REFUGE HOUSE, INC.

PURPOSE:

To establish the governing principles for the safe, lawful, and well-documented administration, storage, monitoring, and reporting of all medications — prescription, non-prescription, supplements, and psychotropic — for children, youth, and young adults in Refuge House foster care, in accordance with the Texas Minimum Standards, STAR Health protocols, T3C requirements, and trauma-informed practice.

POLICY:

Refuge House is committed to ensuring that every medication a child in care receives is properly consented to, correctly administered by a trained and authorized person, securely stored, accurately documented within required timeframes, and continuously monitored for effectiveness and adverse effects. The following commitments govern medication management across all Service Levels and T3C Packages. Operational detail (who, when, where, and how) is maintained in the companion procedure, FC-MED-01.1 Medication Management Procedure.

1. Consent before administration. Refuge House obtains and documents the consent required before any medication is administered to a child, and ensures the person legally authorized to give medical consent is informed of the benefits, risks, and side effects of prescription medication and treatment, and the consequences of refusing them. (26 TAC §749.1461; §749.1463(a))

2. Prescription medication. Prescription medication is administered only on a health-care professional's order, according to the label or subsequent signed orders, within one hour of preparation, by a person trained in and authorized to administer medication (unless the child is on an approved self-medication program). A child is never physically forced to take medication, and medication is never borrowed from or shared between children. (26 TAC §749.1463(b))

3. Non-prescription medication and supplements. Non-prescription medications and supplements are given according to label instructions and only after confirming they are not contraindicated with the child's other medications or medical conditions. (26 TAC §749.1469)

4. Secure storage and destruction. All medication is stored in its original labeled container, secured away from children, and destroyed within required timeframes when discontinued, expired, or upon the child's discharge. (26 TAC §749.1463(b)(2); §749.1521)

5. Documentation within 24 hours. Refuge House maintains a cumulative medication record for each child receiving medication and ensures it is updated within 24 hours of administering medication, capturing every element required by Minimum Standards. (26 TAC §749.1541)

6. Self-medication program. A child may self-administer medication only when the parent has authorized it in writing, the self-medication program is included in the child's service plan, and the prescribing health-care professional has been consulted and any concerns documented; a daily review system is maintained. (26 TAC §749.1501; §749.1503)

7. Medication errors. Refuge House identifies and responds to medication errors, contacting a health-care professional immediately (except for skipped/missed-dose or wrong-time errors, handled per the professional's standing guidance), correcting label errors no later than the next business day, and documenting every error within 24 hours. (26 TAC §749.1561; §749.1563; §749.1565)

8. Adverse reactions and side effects. Observed and reported side effects are documented; serious side effects and adverse reactions are reported immediately to the prescribing health-care professional and the child's parent, and other side effects are reported to the prescriber within 72 hours. (26 TAC §749.1581; §749.1583)

9. Psychotropic medication — enhanced oversight. Before a child is placed on psychotropic medication, the person legally authorized to give medical consent receives the information required by Minimum Standards and provides signed consent (DFPS Form 4526). Refuge House supports the consenter's attendance at prescribing and medication-review appointments, documents any noticeable change in the child's behavior for the prescriber, and ensures the prescribing professional evaluates the child's response, effectiveness, and the appropriateness of continuing the medication at least quarterly, with written rationale required where effectiveness is not substantiated within 90 days (continuation not to exceed an additional 90 days). (26 TAC §749.1603; §749.1605; §749.1607; §749.1609; §749.1611; DFPS Psychotropic Medication Guidelines)

10. Notification to SSCC/DFPS. Refuge House notifies the SSCC and/or DFPS in writing of any psychotropic medication prescription or dosage change by the next business day, provides the signed consent (Form 4526) within the contract timeframe, observes any provider-specific medication requirements of the placing SSCC (see FC-MED-01.1), and documents medication changes through the child's service plan. (DFPS 24-Hr RCC Requirements (FY26) §§5410–5420; SSCC Provider Manuals)

11. Appointment documentation. Each medical, dental, vision, hearing, or behavioral-health appointment involving medication is documented on the required DFPS appointment form and submitted through the designated state systems within required timeframes. (DFPS Form 2403; DFPS 24-Hour RCC Contract)

