REFUGE HOUSE, INC.

PURPOSE:

To establish the governing principles by which Refuge House conducts an initial health screening of every child at pre-placement or admission — identifying any need for immediate medical or psychiatric care, capturing critical safety information before the caregiver begins care, and triggering timely follow-up health services.

POLICY:

Refuge House staff trained by or under the oversight of the Medical Consultant conduct an initial health screening during pre-placement or admission activities using the RH Initial Health Screening Tool. The screening evaluates the child's need for immediate psychiatric intervention and/or medical care and assesses communicable disease, drug/alcohol use, mental-health concerns that may interfere with functioning, suicide risk, known contraindications to physical restraint, and high-risk behaviors requiring caregiver-implementable safety plans.

Refuge House harmonizes this policy with 26 TAC Chapter 749 Minimum Standards, the DFPS 24-Hour Residential Child Care Contract and its addendums, the T3C System Blueprint, and the provider manuals of all Single Source Continuum Contractors (SSCCs) with whom it contracts (4Kids4Families, OCOK, Saint Francis, Belong, 2INgage, EMPOWER). Where these sources prescribe differing timeframes or requirements for the same activity, Refuge House adopts the strictest (most protective, shortest, most stringent) applicable requirement.

SAFETY SCREENING TRIAD:

The RH Initial Health Screening Tool includes three required fields that must be completed and documented as a condition of screening closure, before the caregiver begins care:

1. Suicide risk — documented results of a structured inquiry or screening instrument, including any recent ideation, attempt, or self-injurious behavior (cross-reference TAC §§749.136/.137 and FC-04 Crisis Management).
2. Contraindications to restraint — documented known medical, developmental, or trauma-related contraindications, with the absence of known contraindications documented affirmatively (cross-reference FC-16.06 Emergency Behavior Intervention).
3. High-risk behavior safety plan — identification of high-risk behaviors (e.g., elopement, self-injury, fire-setting, severe aggression) with a caregiver-implementable safety plan captured on the tool.

TRAUMA-INFORMED ADMINISTRATION:

Screening is paced to the child's tolerance and conducted consistent with the Connecting principles of Trust-Based Relational Intervention (TBRI®). Non-urgent items may be deferred and rescheduled within the assessment window if the child's arousal state makes accurate screening impossible; urgent safety items are never deferred.

IMMEDIATE CLINICAL ESCALATION:

When screening identifies active suicidal ideation with plan/intent or recent attempt, acute psychotic symptoms, acute intoxication or withdrawal, untreated injuries, signs of acute abuse requiring a forensic exam, or any condition the Medical Consultant designates as requiring emergency evaluation, the child is immediately transported to the nearest emergency room or psychiatric facility, accompanied by the RH worker, foster family, and/or CPS/SSCC caseworker (see FC10-03 Emergency Medical/Psychiatric Transport).

FOLLOW-UP HEALTH SERVICES:

All children are referred for medical and mental-health follow-up within defined timelines (TB/immunizations, well-child exam, dental, psychiatric evaluation, psychological and developmental assessment, ECI, substance-use assessment), consistent with the medical requirements at admission (TAC §749.1151) and the dental requirements at admission (TAC §749.1153), and screening findings are integrated with the child's CANS 3.0 results to inform the initial T3C Service Package determination. Specific services, timelines, and applicability are maintained in FC2-04.1.

INFORMATION-SHARING AND REASONABLE EFFORTS:

Concurrent with screening, staff review DFPS Form K-908-2279 (Placement Summary) and Attachment A (Child Sexual History Report) with the caregiver, securing acknowledgment on or before the date of placement and returning signed documents to DFPS within 72 hours (24-Hour RCC Contract §1420). When required health-history information is missing or unverified, staff make at least three properly spaced, documented attempts to obtain it (TAC §749.1137).

QUALITY ASSURANCE:

Screening completeness (including the Safety Screening Triad), escalation appropriateness, follow-up referral timeliness, and reasonable-efforts documentation are monitored through Medical Consultant oversight and the agency's PQI process.

REGULATORY ALIGNMENT:

• 26 TAC §749.1133 — required content of an admission assessment (includes health information)
• 26 TAC §749.1151 — medical requirements when admitting a child into care
• 26 TAC §749.1153 — dental requirements when admitting a child into care
• 26 TAC §749.1135 — additional admission assessment requirements for children admitted for treatment services (evaluation recency)
• 26 TAC §749.1137 — actions when required admission-assessment information cannot be obtained (reasonable efforts)
• 26 TAC §749.1187 — completion timing of admission-assessment requirements for an emergency admission
• 26 TAC §749.1301 — requirements for a preliminary service plan
• T3C System Blueprint (current edition); STAR Health clinical guidelines and authorization procedures
• DFPS 24-Hour RCC Requirements (FY26) §1420 (notifications/signatures), §5100 (3-Day Medical Exam; Texas Health Steps checkups), §5200 (dental), §5330 (CANS)
• SSCC Provider Manuals — 4Kids4Families, OCOK, Saint Francis, Belong, 2INgage, EMPOWER

RELATED POLICIES AND PROCEDURES:

• FC2-04.1 Initial Health Screening Procedure
• FC1-01 Admission Screening Policy
• FC2-01 Admission Assessment Policy
• FC10 Physical and Mental Health Care Policy (ongoing health care; follow-up services)
• FC-04 Crisis Management Policy (suicide; immediate clinical escalation)
• FC-16.06 Emergency Behavior Intervention Policy (restraint contraindications)
• FC10-03 Emergency Medical/Psychiatric Transport

DEFINITIONS:

RH Initial Health Screening Tool: A medical and mental-health initial screening developed in conjunction with and co-signed by a qualified medical practitioner; incorporates the Safety Screening Triad as required fields.

Medical Consultant: A licensed medical practitioner retained by Refuge House who co-develops and co-signs the screening tool and provides clinical oversight of the screening process.

Safety Screening Triad: The three required screening elements — (1) suicide risk, (2) restraint contraindications, (3) high-risk behavior safety plan.

CANS 3.0 Assessment: Child and Adolescent Needs and Strengths Assessment — supports service-package determination and service planning.

STAR Health: State of Texas Access Reform — the specialized health-care program for children in foster care.

This policy document establishes the governing principles for Initial Health Screening. The corresponding procedure document (FC2-04.1) operationalizes these principles. While policies require Board approval and remain relatively stable, procedures may be updated by the Executive Director to adapt to regulatory changes or operational improvements without requiring Board approval, provided such changes maintain alignment with the policy's intent.