Procedure

Individual Service Planning Procedure

Refuge House, Inc.
Last updated: July 24, 2026 · Source: policies-procedures/Procedure/Individual Service Planning Procedure.md

REFUGE HOUSE, INC.

Procedure Information Details
PROCEDURE NAME Individual Service Planning Procedure
PROCEDURE NUMBER FC3-01.1
RELATED POLICY FC3-01 Individual Service Planning Policy
EFFECTIVE DATE 5/20/25
REVISION DATE 7/13/26 (pending approval) (prior: 12/08/25; 05/2026; 06/10/26)
LAST UPDATED 5/15/2026
LAST APPROVED 5/22/2026
APPLICABLE T3C PACKAGES: APPLICABLE T3C ADD-ON SERVICES:
☒ T3C Basic Foster Family Home ☒ Transition Support Services for Youth & Young Adults
☒ Substance Use Support Services ☒ Kinship Caregiver Support Services
☒ Short-Term Assessment ☒ Pregnant & Parenting Youth or Young Adult
☒ Mental & Behavioral Health
☒ Sexual Aggression/Sex Offender
☒ Complex Medical Needs or Medically Fragile
☒ Human Trafficking Victim/Survivor
☒ Intellectual or Developmental Disability (IDD)/Autism Spectrum Disorder
☒ T3C Treatment Foster Family Care

PURPOSE:

To establish standardized processes for developing, implementing, and monitoring comprehensive service plans for children in Refuge House foster homes, ensuring compliance with regulatory requirements while incorporating trauma-informed practices and T3C package-specific requirements.

RELATIONSHIP BETWEEN POLICY AND PROCEDURE:

This procedure operationalizes the Individual Service Planning Policy (FC3-01) by providing detailed implementation steps for service plan development, review, and monitoring. While the policy establishes our commitment to individualized, trauma-informed service planning, this procedure specifies the actions, responsible parties, timeframes, and documentation requirements necessary to achieve these goals.

LEXICON NOTE:

Per FC3-01 and the Service Plan Lexicon (cookbook: t3c-service-plan-lexicon): the Service Plan is a living document, continuously maintained; the Monthly Pulse informs it each month; and the Service Plan Review required by 26 TAC §749.1335 — internally the "Service Plan Snapshot" — certifies it: a point-in-time, signed record frozen to the child's permanent file. In this procedure, "Service Plan Review" and "Snapshot" refer to the same event. Basic cadence decision (June 2026): the RCC Contract requires 90-day reviews, superseding the 6-month TAC baseline for all packages including T3C Basic.

RESPONSIBILITY:

PROCEDURE:

1. T3C SERVICE PACKAGE VERIFICATION AND COMPLIANCE PLANNING

Purpose and Overview

The foundation of effective service planning begins with proper verification that both Refuge House and the foster home are credentialed to provide the assigned T3C Service Package. This verification must occur before service planning begins to ensure appropriate services from qualified providers.

The T3C system requires that providers maintain specific credentials for each Service Package they deliver. Mismatches between child needs and provider credentials can result in service denials, placement disruptions, and compliance violations. This section ensures all placements are properly verified and implementation plans are developed for package-specific requirements.

Who How When Where Regulatory Reference
Case Manager
  1. Verify T3C Service Package assignment in IMPACT system
  2. Confirm package matches child's assessed needs per CANS 3.0
 Within 24 hours of placement notification IMPACT system T3C Blueprint p.47-55
Case Manager 2. Complete FC-T3C-01 tool verifying: Refuge House credential status, Foster home credential status, Required services availability, Training requirements met, Staff qualifications confirmed Within 48 hours of placement T3C Compliance Tool (FC-T3C-01) T3C Blueprint p.39
Treatment Director 3. Review package-specific clinical requirements and identify implementation needs Within 72 hours of placement Clinical review meeting TAC §749.673
Case Manager 4. Assess foster family's current capacity to meet package requirements Within 5 days of placement Foster home visit T3C Blueprint p.47-55
Program Director 5. Develop implementation plan addressing any capacity gaps Within 7 days of placement Written plan in Radius TAC §749.665
Case Manager 6. Schedule required package-specific training or support for foster family Within 7 days of placement Training calendar T3C Blueprint requirements

1.7 CANS 3.0 Assessment Implementation

T3C Blueprint Reference: All T3C Service Packages (SU p.60, STASS p.71, TFFC p.139 - October 2025)

Purpose and Overview

The Child and Adolescent Needs and Strengths (CANS 3.0) Assessment is a comprehensive tool that informs individualized service planning and measures outcomes across multiple life domains. For children over age 3, CANS 3.0 assessments are required at specified intervals and directly guide service planning decisions.

CANS 3.0 assesses needs and strengths across domains including behavioral/emotional health, life functioning, risk behaviors, caregiver resources, and traumatic experiences. Results provide objective data to support clinical decision-making and track progress over time.

Assessment Frequency by Child Age

Child Age Initial Assessment Ongoing Assessments Notes
0-3 years Not required Not required May complete if clinically indicated
3-5 years Within 21 days Every 90 days Required for T3C packages
6+ years Within 30 days Every 90 days Required for T3C packages

Package-Specific Considerations:

Short-Term Assessment: Initial CANS 3.0 required within timeline; ongoing typically not applicable due to 30-45 day placement duration unless extension granted beyond 90 days.

All Other Packages: Initial CANS 3.0 per timeline above, then every 90 days throughout placement.

Initial CANS 3.0 Assessment Procedures

Who How When Where Regulatory Reference
Case Manager 1. Verify child's age and determine CANS 3.0 timeline (21 or 30 days)
2. Calendar CANS 3.0 due date
3. Coordinate with Treatment Director for assessment scheduling
4. Gather background information for assessor		 Within 48 hours of placement CANS tracking system T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Treatment Director 1. Assign CANS-certified clinical staff to complete assessment
2. Ensure assessor has access to background information
3. Review clinical history to inform assessment		 Within first week of placement Clinical assignment system T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
CANS-Certified Clinical Staff 1. Schedule assessment with foster parent and youth (if appropriate)
2. Complete CANS 3.0 interview and rating
3. Enter results into CANS system
4. Generate CANS summary report
5. Share results with Treatment Director and Case Manager		 Within 21 days (ages 3-5) or 30 days (ages 6+) CANS 3.0 system T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Treatment Director 1. Review CANS 3.0 results for clinical implications
2. Identify high-need domains requiring immediate attention
3. Provide recommendations for Service Plan integration
4. Flag any concerning findings for team discussion		 Within 5 days of CANS completion Clinical review T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Case Manager 1. Integrate CANS 3.0 findings into Service Plan development
2. Ensure goals address high-need domains
3. Document how services align with CANS results
4. Provide CANS summary to SSCC/DFPS caseworker		 Before Service Plan meeting Service Plan documentation T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)