12. Technology-supported documentation and reminders. Refuge House supports timely, compliant medication documentation through its Pulse medication system and automated caregiver reminder/escalation workflow, which prompt same-day logging and escalate to case management and program leadership before the 24-hour documentation deadline. The current implementation is described in FC-MED-01.1 Medication Management Procedure and is subject to ongoing enhancement. (Implementation guidance; supports 26 TAC §749.1541(b))

13. Caregiver training and competency. Foster parents and other caregivers who administer medication are trained and authorized to do so, and caregivers who administer psychotropic medication complete the required DFPS psychotropic medication training before doing so and annually thereafter. (26 TAC §749.1463(b)(6); Staff and Caregiver Training Policy)

14. Medical consenter training and information duties. Caregivers and employees who serve as Medical Consenters complete the DFPS Medical Consent Training initially and annually thereafter, and submit the completed Acknowledgement and Certificate of Completion of Medical Consent Training (DFPS Form 2759) to the CPS Caseworker each time a child is placed or a caregiver is designated as Medical Consenter for a child (DFPS 24-Hr RCC §1561). When the Medical Consenter or backup is a caregiver affiliated with Refuge House, a Refuge House Representative discusses the designation with the CPS Caseworker and co-signs the appropriate section of Form 2085-B Designation of Medical Consenter (DFPS 24-Hr RCC §1560). For children ages 16–17 designated by the court as their own Medical Consenters, Refuge House supports the child in completing the DFPS computer-based Informed Consent training within seven days of the court's designation (and before any non-emergency health or behavioral-health appointment falling within those seven days), the retake no less than 120 days before the 18th birthday, and submission of the completed Form 2759 to the CPS Caseworker within five days of completion (DFPS 24-Hr RCC §1562); a 16- or 17-year-old own-consenter who is prescribed psychotropic medication also completes the DFPS Psychotropic Medication computer-based training and post-test within seven days of the court's designation and submits documentation to the CPS Caseworker within five days of completing it (DFPS 24-Hr RCC §5440). Within three business days of the child being placed, all foster parents and employees who serve as Medical Consenters provide relevant plans and information to the Behavioral Health clinicians providing therapy to the child (DFPS 24-Hr RCC §5320). Operational steps are in FC-MED-01.1 Section 14.

15. Psychosocial therapies paired with psychotropic medication — universal. Every child receiving psychotropic medication — regardless of Service Level, T3C Package, or Add-On — is provided appropriate psychosocial therapies, behavior strategies, and other non-pharmacological interventions, and is seen by the prescribing physician, physician assistant, or advanced practice nurse in the STAR Health Network at least once every 90 days. (DFPS 24-Hr RCC §5400) Medication is never the sole intervention; verification is performed per FC-MED-01.1 Section 14.

IMPLEMENTATION GUIDANCE:

During the transition period (2025–2027), this policy applies to children served under either the legacy Service Level system or the T3C Package system. The medication commitments above are core requirements that apply to all children regardless of Service Level or Package. Package-specific medication enhancements (for example, Medication-Assisted Treatment coordination and recovery-environment storage protocols for Substance Use Support Services; condition-specific medical protocols for Complex Medical Needs; and enhanced psychiatric medication oversight for Mental & Behavioral Health and Treatment Foster Family Care) are maintained in FC10-01 Physical and Mental Health Care Policy and the package-specific snapshots, and operate in addition to this policy.

The Pulse medication dashboard, the /admin/medications/compliance view, and the automated caregiver reminder/escalation service are operational mechanisms that support compliance with the documentation duty in 26 TAC §749.1541(b); they are described in the companion procedure and continue to be enhanced. This framing reflects a pre-monitoring honesty discipline: the mechanisms support compliance but do not themselves guarantee it.

DEFINITIONS:

Cumulative Medication Record: The running record, maintained for each child receiving medication, of all prescription medication dispensed (and non-prescription medication and supplements for children under five), updated within 24 hours of administration and containing the elements required by 26 TAC §749.1541(c).

Medication Error: Any of the events enumerated in 26 TAC §749.1561, including the wrong medication, a medication prescribed to someone else, the wrong dosage, the wrong time, a skipped or missed dose, expired medication, failure to follow administration instructions, or improper storage.

Psychotropic Medication: Medication prescribed to affect or alter thought processes, mood, or behavior, including but not limited to anti-psychotic, antidepressant, anti-anxiety, and behavior-control medications, prescribed according to the prescribing health-care professional's diagnosis.

Self-Medication Program: An arrangement, meeting the conditions of 26 TAC §749.1501, under which a child administers his or her own medication.

