REFUGE HOUSE, INC.

Procedure Information	Details
PROCEDURE NAME	Initial Health Screening Procedure
PROCEDURE NUMBER	FC2-04.1
RELATED POLICY	FC2-04 Initial Health Screening Policy
EFFECTIVE DATE	5/15/25
REVISION DATE	6/15/26
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 operationalize the Initial Health Screening Policy (FC2-04) by detailing the screening workflow, the Safety Screening Triad, immediate clinical escalation, follow-up referral timelines, information-sharing, and reasonable-efforts documentation. The strictest applicable timeframe always controls.

SCREENING WORKFLOW:

#	Who	Action
1	Trained RH Worker	During admission (or, for non-emergency admissions, before admission in coordination with the complete admission assessment per TAC §749.1133 and FC2-01), and in the presence of the DFPS/SSCC caseworker and foster caregiver whenever possible, screen each child using the RH Initial Health Screening Tool (co-signed by the Medical Consultant). Pace to the child's tolerance per TBRI® Connecting principles; non-urgent items may be deferred and rescheduled within the assessment window if the child's arousal state prevents accurate screening.
2	Trained RH Worker	Complete and document the Safety Screening Triad as a condition of screening closure: (1) suicide risk — structured inquiry/instrument results, including recent ideation, attempt, or self-injury; (2) restraint contraindications — known medical/developmental/trauma-related contraindications, documenting affirmatively when none are known; (3) high-risk behavior safety plan — high-risk behaviors (elopement, self-injury, fire-setting, severe aggression) with a caregiver-implementable safety plan captured before the caregiver begins care.
3	Trained RH Worker / Foster Family / CPS-SSCC Caseworker	Immediate clinical escalation: if screening identifies active suicidal ideation with plan/intent or recent attempt, acute psychotic symptoms, acute intoxication/withdrawal, untreated injuries, signs of acute abuse requiring a forensic exam, or any Medical-Consultant-designated emergency condition, transport the child immediately to the nearest ER or psychiatric facility; accompany the child to inform medical/psychiatric staff of health concerns (see FC10-03 Emergency Medical/Psychiatric Transport).

FOLLOW-UP HEALTH SERVICE REFERRALS:

#	Who	Action
4	Case Manager	Refer all children for follow-up medical/mental-health services within the timelines below (medical requirements at admission per TAC §749.1151; dental per TAC §749.1153); screening findings determine the need for qualified-professional follow-up.

Service / Appointment	Timeline	Applicability
TB test and immunizations (if not previously completed)	Within 30 days of placement	All children
Well-child exam including vision and hearing (if not current)	Within 30 days of placement	All children
3-Day Medical Exam (every child; verify or schedule)	Within 3 business days of removal (RCC §5100)	All ages
Semi-annual dental exam (if not current)	Within 30 days of placement; overdue after 60 days (RCC §5200)	Age 6 months+
Initial psychiatric evaluation	Within 30 days of placement	When applicable
Psychological assessment (if not current; recency 14 mo / 6 mo per §749.1135)	Within 90 days of placement	When applicable
Developmental assessment (if not current)	Within 90 days of placement	When applicable
Early Childhood Intervention (ECI) evaluation	Within 30 days of placement	Under age 3
Comprehensive substance-use assessment (STAR Health authorized)	Within 30 days of placement	Substance Use package
CANS 3.0 integration into the Service Plan	Per admission assessment timeline	All children

INFORMATION-SHARING AND STAR HEALTH:

#	Who	Action
5	Trained RH Worker	Concurrent with (or immediately preceding) screening, review DFPS Form K-908-2279 (Placement Summary) and Attachment A (Child Sexual History Report) with the caregiver; secure acknowledgment on or before the date of placement and before the caregiver provides care; return signed documents to DFPS within 72 hours of placement (24-Hour RCC Contract §1420). Any sexual-history information emerging during screening is documented on Attachment A and triggers re-acknowledgment if previously signed.
6	Case Manager	Within 24 hours of admission, verify the child's STAR Health enrollment status and initiate any authorizations required for follow-up services identified through screening (psychiatric evaluation, developmental assessment, substance-use assessment). Integrate screening findings with CANS 3.0 results to inform the initial T3C Service Package determination; flag any findings suggesting a different Service Package to the Case Manager and Treatment Director within 24 hours for review.

REASONABLE EFFORTS (TAC §749.1137):

#	Who	Action
7	Trained RH Worker	When health-history information required to complete the screening is missing, incomplete, or unverified, make at least three (3) properly spaced, documented attempts to obtain it from the referring worker, prior caregiver, or other appropriate source. Log each attempt with date, time, method, and outcome (Reasonable Efforts Log).

REFERENCES:

Same as Policy FC2-04 — principally TAC §749.1133 (admission assessment), §749.1135 (treatment-admission additional requirements / evaluation recency), §749.1151 (medical requirements at admission), §749.1153 (dental requirements at admission), §749.1137 (information that cannot be obtained), §749.1187 (emergency-admission timing), §749.1301 (preliminary service plan); the T3C System Blueprint; STAR Health clinical guidelines; the DFPS 24-Hour RCC Requirements (FY26) §§1420, 5100, 5200, 5330; and the SSCC provider manuals.

FORMS/ATTACHMENTS:

RH Initial Health Screening Tool (revised, co-signed by Medical Consultant)
Medical Consultant Approval (development and use of the screening tool)
Safety Screening Triad Form (Suicide Risk; Restraint Contraindications; High-Risk Behavior Safety Plan)
DFPS Form K-908-2279 — Placement Summary (Sexual History)
DFPS Form K-908-2279 Attachment A — Child Sexual History Report
DFPS Form 2655 — Medical and Mental Health History
STAR Health Enrollment / Authorization Request Form
Reasonable Efforts Log (Three-Attempt Documentation)
Immediate Clinical Escalation Report Form

This procedure operationalizes the principles established in FC2-04 Initial Health Screening Policy. 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.

Initial Health Screening Procedure