Ongoing CANS 3.0 Assessment Procedures (Every 90 Days)

Who How When Where Regulatory Reference
Case Manager 1. Calendar next CANS 3.0 due date (90 days from last assessment)
2. Send reminder to Treatment Director 30 days before due date
3. Coordinate scheduling with foster parent and youth		 Ongoing tracking CANS tracking calendar T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
CANS-Certified Clinical Staff 1. Complete reassessment using same process as initial
2. Compare results to previous CANS 3.0
3. Note areas of improvement, decline, or stability
4. Generate comparative summary report		 Every 90 days (±5 days) CANS 3.0 system T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Treatment Director 1. Review changes across CANS domains
2. Analyze effectiveness of current interventions
3. Identify need for service adjustments
4. Recommend service plan modifications		 Within 5 days of reassessment Clinical review T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Service Planning Team 1. Review CANS 3.0 changes at Service Plan review
2. Discuss progress in high-need domains
3. Adjust services based on current CANS results
4. Set goals targeting domains needing improvement		 At Service Plan review (90-day for most packages) Service Planning meeting T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Case Manager 1. Document CANS 3.0-informed service adjustments
2. Update Service Plan to reflect new CANS findings
3. Communicate changes to foster parents and service providers
4. Provide updated CANS summary to SSCC/DFPS		 After Service Plan review Service Plan documentation T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)

CANS 3.0 Certification and Qualified Assessors

Only licensed clinical staff certified in CANS 3.0 administration may complete assessments:

Certification Requirements:

Treatment Director Responsibilities:

CANS 3.0 Integration with Service Planning

T3C Blueprint Reference: All T3C Service Packages require CANS 3.0 results to inform Service Plans including service type, frequency, and duration adjustments (SU p.60, STASS p.71, TFFC p.139 - October 2025)

At Initial Service Plan (30 days)

CANS 3.0 results must directly inform all aspects of the initial Service Plan:

CANS Domain Finding Service Planning Response Documentation Required
High-Need Domain (Rating 2-3) Create specific goal addressing domain Goal references CANS domain and rating
Multiple High-Need Domains Prioritize goals; determine service intensity Service Plan notes CANS complexity justifying intensity
Behavioral/Emotional Needs Determine therapy type and frequency Therapy authorization includes CANS justification
Caregiver Resource Depletion Plan caregiver support and respite Service Plan includes caregiver strengthening goals
Risk Behaviors Present Develop safety plan and monitoring Safety plan references specific CANS risk domains
Strengths Identified (Rating 0-1 strengths) Leverage in treatment approach Goals note how strengths support progress

Service Type Determination:

Service Frequency Determination:

Service Duration Planning:

At Ongoing Service Plan Reviews
Who How When Where Regulatory Reference
Treatment Director 1. Compare current CANS to previous assessment(s)
2. Identify domains with improvement, decline, or stability
3. Analyze whether current services effectively addressing needs
4. Recommend service adjustments based on CANS trends		 Before each Service Plan review CANS comparison analysis T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Service Planning Team 1. Review CANS comparison data
2. Discuss effectiveness of current service array
3. Determine if service type still matches needs
4. Adjust service frequency based on progress/regression
5. Modify service duration based on trajectory		 At Service Plan review meeting Service Planning meeting T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)
Case Manager Document in Service Plan:
1. Current CANS domain ratings vs. previous
2. Service effectiveness analysis per domain
3. Service adjustments with CANS-based rationale
4. Projected CANS targets for next review period		 During/after Service Plan review Service Plan in Radius T3C Blueprint, package sections (April 2026: Basic pp.50-58; STASS pp.70-78; MBH pp.79-89; IDD pp.125-136; TFFC pp.137-148)

CANS-Driven Service Adjustments:

When CANS shows improvement:

When CANS shows regression or lack of progress:

When CANS shows mixed results:

Documentation Standards for CANS Integration

Initial Service Plan Must Include:

Service Plan Reviews Must Include:

Example Documentation:

Good: "John's CANS shows improvement in Behavioral/Emotional Needs from 2 to 1, indicating weekly individual therapy has been effective. However, his Caregiver Resources domain declined from 1 to 2, necessitating addition of monthly family therapy to strengthen caregiver support and prevent placement disruption."

Poor: "Services adjusted based on progress and continued needs."

Quality Assurance for CANS Integration
Who How When Regulatory Reference
Treatment Director Review all Service Plans to ensure CANS integration Within 48 hours of plan completion T3C Blueprint (October 2025)
QA Coordinator Audit sample of Service Plans monthly for:
- CANS findings documented
- Goals linked to CANS domains
- Service adjustments justified by CANS
- Frequency/duration tied to CANS data		 Monthly TAC §749.131
Program Director Review aggregate data on CANS-driven service adjustments Quarterly T3C Blueprint (October 2025)

Quality Standards:

Quality Assurance for CANS 3.0 Compliance

Who How When Regulatory Reference
QA Coordinator 1. Audit CANS 3.0 completion timeliness monthly
2. Verify certification status of assessors
3. Review sample of assessments for quality
4. Generate compliance reports		 Monthly TAC §749.131
Treatment Director 1. Address any late assessments
2. Ensure assessor reliability
3. Review reassessment intervals		 Ongoing T3C Blueprint (October 2025)
Program Director 1. Review aggregate CANS trends
2. Implement improvements based on data
3. Report CANS outcomes to Board		 Quarterly T3C Blueprint (October 2025)

Compliance Targets:

2. SERVICE PLAN DEVELOPMENT TIMELINES AND PROCESSES

Purpose and Overview

Service planning timelines are among the most critical regulatory requirements, with the 30-day timeline carrying high weight in compliance monitoring. This section ensures all team members understand their roles in meeting these mandatory timelines while developing quality, individualized plans.

The service planning process must balance regulatory compliance with meaningful, trauma-informed planning that truly addresses each child's unique needs. By following these structured processes, teams can achieve both compliance and quality outcomes.

