Policy

Physical and Mental Health Care Policy

Refuge House, Inc.
Last updated: July 24, 2026 · Source: policies-procedures/Policy/Physical and Mental Health Care Policy.md

REFUGE HOUSE, INC.

Policy Information Details
POLICY NAME Physical and Mental Health Care Policy
POLICY NUMBER FC10-01
ORIGINATED 6/04
APPROVED BY Board of Directors
APPROVED ON 5/20/25
EFFECTIVE DATE 5/20/25
LAST UPDATED 5/15/2026
LAST APPROVED 5/22/2026
SECTION FC10
DATE(S) OF REVISION 6/04, 8/05, 7/06, 4/20/07, 5/26/07, 2/25/08, 8/5/08, 1/22/09, 8/29/09, 1/1/10, 3/23/10, 8/1/11, 1/16/12, 5/20/25, 12/09/25
## 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 comprehensive guidelines ensuring that all children, youth, and young adults in Refuge House foster care receive timely, appropriate, and coordinated physical, dental, vision, and mental health care services in accordance with regulatory requirements, STAR Health protocols, and trauma-informed practices.

POLICY:

Refuge House is committed to ensuring that all children, youth, and young adults in care receive comprehensive physical, dental, vision, and mental health services within the timeframes required by Texas Health Steps, minimum standards, and T3C requirements. Refuge House recognizes the critical importance of addressing each child's comprehensive health needs as part of promoting their overall well-being and development.

In accordance with our Evidence-informed Treatment Model (TBRI), Refuge House acknowledges that physical and mental health care are interconnected and essential components of trauma-informed care. All health care services will be implemented with consideration of each child's trauma history and individual needs, ensuring that services are provided in a manner that promotes safety, healing, and healthy development.

Refuge House will coordinate with STAR Health, medical professionals, and other service providers to ensure that children receive appropriate preventive care, screenings, evaluations, and treatment for identified physical and mental health needs. All services will be documented and tracked to ensure continuity of care and compliance with regulatory requirements.

Foster parents will be actively engaged in the health care process, receiving training, guidance, and support to meet each child's specific health needs. Refuge House will maintain appropriate documentation of all health-related services, appointments, and treatments in accordance with regulatory requirements and best practices for child welfare.

IMPLEMENTATION GUIDANCE:

During the transition period (2025-2027), children in care may be served under either the legacy Service Level system (Basic, Moderate, Specialized) or the new T3C Package system. This policy applies to both systems with the following distinctions:

Minimum Standards Requirements represent core commitments that apply to ALL children regardless of Service Level or T3C Package. These requirements ensure that every child receives basic health care coordination and services that meet regulatory standards and protect their health and safety.

Legacy Service Level Requirements reflect specific commitments based on Basic, Moderate, or Specialized Service Levels that apply during the transition period. These requirements will continue to apply to children who remain in the legacy system until they transition to T3C packages.

T3C Package-Specific Requirements establish enhanced commitments that apply only to specific T3C Packages as outlined in the Package-Specific Requirements section below. These requirements build upon the core requirements to address the specialized needs of children in intensive service packages.

This policy and associated procedures will guide staff in meeting the appropriate requirements based on each child's designated system. When a child transitions from Service Levels to a T3C Package, the T3C Package requirements will supersede the legacy Service Level requirements.

PACKAGE-SPECIFIC REQUIREMENTS:

CORE REQUIREMENTS

All children, youth, and young adults in Refuge House care will receive health services that meet these fundamental commitments, regardless of their Service Level or T3C Package assignment. These core requirements establish the foundation for quality health care coordination and ensure compliance with regulatory standards.

1. Comprehensive Health Assessment and Coordination

Refuge House commits to conducting thorough health assessments for every child that identify immediate health needs, establish baseline health status, and create the foundation for ongoing health care coordination. This assessment process will integrate information from multiple sources including STAR Health records, DFPS health summaries, and direct observation to create a complete picture of each child's health status and needs.

The assessment process will incorporate trauma-informed principles that recognize how past experiences may affect a child's relationship with health care providers and medical procedures. Refuge House will ensure that health assessments are conducted in a manner that promotes trust, safety, and positive associations with health care.

