Substance Use Support Services

Service Package Summary

Service Package Description

A trauma-informed foster home that in addition to providing a child's basic living needs, including food, clothing, shelter, education, vocation, transportation, recreation, and extracurricular needs, has enhanced training and skill in coordinating services and providing care for children, youth, and young adults that may present with a DSM-5 diagnosis of substance-related disorder or with challenges with recurring substance use, and who require routine clinical intervention to support and manage day-to-day activities.

The Substance Use Support Services Package is designed to offer community-based care and treatment/recovery services for children, youth, and young adults based on their individual strengths and needs, and in accordance with their customized Service Plan and permanency goal.

Service Package Expectations

In addition to, and/or consistent with Statutory and Minimum Standards Requirements:

• Child Placing Agency must ensure that child receives regular and frequent individual, family, and group therapy (dependent on eligibility, therapy services should be authorized and paid for through STAR Health). The Service Planning team and Licensed Therapist will determine the frequency which will be customized to align with the child's individual needs, and authorization requests will be sent to STAR Health as needed for Medicaid-covered services. The Child Placing Agency will ensure that written justification of assessed need (to include frequency of therapeutic services) is included in the Service Plan. Therapy services should be provided by a Licensed Chemical Dependency Counselor or Qualified Credentialed Counselor, unless the Service Planning team determines a different type of therapist is needed to meet the child's custom needs. If services are Medicaid-covered services, therapy providers must be credentialed and contracted with the STAR Health managed care organization.

• Service Planning team meetings must occur in accordance with the provider's Treatment Model and based on the child's needs and permanency plan, but a Service Plan review must occur once at least every 90 days. As informed by the child (if appropriate), youth or young adult, and in collaboration with the Service Planning team, the Service Plan must include customized goals, and the planned service(s) and support(s) that will be provided to help with achievement of goals. Service Plan reviews must include documentation to show the progress made toward achieving each goal.

• Evidence-informed Treatment Model(s) that incorporates trauma-informed care for children that have been the victim of abuse and/or neglect. The Treatment Model must include specific programming designed to meet the custom needs of children, youth, and young adults who qualify for the Substance Use Support Services Package. The Treatment Model should be practiced throughout the operation and used as the basis to form all policy, procedures, and practices related to this Service Package. Children, youth, and young adults must be aware of, and all staff and Caregivers providing these services must be trained in, practice, and remain current with, delivery of the Treatment Model.

• The Child Placing Agency must maintain a current Logic Model specific to the provision of the Substance Use Support Services Package, which is modified over time based on the Child Placing Agency's Continuous Quality Improvement process.

• Child Placing Agency must have case manager level or above staff available 24 hours a day/7days a week to respond in person, or by phone or video conference, to any crisis that arises. The operation must ensure that an on-call Licensed Chemical Dependency Counselor (LCDC), or Qualified Credentialed Counselor (QCC) is available to provide consultation.

• The child's CANS 3.0 Assessment must be administered in accordance with the requirements. Results of the most recent CANS 3.0 Assessment must be used to inform the customized Service Plan, including adjustments to the type of, frequency, and duration of services. Children over the age of 3, youth, and young adults receiving this Service Package must receive a CANS 3.0 Assessment every 90 days.

• A Universal Human Trafficking Prevention Training for all staff and Caregivers. Children, youth, and young adults must receive information related to the prevention of Human Trafficking in accordance with the Child Placing Agency's documented and planned method.

• Dedicated Paid Intermittent Alternative Care Program that supports Caregiver wellness and retention. This program must be designed to ensure that, subject to certain exceptions, the Caregiver taking Intermittent Alternative Care receives the same daily rate as the Caregiver offering Intermittent Alternative Care for the same days of care.

• Child Placing Agency is required to have an Information Technology (IT) System(s) that allows for data collection to support Quality Assurance, Continuous Quality Improvement, case management documentation, billing/invoicing, reporting, and child-level outcome tracking processes, as well as tracking outcomes for children, youth, and young adults at the foster home level. The provider must have the ability to track Substance Use Support Services Package referral, admission, and discharge data by child, youth, or young adult, broken out by referral source (whether SSCC or DFPS), the number and percentage of referrals that did, and did not result in admission, the reasons for denial of admissions based on referrals, and for children that were admitted, the average Length of Service, based on time from admission to discharge.

• The Child Placing Agency must maintain Insurance in accordance with SSCC and/or DFPS contractual requirements.

• Awake night supervision in foster homes where there are 7 or more children. Please note that a variance issued by HHSC-CCR is required for foster homes with more than 6 children.

• Foster Family Home Caregivers offer logistical support, transportation, coordination, and documentation/record keeping of services in accordance with court orders and the Service Plan.

• Child Placing Agency and Foster Family Home Caregivers must have enhanced skill in navigating multiple systems, and advocate for and provide coordination of services through STAR Health, HHSC Behavioral Health Services, Early Childhood Intervention (if applicable), and the education and child welfare systems specific to children, youth, and young adults who qualify for the Substance Use Support Services Package.