2.1 72-Hour Preliminary Service Plan

Who How When Where Regulatory Reference
Case Manager 1. Develop preliminary plan addressing: Safety considerations, Medical/dental appointments, School enrollment, Initial TBRI® strategies, Foster parent support needs Within 72 hours of placement 72-Hour Plan template TAC §749.1301
Case Manager 2. Include initial TBRI® implementation: Connecting rituals, Empowering through predictability, Proactive behavioral strategies Within 72 hours TBRI section of plan T3C Blueprint p.48
Case Manager 3. Share plan with foster parents and provide implementation coaching Within 72 hours Phone or in-person T3C Blueprint p.48
Program Director 4. Review and approve preliminary plan Within 72 hours Electronic approval TAC §749.665

2.2 Initial 30-Day Service Plan Meeting

Who How When Where Regulatory Reference
Case Manager 1. Schedule Service Planning meeting with required participants Within 10 days of placement Meeting invitation system TAC §749.1301
Case Manager 2. Send preparation materials to participants: CANS 3.0 results (if available), Admission Assessment summary, TBRI Integration Guide, Package-specific requirements At least 3 days before meeting Secure email TAC §749.1317
Case Manager 3. Prepare child/youth for participation using age-appropriate methods 1-2 days before meeting Pre-meeting visit Best practice
Treatment Director 4. Review clinical assessments and prepare recommendations Before meeting Clinical review TAC §749.673
Case Manager 5. Facilitate collaborative planning meeting ensuring all voices are heard As scheduled Meeting location varies TAC §749.1305
Case Manager 6. Invite the CPS Caseworker to participate in the service planning meeting (initial and every subsequent service-planning meeting) and document the invitation (RCC §4210) With each meeting invitation Meeting invitation system; case record RCC (FY26) §4210
Case Manager 7. Offer children, youth, families, and supportive adults an opportunity to participate in the service planning meeting to help identify needed services and contribute to plan development — "Including extended and supportive network members, such as teachers, coaches, scout leaders, etc." — and document who was invited and who participated (RCC §4210) Before each service-planning meeting Meeting invitation system; case record RCC (FY26) §4210
Case Manager / Program Director 8. Make reasonable efforts to send a Representative to participate in DFPS Permanency Planning meetings; document attendance or the efforts made (RCC §4210) Whenever a DFPS Permanency Planning meeting is convened DFPS meeting location / telecommunication; case record RCC (FY26) §4210

2.3 Service Plan Documentation

Who How When Where Regulatory Reference
Case Manager 1. Document plan using required template with all mandatory sections Within 5 days of meeting Service Plan template TAC §749.1301; §749.1309
Case Manager 2. Include package-specific requirements and interventions Within 5 days of meeting Package supplement section T3C Blueprint requirements
Treatment Director 3. Review plan for clinical appropriateness and TBRI integration Within 24 hours of draft Electronic review TAC §749.673
Program Director 4. Review for regulatory compliance and completeness Within 24 hours of clinical review Compliance checklist TAC §749.665
Case Manager 5. Obtain all required signatures Within 30 days of placement Signature page/DocuSign TAC §749.1317
Case Manager 6. Distribute to all authorized parties Within 2 days of signatures Secure distribution TAC §749.1317
Case Manager 7. Document the plan on Single Child's Plan of Service (Form 3300) — "The provider must use Single Child's Plan of Service (Form 3300) to document the Child's Single Plan of Service" (RCC §4230) With each plan completion (initial and each review) Form 3300 in Radius RCC (FY26) §4230
Case Manager 8. Send a copy of the completed service plan to CPS within 10 days of completing it, documenting the date the plan was sent (RCC §4230). This §4230 transmission applies to every child, every package (including T3C Basic), and is distinct from the 15-business-day Continued Stay Review package submission in §4.6 Within 10 days of plan completion Secure transmission to CPS Caseworker; send date logged in Radius RCC (FY26) §4230

2.4 Youth Participation in Service Planning

T3C Blueprint Reference: All T3C Service Packages require youth-informed service planning (SU p.59, STASS p.70, TFFC p.138 - October 2025)

Purpose and Overview

Service Plans must be informed by the child, youth, or young adult (when age-appropriate) and include customized goals developed through meaningful youth participation. This requirement ensures youth voice drives service planning rather than being an afterthought.

Who How When Where Regulatory Reference
Case Manager 1. Meet with youth individually before Service Planning meeting
2. Use age-appropriate methods to gather input:
- Verbal discussion for older youth
- Visual aids and simplified language for younger children
- Written surveys or preference assessments
- Drawing/creative expression for younger children
3. Document youth's goals, preferences, and priorities in their own words
4. Prepare youth for participation in planning meeting
5. Review previous Service Plan goals with youth		 5-7 days before Service Plan meeting Individual meeting with youth T3C Blueprint p.59, 70, 138 (October 2025)
Treatment Director 1. Review youth's stated goals and preferences
2. Ensure clinical recommendations align with youth voice
3. Identify ways to incorporate youth priorities into treatment planning
4. Reconcile clinical needs with youth-identified goals		 Before Service Planning meeting Clinical review T3C Blueprint p.59, 70, 138 (October 2025)
Service Planning Team 1. Include youth in Service Planning meeting (age-appropriate)
2. Present goals in youth's own words during meeting
3. Ask youth to explain their priorities to the team
4. Develop customized services/supports to achieve youth's goals
5. Ensure youth understands how services connect to their goals
6. Document youth participation and agreement (or concerns)
7. Ensure cultural considerations reflected in goals and services		 At Service Planning meeting Service Planning meeting T3C Blueprint p.59, 70, 138 (October 2025)
Case Manager Document in Service Plan:
1. Youth's stated goals (in their words when possible)
2. Level of youth participation
3. How services align with youth-identified needs
4. Cultural considerations incorporated
5. Any concerns youth expressed
6. Youth's understanding of the plan		 During/after Service Planning meeting Service Plan in Radius T3C Blueprint p.59, 70, 138 (October 2025)

Package-Specific Considerations:

Short-Term Assessment: Youth goals focus on supporting assessment process and preparing for transition to receiving Service Package.

Substance Use: Youth goals include recovery objectives and relapse prevention strategies developed with youth input.

TFFC: Youth goals address intensive mental health needs while honoring youth's perspective on their challenges and desired outcomes.

2.5 Enhanced Continued Stay Requirements for Specialized Packages

Purpose and Overview

The Mental & Behavioral Health and IDD/Autism packages require enhanced documentation and review processes to ensure children receive appropriate intensive services while progressing toward less restrictive placements. These enhanced requirements protect children from remaining in restrictive settings longer than clinically necessary while ensuring their complex needs are met.