2. Timely Medical and Dental Care

Refuge House will ensure that all children receive timely medical and dental examinations in accordance with Texas Health Steps requirements and regulatory standards. This commitment includes ensuring each child receives the 3-Day Medical Exam within three business days of removal and the initial Texas Health Steps medical checkup within 30 days (the "3-in-30") (DFPS 24-Hr RCC §5100). A child receiving treatment services for primary medical needs additionally receives the placement medical exam within seven days before or three days after admission (RCC §§4310, 5700).

Dental care will be provided according to age-appropriate schedules, with initial dental examinations scheduled within thirty days of placement for children six months and older. All subsequent medical and dental care will follow Texas Health Steps Periodicity Schedules and provider recommendations to ensure comprehensive, preventive care.

3. STAR Health Coordination and Advocacy

Refuge House will actively coordinate with STAR Health to ensure that children receive all benefits and services available through this specialized managed care program for children in foster care. This coordination includes verifying enrollment, assisting with provider selection, navigating authorization processes, and advocating for children when services are denied or access barriers exist.

STAR Health coordination will be integrated with Service Plan development to ensure that health services support each child's overall goals for safety, permanency, and well-being. Refuge House will maintain ongoing communication with STAR Health providers and service coordinators to ensure coordinated, comprehensive care.

4. Medication Management and Safety

Refuge House implements comprehensive medication management protocols ensuring the safe administration, monitoring, and documentation of all medications prescribed for children in care, including enhanced oversight for psychotropic medications consistent with DFPS guidelines.

Relocated (cleanup, 6/19/2026): The full medication management governance — consent, prescription and non-prescription administration, the cumulative medication record and 24-hour documentation rule (26 TAC §749.1541), medication errors (§749.1561–1565), adverse reactions and side effects (§749.1581/1583), self-medication programs (§749.1501/1503), storage and destruction (§749.1521), and psychotropic medication oversight (§749.1603–1611) — now lives in the standalone FC-MED-01 Medication Management Policy and FC-MED-01.1 Medication Management Procedure. Refer to those documents for medication requirements. Package-specific medication enhancements remain in this policy's Package-Specific Requirements sections.

5. Vision, Hearing, and Developmental Screening

Refuge House will ensure that all children receive appropriate vision and hearing screenings to identify potential problems that could affect their development, learning, and overall quality of life. These screenings will be completed within thirty days of placement and integrated with regular medical checkups according to Texas Health Steps requirements.

For children under three years of age, Refuge House will facilitate access to Early Childhood Intervention services when developmental concerns are identified, supporting early intervention that can significantly improve long-term outcomes for children with developmental delays or disabilities.

6. Trauma-Informed Health Care Approaches

Refuge House will implement trauma-informed approaches to all health care coordination and services, recognizing that children in foster care have often experienced medical trauma or have anxiety related to medical procedures. This commitment includes training foster parents in trauma-informed support strategies, preparing children for medical appointments using age-appropriate approaches, and advocating with medical providers for trauma-informed care practices.

The TBRI principles of Connecting, Empowering, and Correcting will be integrated into all health care coordination to create felt safety, build trust, and support positive health care experiences that contribute to healing and healthy development.

7. Documentation and Quality Assurance

Refuge House will maintain comprehensive documentation of all health care coordination and services that meets regulatory requirements and supports continuity of care. This documentation will be integrated with Service Plans and reviewed regularly to ensure that health services are supporting each child's overall goals and that quality standards are maintained.

Quality assurance processes will monitor compliance with health care requirements, identify areas for improvement, and ensure that staff receive necessary training and support to provide effective health care coordination that meets the needs of children and families.

☒ COMPLEX MEDICAL NEEDS OR MEDICALLY FRAGILE SUPPORT SERVICES

Children served under the Complex Medical Needs or Medically Fragile Support Services Package require enhanced health care coordination that addresses their specialized medical conditions and supports their complex health needs. Refuge House commits to providing intensive health coordination that ensures these children receive appropriate medical care, necessary equipment and supplies, and specialized support for their caregivers.

