REFUGE HOUSE, INC.

PURPOSE:

To establish a standardized process for ensuring children, youth, and young adults in Refuge House foster care receive timely, appropriate, and well-coordinated physical, dental, vision, and mental health care services that align with T3C requirements, STAR Health protocols, and trauma-informed practices.

RELATIONSHIP BETWEEN POLICY AND PROCEDURE:

This procedure operationalizes the Physical and Mental Health Care Policy (FC10-01) by providing specific implementation steps for ensuring comprehensive health care coordination. While the policy establishes that "Refuge House is committed to ensuring that all children, youth, and young adults in care receive comprehensive physical, dental, vision, and mental health services," this procedure details the specific actions, timeframes, and documentation requirements needed to fulfill that commitment in compliance with regulatory standards and T3C Package requirements.

RESPONSIBILITY:

• Case Managers
• Program Directors/LCPAAs
• Treatment Directors
• Home Developers
• Intake Department
• Foster Parents
• Quality Assurance
• Substance Use Counselor (for SU package coordination)
• STASS Coordinator (for time-limited assessment services)

IMPLEMENTATION GUIDANCE:

This procedure addresses health care requirements across both Minimum Standards and T3C Service Packages. 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 procedure document identifies:

• Minimum Standards Requirements: Core requirements that apply to ALL children regardless of Service Level or T3C Package (identified as "Core Requirements")
• Legacy Service Level Requirements: Specific requirements based on Basic, Moderate, or Specialized Service Levels (identified where applicable during the transition period)
• T3C Package-Specific Requirements: Enhanced requirements that apply only to specific T3C Packages (clearly marked with package names)

Case Managers should identify which system applies to each child and follow the appropriate requirements accordingly. When a child transitions from Service Levels to a T3C Package, the T3C Package requirements will supersede the legacy Service Level requirements.

PROCEDURE:

1. INITIAL HEALTH COORDINATION

Purpose and Overview

The initial health coordination process ensures that every child entering Refuge House care receives immediate attention to their health needs and establishes the foundation for ongoing health care management. Our policy emphasizes that "Refuge House recognizes the critical importance of addressing each child's comprehensive health needs as part of promoting their overall well-being and development." This initial coordination sets the stage for achieving that comprehensive approach.

The first days of placement are critical for health coordination because children may arrive with immediate medical needs, unclear health histories, or anxiety about medical care due to past trauma. The policy states that "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." This procedure section provides the specific steps needed to gather essential health information, verify insurance coverage, and prepare both the child and foster family for ongoing health care coordination.

Effective initial health coordination also supports the T3C model's emphasis on comprehensive assessment and individualized service planning. By systematically gathering health information and coordinating with STAR Health from the beginning, we create the foundation for health services that are tailored to each child's specific needs and integrated with their overall service plan.

2. MEDICAL CARE COORDINATION

Purpose and Overview

Medical care coordination ensures that every child receives timely, appropriate medical examinations and treatment in accordance with Texas Health Steps requirements and T3C standards. The policy establishes that "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." This coordination is essential for maintaining children's health and supporting their overall development.

The Texas Health Steps program provides comprehensive medical services for children in foster care, and compliance with Texas Health Steps requirements is not only a regulatory mandate but also a critical component of quality care. Children in foster care often have complex health needs due to their histories of trauma, neglect, or inadequate medical care prior to placement. Our systematic approach to medical coordination ensures that these needs are identified and addressed promptly.

For children in specialized T3C packages, medical coordination takes on additional importance as health needs may be directly related to the reasons for their specialized placement. The procedure steps below ensure that all children receive appropriate medical care while those in specialized packages receive the enhanced coordination their conditions require.

3. DENTAL CARE COORDINATION

Purpose and Overview

Dental care coordination ensures that children receive appropriate preventive and treatment dental services according to Texas Health Steps requirements. Many children entering foster care have significant dental needs due to neglect or lack of access to dental care in their previous living situations. Our policy recognizes that comprehensive health care includes dental health, and establishing good dental care patterns supports both immediate health needs and long-term wellness.