☒ MENTAL & BEHAVIORAL HEALTH SUPPORT SERVICES
Written Confirmation Requirements
Who How When Where Regulatory Reference
Treatment Director
  1. Complete Treatment Director section of Enhanced Continued Stay Confirmation Form including: "I confirm that [Child's Name] continues to require Mental & Behavioral Health Support Services based on the following clinical indicators:" - Current psychiatric diagnoses requiring intensive intervention - Specific behavioral symptoms (frequency/intensity) - Crisis incidents in past 90 days - Medication management complexity - Therapy engagement and progress
  2. Document why less restrictive placement is insufficient: - Safety risks in lower level of care - Need for 24/7 crisis availability - Therapeutic milieu requirements - Family/caregiver readiness factors
  3. Sign with credentials and date
 At each 90-day review meeting Enhanced Continued Stay Confirmation Form (previewforms.refugehouse.org) CRITICAL: T3C Blueprint p.86 (April 2026)
Program Director
  1. Complete Program Director section stating: "I confirm that [Child's Name] continues to meet admission criteria for Mental & Behavioral Health Support Services and that a less restrictive placement is not appropriate at this time."
  2. Document administrative indicators: - Placement stability factors - Resource utilization patterns - Service availability assessment - Permanency planning progress
  3. Before signing: verify that BOTH the T3C Mental & Behavioral Health Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for (a) Refuge House and (b) the placing foster home (verified per FC-CSR-01.1 §4.1); if either credential has lapsed, do not sign — initiate remediation per FC-MH-01 §1.3 before completing this confirmation
  4. Sign and date confirmation
 Within 24 hours of Treatment Director's completion Same form CRITICAL: T3C Blueprint p.86 (April 2026); FC-MH-01 §1.3
Case Manager
  1. Compile complete submission package: - Both completed confirmation sections - Service Plan T3C Supplement (FC3-03) - Current CANS 3.0 assessment summary - Crisis incident log for review period - Medication compliance data - Therapy attendance records
  2. Submit via IMPACT with cover memo
  3. Confirm SSCC/DFPS receipt
  4. Document submission in case record
 MUST submit within 15 business days of 90-day review date IMPACT system and case record CRITICAL DEADLINE: 15 business days
Clinical Indicators for Continued Stay

The following must be documented to justify continued Mental Health placement:

Domain Indicators Supporting Continued Stay Ready for Step-Down Indicators
Psychiatric Stability - Active psychosis or severe mood symptoms - Medication adjustments in past 30 days - Psychiatric hospitalization in review period - CANS Mental Health items scored 2-3 - Stable on medications 60+ days - No psychiatric symptoms interfering with functioning - CANS Mental Health items improving to 0-1
Crisis Incidents - Self-harm attempts or gestures - Physical aggression requiring intervention - Police involvement for behavioral issues - Use of emergency psychotropic medication - No crisis interventions in 60 days - Using coping skills effectively - Managing triggers independently
Therapeutic Needs - Requires intensive therapy (2+ weekly) - Active trauma processing - High-risk behaviors present - Family therapy critical for stability - Managing with weekly therapy - Trauma work stabilized - Risk behaviors resolved - Family engagement successful
☒ INTELLECTUAL OR DEVELOPMENTAL DISABILITY (IDD)/AUTISM SPECTRUM DISORDER
Written Confirmation Requirements
Who How When Where Regulatory Reference
Treatment Director
  1. Complete Treatment Director section stating: "I confirm that [Child's Name] continues to require IDD/Autism Support Services based on the following developmental and medical indicators:" - Specific adaptive functioning deficits requiring support - Communication challenges and support needs - Behavioral manifestations of disability - Medical complexity factors - Sensory and environmental needs
  2. Document specialized support requirements: - Daily living skill support level - Behavior plan implementation needs - Medical protocol requirements - Environmental modifications
  3. Sign with credentials and date
 At each 90-day review meeting Enhanced Continued Stay Confirmation Form (previewforms.refugehouse.org) CRITICAL: T3C Blueprint p.135 (April 2026)
Program Director
  1. Complete Program Director section: "I confirm that [Child's Name] continues to meet admission criteria for IDD/Autism Support Services and that the specialized supports provided through this package remain necessary."
  2. Verify: - RN consultation being utilized - Behavior supports implemented - Communication strategies in place - Family training ongoing - Dual credential status: verify that BOTH the T3C IDD/Autism Spectrum Disorder Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for (a) Refuge House and (b) the placing foster home (verified per FC-CSR-01.1 §5.1); if either has lapsed, do not sign — initiate remediation per FC-IDD-01 §1.4 before completing this confirmation
  3. Sign and date
 Within 24 hours of Treatment Director Same form CRITICAL: T3C Blueprint p.135 (April 2026); FC-IDD-01 §1.4 (v1.2)
Registered Nurse
  1. Provide medical necessity documentation: - Current medical diagnoses and complications - Medication administration requirements - Medical equipment and supplies needed - Specialized medical procedures - Emergency medical protocols
  2. Sign RN consultation section
 Prior to 90-day review RN Consultation Form attached to confirmation T3C Blueprint p.124
Case Manager
  1. Compile submission package including: - Completed confirmations with RN input - Service Plan T3C Supplement (FC3-03) - Developmental assessment data - Behavior data graphs (3-month trend) - Communication progress documentation - Skills acquisition tracking - Medical stability indicators
  2. Submit complete package via IMPACT
  3. Track receipt confirmation
 MUST submit within 15 business days of 90-day review date IMPACT system and case record CRITICAL DEADLINE: 15 business days
Developmental Indicators for Continued Stay

The following must be documented to justify continued IDD/Autism placement:

Domain Indicators Supporting Continued Stay Ready for Step-Down Indicators
Adaptive Functioning - Requires full assistance with ADLs - Cannot communicate basic needs - No safety awareness - Requires 24/7 specialized supervision - Increasing independence in ADLs - Functional communication established - Basic safety skills demonstrated - Standard supervision sufficient
Medical/Nursing - Complex medical conditions requiring RN oversight - Multiple daily medications requiring administration - Specialized medical equipment - Frequent medical crises - Medical conditions stable - Simplified medication regimen - Standard medical needs - Rare medical incidents
Behavioral Support - Severe self-injurious behaviors - Aggressive behaviors requiring specialized intervention - Property destruction patterns - Elopement risk requiring environmental modifications - Behaviors manageable with standard approaches - Minimal behavioral incidents - No specialized interventions needed - Safe in standard environment

2.6 Substance Use Support Services - Service Plan Requirements

Purpose and Overview

Substance Use Support Services follows the Mental & Behavioral Health pattern (90-day reviews) with recovery-focused enhancements. Detailed procedures are in FC-SU-01 §13-14.

2.6.1 Service Plan Development

Per Sections 2.1-2.3 with the following package-specific additions:

Component Requirement Regulatory Reference
Recovery goals Include in initial Service Plan FC-SU-01 §13.2
Therapy frequency Determined by the Service Planning team in consultation with the Licensed Therapist based on clinical need; document frequency determination with clinical justification; frequency may be adjusted at 90-day review with documented clinical rationale FC-SU-01 §5.2 (v1.4)
Drug screening protocol Include if clinically indicated FC-SU-01 §14
2.6.2 90-Day Service Plan Reviews

Per Section 4.2 (same as Mental & Behavioral Health):

Who How When Regulatory Reference
Service Planning Team Review per Section 4.2 with recovery progress focus Every 90 days FC-SU-01 §13.3
Treatment Director Complete Continued Stay Evaluation per FC-CSR-01.1 Every 90 days FC-SU-01 §16
Case Manager Submit review package to SSCC/DFPS Within 15 business days RCC (FY26) §4230

Cross-Reference: Drug screening response and relapse procedures per FC-SU-01 §14.