Person Legally Authorized to Give Medical Consent (Medical Consenter): The individual authorized under Texas Family Code Chapter 266 to consent to the child's medical care, including the administration of psychotropic medication.

DFPS Form 4526 (Psychotropic Medication Treatment Consent): The DFPS form by which the medical consenter documents informed consent for a child's psychotropic medication.

DFPS Form 2403 (Medical/Dental/Vision/Hearing/Behavioral-Health Appointment Form): The DFPS form used to document each applicable health appointment for upload to the Texas Provider Gateway and submission to the SSCC.

REFERENCES:

• 26 TAC §749.1461 — Consent to administer medication
• 26 TAC §749.1463 — Requirements for administering prescription medication
• 26 TAC §749.1469 — Requirements for administering non-prescription medication and supplements
• 26 TAC §749.1501, §749.1503 — Self-medication program
• 26 TAC §749.1521 — Medication storage and destruction
• 26 TAC §749.1541, §749.1543, §749.1545 — Medication records (24-hour update; required elements)
• 26 TAC §749.1561, §749.1563, §749.1565 — Medication errors and label errors
• 26 TAC §749.1581, §749.1583 — Adverse reactions and side effects
• 26 TAC §749.1603–§749.1611 — Psychotropic medication (consent, emergency administration, documentation, quarterly evaluation)
• RCC Contract: Term 7; DFPS 24-Hour RCC Contract; applicable SSCC Provider Manuals (see review.basis)
• DFPS 24-Hour RCC Requirements (FY26): §1560 (medical consent; Form 2085-B representative co-signature); §1561 (Form 2759 per placement/designation; initial + annual training); §1562 (child-as-consenter informed-consent training pipeline); §5320 (information to Behavioral Health clinicians within 3 business days of placement); §5400 (psychosocial therapies paired with psychotropic medication; 90-day prescriber visits); §5440 (child-as-consenter psychotropic training)
• DFPS Psychotropic Medication Utilization Parameters and Guidelines
• Texas Family Code Chapter 266 (medical consent)

SSCC alignment (FY-26): Verified 2026-06-19 against the converted SSCC provider manuals (regulatory-references/SSCC/…). 2INgage, EMPOWER, and SFCS impose psychotropic notification/consent timeframes that this policy and FC-MED-01.1 already reflect (next-business-day notice; Form 4526 within 3 business days; in-person consenter attendance; 90-day prescriber review). OCOK and Belong carry medication provisions beyond Minimum Standards — OCOK's monthly medication-monitoring logs and medication-error Serious Incident Reporting, and Belong's pre-consent for any new or increased psychotropic and 4-business-day Form 4526 timeframe — which are captured as inline provider-specific blocks in FC-MED-01.1. 4Kids imposes no provider-specific medication obligation (DFPS nurse-consultant/PMUR support only). Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix (temporary-reference/fy26-sscc-joint-monitoring/sscc-alignment/).

RELATED PROCEDURES:

• FC-MED-01.1 Medication Management Procedure
• FC10-01 Physical and Mental Health Care Policy
• FC10-01.1 Physical and Mental Health Care Procedure
• FC10-01.2 STAR Health Coordination Procedure
• FC3-01 Individual Service Planning Policy / FC3-01.1 Procedure
• Serious Incident Reporting Policy
• Staff and Caregiver Training Policy

FORMS/ATTACHMENTS:

• Cumulative Medication Record / Medication Administration Record (26 TAC §749.1541)
• Medication Error Form (26 TAC §749.1561–1565)
• DFPS Form 4526 — Psychotropic Medication Treatment Consent
• DFPS Form 2403 — Medical/Dental/Vision/Hearing/Behavioral-Health Appointment Form
• DFPS Form 2759 — Acknowledgement and Certificate of Completion of Medical Consent Training (DFPS 24-Hr RCC §§1561, 1562)
• DFPS Form 2085-B — Designation of Medical Consenter (DFPS 24-Hr RCC §1560)
• Pulse Medication Dashboard (staff entry point) and /admin/medications/compliance view

This policy establishes the governing principles for Medication Management. The corresponding procedure (FC-MED-01.1) operationalizes these principles. Policies require Board approval and remain relatively stable; procedures may be updated by the Executive Director to adapt to regulatory, technological, or operational change without Board approval, provided alignment with the policy's intent is maintained.