The timing requirements for dental examinations are specifically designed to identify urgent dental problems quickly while ensuring that all children receive comprehensive dental assessments within reasonable timeframes. For very young children, the timing of initial dental visits is tied to the emergence of teeth and the child's developmental readiness for dental care.

Regular dental care not only addresses immediate problems but also establishes positive dental health habits that children can carry into adulthood. Through coordination with STAR Health dental providers and support for foster parents, we ensure that dental care becomes a normal, non-threatening part of each child's health care routine.

4. VISION AND HEARING SCREENING

Purpose and Overview

Vision and hearing screening is essential for identifying potential problems that could significantly impact a child's development, learning, and overall quality of life. Many children in foster care have not received regular vision and hearing screenings, and unidentified problems in these areas can contribute to behavioral challenges, academic difficulties, and social problems that may be misattributed to trauma or other factors.

Early identification of vision and hearing problems allows for prompt intervention, which can dramatically improve outcomes for children. The policy emphasizes the importance of comprehensive health assessments, and vision and hearing screening are critical components of this comprehensive approach. These screenings are typically integrated into regular medical checkups but may require specialized follow-up if problems are identified.

The trauma-informed approach is particularly important for vision and hearing screening because the procedures can be anxiety-provoking for children who have experienced medical trauma or who have sensory sensitivities related to their trauma history.

5. IMMUNIZATION MANAGEMENT

Purpose and Overview

Immunization management ensures that children receive all required immunizations according to CDC recommendations and state requirements while maintaining accurate records that comply with regulatory standards. Children entering foster care may have incomplete immunization records or may be behind on recommended immunizations, making this a critical area for immediate attention and ongoing monitoring.

The immunization process requires careful coordination between reviewing existing records, identifying needed immunizations, and ensuring timely administration of vaccines. This process must be completed quickly to protect the child's health and ensure compliance with school and program requirements. Documentation of immunizations must meet specific regulatory standards and be readily accessible for various purposes including school enrollment and medical care.

The trauma-informed approach to immunizations recognizes that medical procedures can be particularly challenging for children who have experienced trauma, and the process should be designed to minimize anxiety and build positive associations with medical care.

6. MENTAL HEALTH AND DEVELOPMENTAL SERVICES

Purpose and Overview

Mental health and developmental services address the complex psychological and developmental needs of children who have experienced trauma, loss, and disruption in their lives. Our policy acknowledges that "physical and mental health care are interconnected and essential components of trauma-informed care" and emphasizes that "All health care services will be implemented with consideration of each child's trauma history and individual needs."

The T3C model places significant emphasis on trauma-informed care and evidence-based treatment approaches. For children in specialized mental health packages, these services become the primary focus of their care coordination. For children in basic foster care, mental health services provide essential support for healing and healthy development. Early identification of developmental concerns through ECI services for young children ensures that interventions begin as early as possible when they are most effective.

The integration of psychological evaluations, therapy services, and specialized interventions must be carefully coordinated to ensure that all services work together to support the child's healing and development rather than creating additional stress or confusion.

Implementation guidance (ECI follow-through). The §4820 five-day enrollment-verification letter, §4830 decline report, and §4850 Health Passport/caseworker consents are planned as dated Pulse tasks triggered by ECI referral outcomes; until built, the Case Manager files each document and its send date in Radius. | Case Manager | 1. Make referral for psychological/developmental evaluation 2. Ensure evaluation is completed within required timeframe 3. If scheduling delays occur, document when evaluation is scheduled 4. Coordinate with STAR Health for evaluation authorization | Within 3 days of placement; evaluation completed within 30 days | Psychological evaluation providers | TAC §749.1413; Evaluation requirements | | Case Manager | 1. Upon receiving evaluation results, complete Psychological Evaluation service plan addendum 2. Include diagnosis, recommendations, and Refuge House implementation plan 3. Email completed psychological evaluation to DFPS/SSCC caseworker 4. Schedule annual evaluation updates | Upon receipt of evaluation results | Service Plan documentation | T3C Blueprint p.47-55; Service planning | | Treatment Director | 1. Review psychological evaluation for treatment recommendations 2. Develop implementation plan for recommended interventions 3. Coordinate between evaluation recommendations and TBRI implementation 4. Ensure Service Plan reflects psychological evaluation findings | Within 5 days of receiving evaluation | Clinical review and planning | T3C Blueprint p.47-55; Clinical coordination |