2.7 Short-Term Assessment - Service Plan Requirements

Purpose and Overview

Short-Term Assessment has a fundamentally different Service Plan purpose: assessment coordination for Service Package determination. NO Continued Stay Review. Detailed procedures in FC-STASS-01 §13.

2.7.1 Service Plan Development

Per Sections 2.1-2.3 with assessment focus:

Component Requirement Timeline Regulatory Reference
Assessment Coordination Plan Incorporate from FC2-01.1 Within 72 hours T3C Blueprint pp.70-78 (April 2026)
CANS 3.0 Document completion timeline 21 days (≤5) / 30 days (6+) T3C Blueprint p.69
Service Package recommendation Document as primary goal Before discharge T3C Blueprint p.70-71
Normalcy Activities Support age-appropriate normalcy activities (clothing, hygiene, birthdays, extracurriculars, social, cultural, and employment activities) per the Reasonable and Prudent Parent Standard; apply assessment-period adaptation guidance — gradual community-based engagement when assessment findings indicate individualized pacing is warranted Throughout placement FC-STASS-01 §5.15 (v2.2); Texas Family Code §264.125; TAC §749.2605
2.7.2 30-Day Service Plan Reviews

Package-Specific Modification: Reviews every 30 days (vs. 90 days for Basic)

Who How When Regulatory Reference
Service Planning Team
  1. Review assessment progress
  2. Update Service Plan
  3. Evaluate transition readiness
  4. Recommend Service Package if assessments complete
 Every 30 days T3C Blueprint pp.70-78 (April 2026)

NOTE: Continued Stay Review is NOT APPLICABLE for this package.

2.7.3 Discharge Planning

Per FC-STASS-01 §14: Case Manager prepares Transition Summary with Service Package recommendation. Aftercare NOT required.

2.8 T3C Treatment Foster Family Care - Service Plan Requirements

Purpose and Overview

Treatment Foster Family Care has accelerated 60-day reviews with dual signature requirement. Step-down planning from Day 1. Detailed procedures in FC-TFFC-01 §12-15.

2.8.1 Service Plan Development

Per Sections 2.1-2.3 with the following enhancements:

Component Requirement Timeline Regulatory Reference
Step-down goals Required in initial Service Plan Within 30 days T3C Blueprint p.144
Therapy justification Written clinical justification for frequency Within 30 days T3C Blueprint p.143-144
365-day tracking Document placement start date and track days Ongoing T3C Blueprint p.142
Treatment Director approval Required written approval Within 5 days of draft Texas Family Code §264.1073
2.8.2 60-Day Service Plan Reviews

Package-Specific Modification: Reviews every 60 days (vs. 90 days for MH)

Who How When Regulatory Reference
Case Manager Prepare review per FC-TFFC-01 §13.1 7 days before review T3C Blueprint pp.137-148 (April 2026)
Service Planning Team Review treatment progress, update Service Plan, assess step-down readiness Every 60 days T3C Blueprint pp.137-148 (April 2026)
2.8.3 Dual Confirmation Process

CRITICAL: Both signatures required per T3C Blueprint pp.137-148 (April 2026)

Who How When Regulatory Reference
Treatment Director Sign confirming child requires TFFC and is benefitting from Treatment Model At 60-day review T3C Blueprint pp.137-148 (April 2026)
Program Director Sign confirming continued need and less-restrictive placement not appropriate Within 24 hours of TD signature T3C Blueprint pp.137-148 (April 2026)
Program Director Before signing: verify that BOTH the T3C Treatment Foster Family Care Support Services credential AND the T3C Basic Foster Family Home Support Services credential are current and in good standing for Refuge House and the placing foster home (per FC-CSR-01.1 §7.1); if either credential has lapsed, do not sign — initiate remediation per FC-TFFC-01 §7.1 before completing this confirmation Before Program Director signature FC-TFFC-01 v2.1 §8.1; FC-CSR-01.1 v1.1 §7.4
Case Manager Submit to SSCC/DFPS Within 15 business days RCC (FY26) §4230

Form: Enhanced Continued Stay Confirmation Form - Treatment Foster Care Version (dual signature)

2.8.4 Aftercare Planning

Per FC-TFFC-01 §16: 6-month aftercare REQUIRED (Month 1 weekly, Months 2-6 twice monthly).

2.9 Youth Transition Support Services Add-On — Service Plan Requirements

Purpose and Overview

Youth ages 14–22 receiving the Youth Transition Support Services Add-On require integration of transition goals into the primary service plan. Per FC-YT-01 §8.1–9.2, transition goals must be individualized based on the youth's age, developmental stage, primary service package needs, and youth voice. The service plan must document mandatory transition-specific items at each 90-day review.

2.9.1 Transition Goal Integration
Who How When Where Regulatory Reference
Case Manager / Transition Specialist
  1. Integrate transition goals at each service plan review considering: - Youth's age and developmental stage (14–22 spectrum) - Primary service package needs and clinical requirements - Individual strengths, challenges, and cultural preferences - Required PAL program activities and benefit support needs
  2. Adapt service approach by age group: - 14–16: Focus on exploration and skill building - 17–18: Intensive preparation and planning - 19–22: Support implementation and independence
 At next scheduled service plan review after Add-On enrollment Service plan in Radius T3C Blueprint p.149–151; FC-YT-01 §8.1
Youth (age 14+) 1. Actively participate in service planning with full understanding of: - Available transition services and supports - PAL participation expectations - Their role in directing service planning - Expected outcomes and how services adapt to their needs At service plan review Service plan documentation TAC §749.1311; FC-YT-01 §5.2
2.9.2 Mandatory 90-Day Service Plan Documentation

At every 90-day service plan review, the Case Manager must document all of the following for youth receiving the Youth Transition Add-On:

Who How When Where Regulatory Reference
Case Manager
  1. Document status of state/federal benefit applications or guardianship eligibility
  2. Document driver's license plan including education, insurance coordination, and DMV support (or state ID plan if applicable)
  3. Document educational/vocational goals and current progress
  4. Document housing preparation progress
  5. Document permanent connections development (identified supportive adults, Circle of Support, mentors)
 At each 90-day service plan review Service plan T3C supplement in Radius T3C Blueprint p.151; FC-YT-01 §9.2
Transition Specialist
  1. Provide Casey Life Skills Assessment update for service plan integration
  2. Report PAL program participation and attendance status
  3. Summarize benefit application actions taken since last review
 Before 90-day review Transition progress summary T3C Blueprint p.149–151; FC-YT-01 §14.2
2.9.3 Aftercare Planning Cross-Reference

Per FC-YT-01 §13.1, develop written aftercare plan with youth 6 months before anticipated discharge. See FC-AF-01.1 §2.5 and §3.1 for contact schedule requirements (Month 1: Weekly; Months 2–3: Bi-weekly; Months 4–6: Twice monthly).