8. Specialized Medical Care Coordination

Refuge House will coordinate with medical specialists, STAR Health service coordinators, and other healthcare professionals to ensure that children with complex medical needs receive comprehensive, coordinated care that addresses all aspects of their health conditions. This coordination will include regular communication with medical providers, integration of medical recommendations into daily care, and advocacy for necessary services and equipment.

Medical status reviews will be conducted every ninety days by qualified medical professionals to assess the child's condition, review treatment effectiveness, and adjust care plans as needed. These reviews will be documented and integrated into Service Plan reviews to ensure that medical care supports the child's overall goals.

9. Caregiver Training and Support

Refuge House will ensure that foster parents caring for children with complex medical needs receive specialized training and ongoing support to safely and effectively meet each child's medical requirements. This training will include instruction in the use of medical equipment, administration of specialized treatments, recognition of medical emergencies, and coordination with healthcare providers.

Training will be documented and updated as the child's medical needs change or as new equipment or procedures are introduced. Refuge House will provide ongoing support and consultation to help foster parents feel confident and competent in providing specialized medical care.

☒ MENTAL & BEHAVIORAL HEALTH, ☒ SUBSTANCE USE SUPPORT SERVICES, ☒ SEXUAL AGGRESSION/SEX OFFENDER, ☒ HUMAN TRAFFICKING VICTIM/SURVIVOR SUPPORT SERVICES

Children served under these specialized behavioral health packages require intensive mental health services and coordination that addresses their specific therapeutic needs while supporting their overall healing and development. Refuge House commits to providing comprehensive behavioral health coordination that integrates with the child's overall treatment plan and supports positive outcomes.

10. Intensive Behavioral Health Services

Refuge House will ensure that children in specialized behavioral health packages receive intensive therapeutic services that are tailored to their specific needs and circumstances. This includes weekly therapy sessions with qualified providers, coordination with psychiatric services when medication is prescribed, and integration of therapeutic recommendations into all aspects of the child's care.

Behavioral health services will be provided by qualified providers who have experience and training in trauma-informed care and evidence-based treatment approaches appropriate for each child's specific needs. Service coordination will ensure that all behavioral health providers work collaboratively to support the child's treatment goals.

11. Integrated Treatment Approach

Refuge House will implement an integrated approach to behavioral health care that ensures all services work together to support the child's healing and development. This integration includes coordination between therapists, psychiatrists, medical providers, and other professionals to ensure that all aspects of the child's care support their treatment goals.

Treatment planning will incorporate the child's voice and preferences when developmentally appropriate, and will involve foster parents and other caregivers in understanding and supporting the therapeutic process. Regular review of treatment progress will ensure that services remain effective and appropriate for the child's evolving needs.

☒ INTELLECTUAL OR DEVELOPMENTAL DISABILITY (IDD)/AUTISM SPECTRUM DISORDER SUPPORT SERVICES

Children served under the IDD/Autism Spectrum Disorder Support Services Package require specialized coordination that addresses their developmental needs while ensuring that medical and dental services are provided in ways that accommodate their specific challenges and sensitivities. Refuge House commits to providing individualized health coordination that supports both their developmental and medical needs.

12. Developmental Services Coordination

Refuge House will coordinate with developmental specialists, educational providers, and therapeutic services to ensure that children with intellectual disabilities or autism spectrum disorders receive comprehensive services that support their development and learning. This coordination will include regular communication with all providers to ensure that services are complementary and effective.

Health care coordination will be adapted to accommodate each child's specific needs, including sensory sensitivities, communication challenges, and behavioral considerations. Medical and dental appointments will be planned and conducted in ways that minimize stress and maximize the child's comfort and cooperation.

13. Accommodations and Support

Refuge House will ensure that appropriate accommodations are made for medical and dental care that address each child's specific needs related to their intellectual disability or autism spectrum disorder. This may include longer appointment times, specialized preparation for medical procedures, and coordination with providers who have experience serving children with developmental disabilities.

Foster parents will receive training and support in helping children with developmental disabilities navigate medical and dental care, including strategies for preparation, communication, and behavioral support during appointments. This training will be individualized to address each child's specific needs and characteristics.