7. THERAPY SERVICES COORDINATION

Purpose and Overview

Therapy services coordination ensures that children receive appropriate therapeutic interventions based on their individual needs and service package requirements. The policy states that "Foster parents will be actively engaged in the health care process, receiving training, guidance, and support to meet each child's specific health needs," and therapy coordination is a critical area where this engagement is essential for success.

During the transition period, therapy requirements vary significantly between the legacy Service Level system and the new T3C packages. Case managers must clearly understand which system applies to each child and ensure that therapy services meet the appropriate standards. The frequency and intensity of therapy services are carefully calibrated to match the child's needs and the service expectations of their assigned package.

Coordination with therapists involves more than simply scheduling appointments; it requires ongoing communication about treatment progress, integration of therapeutic recommendations into daily care, and regular review of treatment effectiveness. This coordination supports the T3C model's emphasis on evidence-informed treatment and outcome measurement.

8. MEDICATION MANAGEMENT

Relocated — see FC-MED-01.1 Medication Management Procedure

Note (cleanup, 6/19/2026): The full medication management workflow — same-day logging, the cumulative medication record (26 TAC §749.1541), the automated reminder/escalation service, the "log-on-behalf" override, medication errors (§749.1561–1565), adverse reactions and side effects (§749.1581/1583), psychotropic consent/notification/monitoring (§749.1603–1611), self-medication programs (§749.1501/1503), storage and destruction (§749.1521), and the Pulse medication dashboard — has been consolidated into the standalone FC-MED-01.1 Medication Management Procedure (governed by FC-MED-01 Medication Management Policy).

Refer to FC-MED-01.1 for all medication administration, documentation, error, side-effect, psychotropic, self-medication, storage, and compliance-monitoring steps. Package-specific medication enhancements remain in Sections 9–12 of this procedure (e.g., MAT coordination for Substance Use; enhanced psychiatric medication management for MBH and Treatment Foster Family Care).

9. PACKAGE-SPECIFIC HEALTH REQUIREMENTS

Purpose and Overview

Package-specific health requirements ensure that children in specialized T3C packages receive the enhanced health coordination and services that their conditions require. While all children receive comprehensive health care, those in specialized packages have additional needs that require more intensive coordination, specialized providers, or enhanced monitoring.

The T3C model recognizes that children with complex medical needs, behavioral health challenges, or developmental disabilities require individualized approaches that go beyond standard foster care health services. These package-specific requirements ensure that health services are tailored to support the specific goals and outcomes expected for each specialized package.

Implementation of package-specific requirements requires close coordination between case management, clinical staff, specialized providers, and STAR Health service coordination to ensure that all components of the child's health care work together to support their specialized needs.

10. SUBSTANCE USE SUPPORT SERVICES HEALTH CARE PROCEDURES

Purpose and Overview

Health care procedures for children and youth in the Substance Use Support Services package require integration of recovery-focused health services with traditional medical care coordination. These procedures ensure that substance use treatment, including Medication-Assisted Treatment (MAT) when appropriate, is coordinated alongside physical health care in a trauma-informed manner that supports sustained recovery.

The policy establishes enhanced health care requirements including "Substance Use Assessment and Treatment Coordination within 21 days of placement" and "Medication-Assisted Treatment (MAT) coordination when clinically appropriate." These procedures provide the operational steps for implementing these requirements while ensuring drug screening is used as a clinical tool rather than a punitive measure.

11. SHORT-TERM ASSESSMENT SUPPORT SERVICES HEALTH CARE PROCEDURES

Purpose and Overview

Health care procedures for children and youth in the Short-Term Assessment Support Services (STASS) package focus on completing comprehensive health assessments efficiently within the time-limited service period (30-45 days). These procedures prioritize rapid identification of health needs and establishing a complete health picture to inform recommendations for appropriate ongoing placement and services.