2.10 Kinship Caregiver Add-On — Service Plan Requirements

Purpose and Overview

Youth placed with kinship caregivers receiving the Kinship Caregiver Support Services Add-On require coordinated service planning between the primary ISP and the Kinship Support Plan. Per FC-KIN-01.1 §14.1, the Kinship Support Plan is developed within 30 days of placement and must be integrated with the primary service team to avoid duplication and ensure aligned service delivery.

2.10.1 Kinship Support Plan Integration
Who How When Where Regulatory Reference
Case Manager
  1. Coordinate with Kinship Support Worker to: - Share ISP assessment findings relevant to kinship dynamics - Align service delivery goals across ISP and Kinship Support Plan - Avoid service duplication or conflicting interventions - Schedule joint team coordination as needed
  2. Document Kinship Support Plan integration status in ISP
 During ISP development and at each review ISP and Kinship Support Plan in Radius T3C Blueprint p.154–155; FC-KIN-01.1 §14.1
Kinship Support Worker
  1. Participate in ISP meetings when kinship-specific factors are relevant
  2. Provide Kinship Support Plan summary for ISP record
  3. Report benefit application status for ISP documentation
 At ISP development and reviews ISP documentation in Radius FC-KIN-01.1 §14.1
2.10.2 Aftercare Planning Cross-Reference

Per FC-KIN-01.1 §16.1, develop Kinship aftercare plan 30 days before discharge. See FC-AF-01.1 §2.5 and §3.1 for contact schedule (Months 1–3: Weekly; Months 4–6: Twice monthly).

2.11 Pregnant & Parenting Youth Add-On — Service Plan Requirements

Purpose and Overview

Pregnant or parenting youth receiving the Pregnant & Parenting Youth Support Services Add-On require integration of the Custom Parenting Plan into the primary ISP. Per FC-PPY-01 §7.2, the Custom Parenting Plan must be completed within 7 days of assessment and reviewed by the treatment team for integration into the service plan at the next review.

2.11.1 Custom Parenting Plan Integration
Who How When Where Regulatory Reference
Parenting Support Specialist 1. Complete Custom Parenting Plan within required timeline covering all T3C Blueprint p.159–161 required areas: - Safe sleeping arrangements - Childproofing suggestions for dangerous settings - Child development and methods to cope with challenging behaviors - Selection of appropriate substitute caregivers - Benefits of reading, singing, and talking to young children - Healthy relationships including intimate partner violence prevention Within 7 days of assessment completion Service plan supplement in Radius T3C Blueprint p.159–161; FC-PPY-01 §7.2
Treatment Team
  1. Review Custom Parenting Plan for integration with primary ISP
  2. Ensure ISP goals support both youth development and parenting success
  3. Coordinate dual-generation service delivery to avoid duplication
 At next service plan review after Custom Parenting Plan completion ISP in Radius TAC §749.1309; FC-PPY-01 §7.2
Case Manager
  1. Ensure ISP includes comprehensive support and coordination for both youth and their child(ren) including: - Early Childhood Intervention referral (within 14 days of identification, if applicable) - HHSC Women and Children's Health coordination - DFPS Prevention and Early Intervention program - Childcare/daycare coordination - All other applicable state, federal, and community benefits
  2. Document all coordination in ISP record
 During ISP development and reviews ISP in Radius T3C Blueprint p.159–161; FC-PPY-01 §10.1
2.11.2 Aftercare Planning Cross-Reference

Per FC-PPY-01 §12.1, develop Pregnant & Parenting Youth aftercare plan 60 days before discharge. See FC-AF-01.1 §2.5 and §3.1 for contact schedule (Weeks 1–4: Weekly; Months 2–6: Bi-weekly).

2.12 Compliance Monitoring for Enhanced Packages

Who How When Where Regulatory Reference
Aftercare Coordinator
  1. Track all Mental Health and IDD/Autism reviews on master calendar
  2. Send alerts to Case Managers at: - 30 days before review due - 7 days before review due - Day of review - 10 business days post-review - 14 business days (DEADLINE WARNING)
 Ongoing monitoring Compliance tracking system T3C Blueprint review cadence; RCC (FY26) §4230
QA Coordinator
  1. Audit all enhanced continued stay submissions for: - Both Director signatures present - Clinical justification adequate - All supporting documents included - Submission within 15-day deadline
  2. Report compliance rates monthly
 Monthly audit QA dashboard TAC §749.131
Program Director
  1. Review any late submissions
  2. Implement corrective action for missed deadlines
  3. Report patterns to Executive Director
  4. Celebrate teams achieving 100% compliance
 As needed and monthly Leadership reports T3C Blueprint requirements

3. SERVICE PLAN CONTENT REQUIREMENTS

Purpose and Overview

Quality service plans go beyond regulatory compliance to create meaningful roadmaps for each child's care. This section ensures all required content is included while maintaining focus on individualization and trauma-informed approaches.

3.1 Core Content Development

Who How When Where Regulatory Reference
Case Manager 1. Include all required content areas per TAC §749.1309 During plan development Service Plan sections 1-15 TAC §749.1309
Case Manager 2. Integrate CANS 3.0 Assessment findings into each goal area During plan development CANS integration summary T3C Blueprint p.48
Case Manager with Foster Parents 3. Develop TBRI implementation strategies specific to child During/after planning meeting TBRI strategies section T3C Blueprint p.47-48
Case Manager 4. Create measurable goals with specific timelines During plan development Goals and objectives section TAC §749.1309
Treatment Team 5. Ensure cultural, linguistic, and religious needs are addressed During planning meeting Cultural considerations section TAC §749.1309(a)(13)
Case Manager / Education Liaison 6. For any child with an Individual Education Plan (IEP) or Individual Transition Plan (ITP) (developed by the school's Admission, Review, and Dismissal (ARD) committee), incorporate the components of the IEP and ITP into the service plan — this applies to every child with an IEP/ITP regardless of service package (RCC §4220). Source the current IEP/ITP from the Education Portfolio (FC09-01.1) During plan development and at each review IEP/ITP integration section of the plan RCC (FY26) §4220

4. SERVICE PLAN REVIEWS AND UPDATES

Purpose and Overview

Regular service plan reviews ensure services remain relevant and effective while meeting regulatory requirements. Reviews must balance compliance with meaningful evaluation of progress and emerging needs.