☒ SUBSTANCE USE SUPPORT SERVICES (Enhanced)

For children receiving Substance Use Support Services, health care coordination includes specialized substance use assessment and treatment components:

14. Substance Use Screening and Assessment

Upon admission, Case Manager completes initial substance use screening documenting substances used, frequency, duration, and last use. Within 30 days of admission, comprehensive substance use assessment is coordinated through STAR Health to determine appropriate level of treatment.

15. Substance Use Treatment Services

Children in this package receive coordinated substance use treatment including:

16. Drug Screening as Clinical Tool

Drug screening is conducted as clinically indicated based on treatment team judgment. Screening serves as a clinical tool to inform treatment planning and is NOT used as a punitive measure. Positive screens result in treatment adjustment, not punishment, consistent with recovery-supportive approach.

17. STAR Health Coordination for Substance Use Services

All substance use treatment services are coordinated through STAR Health per FC10-01.2 STAR Health Coordination Procedure. Case Manager ensures:

18. Recovery Environment Health Supports

Health care coordination supports recovery environment including:

19. Elevated Human Trafficking Risk

Youth with substance use disorders may have elevated human trafficking risk. Enhanced screening per FC-HT-01 Human Trafficking Prevention Policy is required, with health indicators of trafficking monitored during all health care encounters.

☒ SHORT-TERM ASSESSMENT SUPPORT SERVICES

For children receiving Short-Term Assessment Support Services, health care coordination focuses on comprehensive, time-limited assessment to determine appropriate ongoing Service Package:

20. Expedited Assessment Timeline

Child Age Assessment Completion Deadline
Age 5 and under Within 21 days of admission
Age 6 and older Within 30 days of admission

All assessments must be completed within these timeframes to support Service Package determination before the placement time limit expires.

21. Comprehensive Assessment Domains

Assessment coordination addresses all applicable domains:

22. STAR Health Authorization for Multiple Assessments

Due to the assessment-intensive nature of this package, Case Manager coordinates multiple prior authorization requests through STAR Health per FC10-01.2 STAR Health Coordination Procedure. Authorization requests are submitted promptly upon admission to ensure assessments can be completed within required timeframe.

23. Assessment Tracking and Monitoring

Case Manager maintains assessment tracking log documenting:

Supervisor is alerted immediately if delays threaten timeline compliance.

24. Service Package Recommendation Health Component

Health assessment findings are integrated into Service Package recommendation. Treatment Director reviews all health-related assessments when determining appropriate ongoing Service Package, ensuring health needs inform placement decision.

25. No Ongoing Treatment Focus

This package focuses on assessment coordination, not ongoing treatment. While immediate health needs are addressed, the primary goal is completing assessments to inform Service Package determination. Ongoing treatment is provided by the receiving Service Package.

26. Documentation Transfer

All health assessment results are compiled in Transition Summary for transfer to receiving Case Manager, ensuring continuity of care and eliminating need to repeat assessments.

☒ T3C TREATMENT FOSTER FAMILY CARE (Enhanced)

For children in Treatment Foster Family Care, health care coordination supports intensive clinical intervention for children with serious mental, emotional, and/or behavioral disorders:

27. Intensive Therapeutic Services

Children in this package receive intensive therapeutic services coordinated through STAR Health:

All therapy services are provided by Licensed Therapist specializing in serious mental, emotional, and/or behavioral disorders.

28. Therapy Frequency Justification

Therapy frequency must be justified in writing in the Service Plan. Treatment Director provides clinical oversight ensuring therapy frequency aligns with child's treatment needs and Treatment Model.

29. Enhanced Psychiatric Coordination

Given the severity of mental health needs in this population:

30. Behavioral Health Crisis Response

Health care coordination includes behavioral health crisis protocols:

31. Treatment Director Clinical Oversight

Treatment Director provides monthly minimum clinical oversight of all therapeutic services:

32. STAR Health Authorization for Intensive Services

Due to intensive service requirements, Case Manager ensures:

33. Health Documentation for Step-Down Planning

Health care documentation supports step-down planning from Day 1:

PACKAGE-SPECIFIC HEALTH CARE REQUIREMENTS COMPARISON

Health Care Element Substance Use Short-Term Assessment Treatment Foster Care
Primary Focus Recovery support Assessment completion Intensive treatment
Therapy Frequency Weekly minimum As indicated by assessment Weekly minimum
Therapy Provider SU-qualified Per assessment need Specialist in serious MH/behavioral
Assessment Timeline Standard (30 days) Expedited (21/30 days by age) Standard (30 days)
Psychiatric Services As clinically indicated If indicated by assessment Required evaluation
Special Screening Substance use screening; Drug screening (clinical) Multiple domain assessment Enhanced MH assessment
STAR Health Focus SU treatment authorization Multiple assessment authorization Intensive therapy authorization
Treatment Director Role Clinical oversight Assessment review; Package recommendation Monthly clinical oversight
Crisis Protocol SU-specific crisis response Standard Enhanced behavioral crisis

DEFINITIONS:

CANS 3.0 Assessment: A multi-purpose tool used to support decision-making, including identifying the optimal Service Package for T3C and planning, facilitating quality improvement initiatives, and monitoring outcomes of children in care.

Early Childhood Intervention (ECI): A statewide program that provides services to families with children birth to 36 months with developmental delays or disabilities.

Primary Medical Needs (PMN): Refers to children who require medical equipment to sustain life or have conditions that require regular, ongoing care from medical professionals.

STAR Health: A comprehensive, managed care approach for addressing healthcare needs of children in foster care, which includes physical health, behavioral health, dental, vision, and pharmacy services.

TBRI® (Trust-Based Relational Intervention): An evidence-informed approach designed for children who have experienced relationship-based traumas, focusing on building trust and secure attachments through three principles: Connecting, Empowering, and Correcting.

Texas Health Steps: The Texas Health Steps program provides medical and dental checkups and care to children from birth through age 20 who have Medicaid.

Comprehensive Substance Use Assessment: Clinical evaluation conducted by qualified substance use treatment provider to determine appropriate level of substance use treatment, including assessment of substance use history, severity, and treatment recommendations.

Drug Screening (Clinical): Laboratory testing for presence of substances used as a clinical tool to inform treatment planning, NOT as a punitive measure. Positive results trigger treatment adjustment, not punishment.

Expedited Assessment Timeline: Shortened assessment completion deadline for Short-Term Assessment package (21 days for age 5 and under; 30 days for age 6+) to support Service Package determination within placement time limits.

Medication-Assisted Treatment (MAT): Use of FDA-approved medications in combination with counseling and behavioral therapies to treat substance use disorders.

Service Package Determination: Clinical decision regarding appropriate ongoing T3C Service Package based on comprehensive assessment findings; applies specifically to Short-Term Assessment transitions.

REFERENCES:

SSCC alignment (FY-26): Reviewed against the 2INgage Provider Manual Rev. 1.2026; aligned — no additional provider-specific provisions required. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC coverage tracker (temporary-reference/fy26-sscc-joint-monitoring/sscc-alignment/).

SSCC alignment (FY-26) — EMPOWER: EMPOWER Provider Manual Rev. 1.2026 — reviewed; aligned, no additional provider-specific provisions required. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — OCOK: OCOK Network Management Operations Manual Rev. 7-1-2025 — reviewed; aligned, no additional provider-specific provisions required in this document. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — 4Kids: 4Kids4Families Joint Operations Manual (Dec 2025) / Subcontractor Agreement — reviewed; aligned (4Kids items here are casework/Minimum-Standards-level), no additional provider-specific provisions required in this document. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — Belong: Belong Stage I & II Provider Manual (Aug 2025) / Provider Services Agreement — reviewed; aligned, no additional provider-specific provisions required in this document. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

SSCC alignment (FY-26) — SFCS: SFCS Placement Provider Manual (July 2020, publicly-sourced — currency unconfirmed) / 2019 Affiliate Provider Agreement — reviewed; aligned, no additional provider-specific provisions required in this document. Cross-reference: FC-CQI-01 Continuous Quality Improvement Policy; FY-26 SSCC variance matrix.

RELATED PROCEDURES:

FORMS/ATTACHMENTS:


This policy document establishes the governing principles for Physical and Mental Health Care. The corresponding procedure document (FC10-01.1) operationalizes these principles 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.