The policy establishes that "STAR Health Service Coordination is requested within 3 business days of placement" and health assessments follow "Expedited Assessment timelines (21 days for ages 0-5, 30 days for ages 6+)." These procedures ensure health assessment completion supports the overall assessment process and generates comprehensive health documentation for transition to the recommended service package.

12. T3C TREATMENT FOSTER FAMILY CARE HEALTH CARE PROCEDURES

Purpose and Overview

Health care procedures for children and youth in the T3C Treatment Foster Family Care (TFFC) package require intensive psychiatric and behavioral health coordination alongside standard medical care. These procedures support the package's focus on time-limited, intensive treatment leading to step-down to lower levels of care within the 365-day maximum service period.

The policy establishes enhanced requirements including "Initial Psychiatric Evaluation within 14 days of placement," "Monthly Treatment Director reviews of psychiatric care and treatment progress," and "Treatment Director oversight required for all psychiatric medication changes." These procedures ensure intensive health coordination supports treatment goals while preparing for successful step-down.

13. DOCUMENTATION AND QUALITY ASSURANCE

Purpose and Overview

Documentation and quality assurance processes ensure that all health coordination activities are properly recorded, monitored, and evaluated for effectiveness and compliance. Our policy emphasizes that "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."

The documentation requirements serve multiple purposes: they ensure regulatory compliance, support continuity of care when staff changes occur, provide evidence of appropriate services for auditing purposes, and create a comprehensive health history that follows the child throughout their placement and beyond. Quality assurance processes help identify areas for improvement and ensure that documentation standards are consistently maintained.

The integration of health documentation with the overall Service Plan and T3C Implementation Tool ensures that health services are not viewed in isolation but as integral components of the child's comprehensive care plan that supports their safety, permanency, and well-being.

REGULATORY REFERENCES:

• T3C Blueprint: Pages 47-55, T3C Basic Foster Family Home Support Services; Pages 99-110, Complex Medical Needs or Medically Fragile Support Services
• TAC §749.1401-1435 (Medical and Dental Care)
• TAC §749.1461/1463/1469 (medication consent & administration); §749.1603–1611 (psychotropic medication)
• DFPS 24-Hour RCC Requirements (FY26): §§4800–4850 (ECI referral, enrollment verification, decline reports, Health Passport/caseworker consents), §5000, §5700 (legacy "RCC Contract: Term 7" citation superseded by FY26 section numbering)
• SSCC Contract: (if applicable)
• Texas Health Steps Periodicity Schedule

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.

FORMS/ATTACHMENTS:

• DFPS Medical/Dental/Vision Appointment Form (https://www.dfps.state.tx.us/Child_Protection/Medical_Services/documents/Medical_Appointment_Form.pdf)
• DFPS Form 2403 — Medical/Dental/Vision/Hearing/Behavioral-Health Appointment Form
• DFPS Form 4526 — Psychotropic Medication Treatment Consent
• Medication Error Form
• Medication Administration Record
• Immunization Worksheet
• TB Screening Documentation Form
• Texas Health Steps Periodicity Schedule (https://www.hhs.texas.gov/providers/health-services-providers/texas-health-steps/forms-tools-resources/periodicity-schedule)
• STAR Health Member Handbook (https://www.superiorhealthplan.com/members/medicaid/star-health/resources.html)
• STAR Health Contact Information (https://www.superiorhealthplan.com/members/medicaid/star-health/contact-us.html)

Substance Use Support Services Forms:

• Substance Use Health Care Coordination Checklist
• MAT Coordination and Monitoring Log
• Drug Screening Clinical Documentation Form

Short-Term Assessment Support Services Forms:

• STASS Assessment Tracking Form
• STASS Health Summary for Transition
• Expedited Assessment Timeline Worksheet

T3C Treatment Foster Family Care Forms:

• TFFC Psychiatric Care Coordination Log
• Treatment Director Monthly Health Review Form
• TFFC Health Care Transition Summary (for Step-Down)

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.