4.1 Routine Service Plan Reviews

Who How When Where Regulatory Reference
Case Manager 1. Schedule review meeting with required participants 30 days before review due date Meeting invitation system TAC §749.1335
Case Manager 2. Gather updated information: New CANS 3.0 results, Progress on current goals, School reports, Medical updates, Foster parent input 2 weeks before review Assessment compilation TAC §749.1335
Treatment Team 3. Conduct comprehensive review meeting Every 90 days (RCC contract floor; 26 TAC §749.1335 6-month baseline superseded) Meeting location varies TAC §749.1335
Case Manager 4. Document all changes and rationale Within 5 days of review Service Plan Review Form TAC §749.1335
Program Director 5. Approve revised service plan Within 48 hours of documentation Electronic approval TAC §749.665

4.2 90-Day Reviews for Specialized Packages

Who How When Where Regulatory Reference
Treatment Director 1. Complete Service Plan T3C Supplement Form including Continued Stay Evaluation section Every 90 days from admission FC3-03 Form CRITICAL: T3C Blueprint p.79, p.125 (April 2026)
Program Director 2. Provide written confirmation of continued need Within 48 hours of review Confirmation form CRITICAL: T3C Blueprint requirement
Case Manager 3. Submit review package to SSCC/DFPS Within 15 business days of review IMPACT submission CRITICAL DEADLINE

4.3 Service Plan Review Requirements by Package

Package Review Cycle Continued Stay Special Requirements
T3C Basic 90 days PD confirmation within Snapshot (not submitted to SSCC/DFPS) RCC contract floor; FC-CSR-01 §3.1; CANS annual (age 3+)
Mental & Behavioral Health 90 days 90 days Per Section 2.5
IDD/Autism 90 days 90 days Per Section 2.5
Substance Use 90 days 90 days Per Section 2.6; FC-SU-01
Short-Term Assessment 30 days N/A Per Section 2.7; FC-STASS-01
Treatment Foster Family Care 60 days 60 days (dual signature) Per Section 2.8; FC-TFFC-01
Youth Transition Add-On Per primary package N/A Per Section 2.9; FC-YT-01
Kinship Caregiver Add-On Per primary package N/A Per Section 2.10; FC-KIN-01.1
Pregnant & Parenting Youth Add-On Per primary package N/A Per Section 2.11; FC-PPY-01

4.3a Goal-Type-Aware Status Scales

Per FC3-01 Provision 8, every goal's review documentation uses the scale matching its goal type:

Goal Type Status Scale Disposition Rules
Maintenance Sustained / At-risk / Lapsed (never a progress scale) Continued or adjusted; never closed while the child is in care
Achievement 5-point progress scale (no / minimal / moderate / significant progress / achieved) At target: close, step down, or convert to maintenance
Hybrid Progress scale until target, then Sustained / At-risk Converts to maintenance at target; does not close

A sustained maintenance goal is succeeding, not stalled: 26 TAC §749.1335(1) requires evaluating "progress and the effectiveness of strategies," which the maintenance scale satisfies. Scoring a maintenance goal "no progress" is a documentation error. CANS guidance: actionable ratings 2–3 generally indicate achievement goals; ratings 0–1 indicate maintenance posture (consistent with the CANS-driven frequency guidance in §1.7). Reference: Service Plan Snapshot — Definition of Done (cookbook: t3c-service-plan-review-matrix) and the Goal Types reference within it.

4.4 Progress Documentation Toward Goals

T3C Blueprint Reference: All T3C Service Packages require goal-specific progress documentation in Service Plan reviews (SU p.59, STASS p.70, TFFC p.138 - October 2025)

Purpose and Overview

Service Plan reviews must demonstrate the progress made toward achieving each goal identified in the Service Plan. This goal-by-goal documentation ensures accountability, allows for data-driven adjustments to services, and provides clear evidence of treatment effectiveness or need for modification.

Generic statements like "child is doing well" or "some progress noted" do not meet this requirement. Each goal requires individualized progress analysis with specific examples.

Who How When Where Regulatory Reference
Case Manager 1. Review each goal in current Service Plan
2. Gather progress information from all sources:
- Foster parent observations and reports
- Therapist progress notes and summaries
- School reports and educational progress
- Medical/psychiatric provider updates
- BSS/Mentor documentation
- Youth self-report
3. Compile goal-specific progress notes		 5-7 days before Service Plan review Progress compilation worksheet T3C Blueprint p.59, 70, 138 (October 2025)
Treatment Director 1. Review clinical progress toward therapeutic goals
2. Analyze effectiveness of interventions
3. Identify clinical barriers to progress
4. Recommend service adjustments		 Before Service Plan review Clinical review T3C Blueprint p.59, 70, 138 (October 2025)
Licensed Therapist 1. Provide written summary of progress toward therapy-related goals
2. Include specific examples from therapy sessions
3. Document intervention effectiveness
4. Recommend frequency/approach adjustments		 At least 3 days before review Therapy progress summary T3C Blueprint p.59, 70, 138 (October 2025)
Service Planning Team 1. Review progress for each goal collaboratively
2. Discuss what's working and what's not
3. Determine if goals need modification
4. Identify service adjustments needed
5. Document team consensus on progress		 At Service Plan review meeting Service Plan review meeting T3C Blueprint p.59, 70, 138 (October 2025)
Case Manager Document for each goal:
1. Current Status: Level of progress (no/minimal/moderate/significant/achieved)
2. Specific Examples: Observable behaviors or achievements demonstrating current functioning
3. Effective Supports: What services/interventions are helping
4. Barriers: What's hindering progress
5. Adjustments: Changes needed to services, supports, or goal itself
6. Next Steps: Action plan for continued progress		 During/after Service Plan review Service Plan in Radius T3C Blueprint p.59, 70, 138 (October 2025)

Documentation Template for Each Goal:

GOAL: [State original goal as written in Service Plan]

CURRENT STATUS: [No Progress / Minimal Progress / Moderate Progress / Significant Progress / Goal Achieved]

SPECIFIC EXAMPLES:
- [Example 1 with date/context]
- [Example 2 with date/context]

EFFECTIVE INTERVENTIONS:
- [What's working]

BARRIERS TO PROGRESS:
- [What's hindering progress]

ADJUSTMENTS NEEDED:
- [Changes to services/supports]
- [Goal modification if needed]

NEXT STEPS:
- [Action plan for next review period]

Package-Specific Review Frequency:

Package Review Frequency Note
Basic Foster Home Every 90 days (RCC contract floor) May be more frequent per treatment model
Substance Use Every 90 days In conjunction with Continued Stay Review
Short-Term Assessment Every 30 days Focused on assessment progress
Mental & Behavioral Health Every 90 days In conjunction with Continued Stay Review
IDD/Autism Every 90 days In conjunction with Continued Stay Review
TFFC Every 60 days Accelerated due to intensive intervention

Quality Assurance Review:

Quality Assurance staff review random Service Plan reviews monthly to ensure:

4.5 MONTHLY PULSE

Purpose and Overview

The Monthly Pulse (FC3-01 Provision 7) is the monthly instrument that keeps the living Service Plan current between Snapshots. It informs the plan; it certifies nothing.

