Caregiver Training Policy, Section 4.6 and TAC §749.863(c)
Training Component Duration Content Completion Initial Specialized Training 20 hours - Managing high-acuity behaviors
- Implementing intensive behavior support plans
- Crisis intervention and de-escalation
- Supporting concentrated therapeutic treatment
- Recognizing and responding to psychiatric emergencies
- On-Call Licensed Therapist coordination
- Treatment team participation expectations
- Step-down transition supportBefore first TFFC placement Annual Specialized Training 8 hours - Advanced behavior management
- Updates on best practices
- Case reviewAnnually
TREATMENT MODEL AND CQI
19. TREATMENT MODEL APPLICATION
📋 DERIVED FROM: TBRI Treatment Model Executive Summary
For Treatment Foster Family Care, TBRI® principles are enhanced with intensive clinical interventions:
Connecting Principles: Intensive relationship-building to address severe attachment disruptions and trust deficits.
Empowering Principles: Comprehensive regulation support including crisis prevention and intensive behavioral support.
Correcting Principles: Highly structured therapeutic environment with immediate clinical intervention access.
20. CONTINUOUS QUALITY IMPROVEMENT
📋 DERIVED FROM: FC-17 Continuous Quality Improvement Policy; CQI Plan
Metric Target Frequency Weekly therapy completion 95% Monthly review 60-day reviews completed on time 100% Monthly review Dual signatures obtained 100% Every review Step-down within 365 days Target based on clinical appropriateness Quarterly review Foster parent training completion (20 hours) 100% Prior to placement
REFERENCE SECTIONS
21. DEFINITIONS
Dual Credentialing: Requirement that CPA and foster home maintain credentials for BOTH Treatment Foster Family Care and Basic Foster Family Home packages.
Step-Down: Planned transition from Treatment Foster Family Care to less-restrictive placement based on treatment progress.
Treatment Foster Family Care: Highest level of clinical intervention in family setting for children with DSM-5 diagnosis plus two additional criteria, requiring intensive, time-limited (365-day maximum) therapeutic services.
Time-Limited Service: Service with defined maximum duration; TFFC lasts up to 274 days with one extension of up to 91 days (365-day maximum).
22. REGULATORY REFERENCES
- T3C Blueprint Standards: Pages 137-148, T3C Treatment Foster Family Care Support Services (April 2026)
- Texas Family Code Section 264.1073
- Texas Administrative Code Rule §700.1335
- TAC Chapter 749: Minimum Standards for Child Placing Agencies
- TAC §749.863(c): Treatment Foster Care training requirements
- DFPS 24-Hour RCC Requirements (FY26)
23. FORMS AND ATTACHMENTS
Core Forms:
- Treatment Foster Care Admission Screening Checklist
- Service Plan - Treatment Foster Care Supplement
- Enhanced Continued Stay Confirmation Form (60-Day) - BOTH signatures required
- Step-Down Readiness Assessment Tool
- Step-Down Planning Worksheet
- Aftercare Services Plan Template
- Monthly Aftercare Report Template
Crisis Management Forms:
- Treatment Foster Family Care Psychiatric Emergency Checklist
- TFFC 60-Day Crisis Pattern Analysis Template
- On-Call Licensed Therapist Consultation Log
Training Documentation:
- Treatment Foster Family Care Training Completion Record (20-hour)
- Foster Parent TFFC Training Verification
- Annual 8-Hour 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 5.6 Service Documentation and Cost Coverage per T3C Blueprint p.141 requirements |
| 2.0 | February 2026 | Refuge House Leadership | Enhancement Round 1: Expanded §5.2 (Service Plan content detailing who informs the plan, progress documentation requirements per p.139); Enhanced §5.2.3 (CANS 3.0 frequency for children over age 3 every 90 days per p.140); Enhanced §5.2.4 (CANS 3.0 results usage to inform Service Plan per p.139); Added §5.7 (Educational coordination with testing, plans, supports, accommodations per p.141-142); Added §5.8 (Foster Family Home Caregiver Responsibilities: enhanced logistical support per p.141, multi-system navigation per p.141, caregiver participation in therapy per p.142); Expanded §3.5 (Admission Guidelines per p.146); Expanded §4.2-4.4 (Anticipated Length of Service individualization, CPA policy requirement, Time-Limited Service, extensions per p.142-143); Updated §8.2-8.3 (Continued Stay evaluation criteria and dual signature per p.146-147); Updated regulatory references to October 2025 Blueprint |
| 2.1 | May 2026 | Refuge House Leadership | Round 2 enhancement: §5.5 Family Engagement expanded with throughout-placement and aftercare framing per FC7-01, including identification of family members in collaboration with the child/youth and aftercare continuation; §8.1 added credential-status verification as a required 60-day CSR component, with explicit credential-lapse remediation language tying back to §7.1 Dual Credentialing |
COMPLIANCE STATEMENT
This Comprehensive Enhanced Snapshot demonstrates Refuge House's compliance with T3C Blueprint (April 2026) for T3C Treatment Foster Family Care Support Services. All regulatory references have been verified against the October 2025 T3C System Blueprint, pages 137-148.
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 | High-acuity crisis principles |
| FC-04.1 Crisis Management Procedure | Section 6: Treatment Foster Family Care crisis protocols |
| FC-16 Staff and Caregiver Training Policy | Section 4.6: TFFC training (20-hour requirement) |
| FC-AF-01 Aftercare Services Policy | Mandatory 6-month aftercare requirements |
| FC-CSR-01.1 Continued Stay Review Procedure | 60-day review process with dual signature |
| 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 step-down from Day 1 |
| FC6-01 Admission Matching & Criteria Policy | Placement matching |
| FC7-01 Family Connections and Engagement Policy | Intensive family engagement |
| FC10-01 Physical and Mental Health Care Policy | Health care coordination |
| FC14-01 Discharge and Permanency Planning Policy | Step-down and discharge process |
| FC-HT-01 Human Trafficking Prevention Policy | Trafficking screening |
| FC-STAR-01.1 STAR Health Coordination Procedure | Intensive therapy authorization; Service Documentation and Cost Coverage |
| FC-CRED-01.1 Foster Family Home Credentialing Procedure | Dual credentialing requirement |
| 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.