Responsible Party Action Steps Timeframe Documentation Regulatory Reference
Case Manager
  1. Generate the tailored Pulse questionnaire from the current Service Plan, needs/goals assessments (CANS 3.0), and any new documents (AI-assisted generation permitted).
  2. If a tailored instrument cannot be generated for any reason, use the General Pulse Questionnaire (standing fallback form) and document the reason — the Pulse is never skipped.
 Monthly Pulse Questionnaire (tailored or general) FC3-01 Provision 7
Case Manager 3. Conduct the caregiver interview and a separate, age-appropriate child interview using the questionnaire. Record with documented consent per FC-REC-01; if consent is refused, proceed unrecorded with notes. Monthly Recording Consent Form; session record FC-REC-01
Case Manager (Treatment Director where clinical) 4. Review the AI-drafted summary and recommendations; edit; sign. Label AI-assisted. 5. Enter accepted findings into the living Service Plan as updates; open new needs/goals or document why not. Within 5 business days of interviews Pulse Summary & Recommendations Form; plan updates in Radius FC3-01 Provision 7; FC-REC-01

Pulse outputs satisfy and document the monthly contact expectations otherwise captured in CM Monthly Notes (CMMONTH4PT); where both exist, they must be consistent.

4.6 SERVICE PLAN SNAPSHOT ASSEMBLY

Purpose and Overview

The Snapshot is the certification event (Service Plan Review, 26 TAC §749.1335): it freezes, signs, and files the living plan on the package beat (90 days standard; 60 days TFFC, initial ≤30; 30 days STASS). The maintained contents inventory is the Service Plan Snapshot — Definition of Done page (cookbook: t3c-service-plan-review-matrix); do not duplicate that item list here.

Responsible Party Action Steps Timeframe Documentation Regulatory Reference
Case Manager 1. Run the contents inventory per the Definition of Done: universal §749.1335 review actions, per-goal documentation block (type-aware scales per §4.3a), package overlay items, plugin currency. Resolve gaps before sign-off. At each Snapshot beat Snapshot Contents Checklist 26 TAC §749.1335
Program Director / Treatment Director (per package) 2. Complete the continued-stay confirmation per FC-CSR-01: PD only for Basic (not submitted); PD + TD for MBH, IDD/Autism, and SU; dual signature for TFFC at 60 days. At each Snapshot beat Enhanced Continued Stay Confirmation Form (or Basic confirmation) FC-CSR-01 §3.1, §4
Case Manager 3. Freeze the certified record — the signed Snapshot is immutable — and file it to the child's permanent record in Radius. At completion of signatures Snapshot record in Radius 26 TAC §749.1335(9)
Case Manager 4. Submit to SSCC/DFPS within 15 business days (MBH, IDD/Autism, SU, TFFC; Basic is not submitted) and confirm receipt. Separately, for every package including Basic, send a copy of the completed service plan (Form 3300) to CPS within 10 days of completion with the send date documented per §2.3 step 8 (RCC §4230) — the CSR-package submission does not replace the §4230 plan transmission. Within 15 business days (CSR); within 10 days (§4230 plan copy) Submission + receipt confirmation FC-CSR-01 §6; RCC (FY26) §4230

5. MONITORING AND QUALITY ASSURANCE

Purpose and Overview

Systematic monitoring ensures service plans meet both regulatory requirements and quality standards while driving continuous improvement in service delivery.

5.1 Internal Quality Reviews

Who How When Where Regulatory Reference
QA Coordinator 1. Review sample of service plans for: Regulatory compliance, TBRI integration, Goal measurability, Documentation quality, Signature completion Monthly (10% sample) QA checklist TAC §749.131
Treatment Director 2. Review clinical appropriateness of all specialized package plans Within 48 hours of completion Clinical review form TAC §749.673
Program Director 3. Monitor timeline compliance for all plans Weekly Compliance dashboard TAC §749.665

5.2 External Reporting

Who How When Where Regulatory Reference
Case Manager 1. Submit service plans to DFPS/SSCC as required Per contract requirements IMPACT system RCC (FY26) §4230
Aftercare Coordinator 2. Prepare aggregate reports on service plan compliance Monthly SSCC/DFPS reports Contract requirements
Program Director 3. Address any findings from external reviews Within 10 days of notification Corrective action plan TAC §749.43

FORMS/ATTACHMENTS:

Core Forms:

Mental & Behavioral Health Forms:

IDD/Autism Forms:

Substance Use Forms:

Short-Term Assessment Forms:

Treatment Foster Family Care Forms:

Youth Transition Add-On Forms:

Kinship Caregiver Add-On Forms:

Pregnant & Parenting Youth Add-On Forms:

REGULATORY REFERENCES:

TAC Chapter 749 (Minimum Standards):

RCC Contract:

T3C Blueprint:

Other:

This procedure document operationalizes the principles established in the corresponding policy by providing specific implementation details (who, when, where, and how). While policies require Board approval and remain relatively stable, procedures may be updated by the Executive Director to adapt to regulatory changes, technological advancements, or operational improvements without requiring Board approval, provided such changes maintain alignment with the policy's intent.

IMPLEMENTATION GUIDANCE

Guidance for operationalizing the following enhancement(s), including build-out in Pulse. Recovered from the prior T3C Basic procedure draft (6/2025); align to the T3C Blueprint (April 2026).

IG · 72-Hour Preliminary Service Plan

Establish an interim preliminary service plan completed within 72 hours of placement, ahead of the 30-day Initial Service Plan — covering immediate safety needs, medical/dental and medication continuity, school-enrollment continuity, and initial TBRI® connecting/bedtime routines. (Source: T3C Blueprint April 2026 service planning; recovered T3C Basic procedure draft.)

IG · Casey Life Skills Assessment at age 14+

For youth age 14 or older, complete a Casey Life Skills Assessment within 30 days of placement (agency standard, aligned with FC2-01.1 and the YTSS Add-On) to inform ISP transition/independence objectives (a Basic-package trigger, distinct from the YTSS add-on). (Source: recovered T3C Basic procedure draft; CLSA.)

IG · Service Plan T3C Supplement / Continued Stay Evaluation (FC3-03)

Build a Pulse capture (FC3-03) recording, at each 90-day Continued Stay Review: CANS 3.0 reassessment results, the Continued Stay Evaluation, treatment-progress indicators, crisis-incident summary, and family-engagement progress; submitted with the CSR package within 15 business days. Until built in Pulse, the Case Manager records the same data in the case record. (Source: T3C Blueprint pp.78–79, 124–125; recovered T3C Basic procedure draft.)

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