• In collaboration with the Medical Consenter, the Child Placing Agency must document all services the child, youth, or young adult is receiving through STAR Health, HHSC Behavioral Health, Early Childhood Intervention, the education system, and any other county, community, or state agency. Requests for specific services determined necessary as a part of the CPA's Service Plan or Service Plan review, and for which the child, youth, or young adult is referred, and the service is not readily available and/or it is determined that the child, youth, or young adult is ineligible for the service must also be documented by the Child Placing Agency in the case record. This documentation should include the date the service request, application, or referral was made, the specific type of service being requested, and the status of the service request, including the reason provided for the denial (if applicable), and status of any service request appeals (if applicable). The Child Placing Agency should notify the SSCC or DFPS caseworker of any challenges encountered with access to services, and/or service referral denials within 3 business days. The Child Placing Agency should seek community resources to obtain any needed services that are not covered through STAR Health. If community resources are not available and/or STAR Health does not cover the needed service(s) consistent with the specific Service Package, and as outlined in the CPA's Service Plan or Service Plan review, the Child Placing Agency must ensure delivery of, and cover the cost of the needed service(s) and related supports.

• This Service Package requires coordination and participation in school enrollment, including advocating for, and ensuring various educational testing and plans are completed, and accommodations and/or supports are in place to aid in the child's educational success.

• Child Placing Agency and Foster Family Home Caregiver are required to coordinate care with the child or youth's medical consenter and is required to participate in STAR Health Service Coordination (dependent and based on child, youth, or young adult's individual eligibility).

• Foster Family Home Caregiver is required to participate in STAR Health Service Coordination (dependent on eligibility).

• Foster Family Home Caregivers must support Normalcy activities to include, but not limited to, clothing, hygiene products, hair care, birthdays, holidays, graduations, and other Normalcy activities that are age appropriate and in accordance with the Service Plan.

• To the extent that it is safe and appropriate, and in collaboration with the DFPS or SSCC caseworker, the Child Placing Agency and Foster Family Home Caregivers must outreach to, engage, and collaborate with the child, youth, or young adult, their biological parents, other relatives (including all siblings), potential Kinship (including fictive) Caregivers, adoptive Caregivers, and supportive persons in care coordination and Service Planning throughout the duration of the child's placement, and as a part of Aftercare Services (if appropriate). The Child Placing Agency must have policy that outlines the Child Placing Agency's family outreach and engagement approach and process for inclusion of all individuals previously listed, which includes working with the child, youth, and young adult to identify family members and/or other supportive persons and sharing this information with the SSCC or DFPS (if child is from an area not yet under CBC) caseworker. Family outreach and engagement efforts must be documented as a part of the Service Plan and in Aftercare Service documentation (if appropriate) in the child's case record maintained by the Child Placing Agency.

• In addition to maintaining the necessary Credential to provide the Substance Use Support Service Package, the Child Placing Agency and Foster Family Home Caregivers must be Credentialed to provide the T3C Basic Foster Family Home Support Service Package. This will allow for the child, youth, or young adult to transition to, and receive the T3C Basic Foster Family Home Service Package in the same foster family home, when the SSCC or DFPS (in areas not operating under Community-Based Care) in collaboration with the Child Placing Agency (as informed by the Quality Assurance & Continued Stay Guidelines) determines the child has successfully completed, and no longer requires, the therapeutic and recovery services inherent in the Substance Use Support Service Package.

Anticipated Length of Service

Length of service is individualized and based on the Child Placing Agency's Treatment Model for providing the Substance Use Support Services, Admission Guidelines, and Continued Stay Guidelines, as well as the child's CANS 3.0 Assessment, and the child's ability to make progress in accordance with the Service Plan.

Although the exact Length of Service will be customized in accordance with the operation's Continued Stay Guidelines, the Child Placing Agency's policy must include an anticipated Length of Service for children, youth, and young adults served under the Substance Use Support Services Package.

Staffing Requirements

• Full-time Licensed Child Placing Agency Administrator dedicated to single Child Placing Agency.
• Child Placing Agency must have a Program Director (this position may serve as the Licensed Child Placing Agency Administrator for the operation) that is responsible for the overall administration, operations, and management of services, including those inherent in the Substance Use Support Services Package.
• Program Director must have a bachelor's level or above degree; at least 5 years' experience working in a residential childcare setting can substitute for education.
• Child Placing Agency must have a Treatment Director whose responsibilities include supervision of LCDC and/or QCC therapists on staff.
• The Treatment Director must be either:
  • Be a psychiatrist or psychologist.
  • Have a master's degree in human services field from an accredited college or university and three years of experience providing treatment services for children with an emotional disorder, including one year in a residential setting; or
  • Be a licensed master social worker, a licensed clinical social worker, a licensed professional counselor, or a licensed marriage and family therapist, and have three years of experience providing treatment services for children with an emotional disorder, including one year in a residential setting.
• Identified personnel and infrastructure to support the following:
  • Case Management
  • Intake/Placement
  • Staff Training and Workforce Development
  • Crisis Management Staff
  • Licensed Chemical Dependency Counselor (LCDC) or Qualified Credentialed Counselor (QCC) to oversee treatment and service planning for children, youth, and young adults
  • Staff Recruitment and Retention
  • Foster Family Home Caregiver Recruitment and Retention
  • Education liaison for children in care
  • Aftercare Services Planning and Case Management
  • Continuous Quality Assurance and Improvement Program
  • Billing, cost reporting, and claims administration
  • Cross-system coordination including, but not limited to, maintaining, and supporting the child's school, medical, dental, behavioral health, and other service needs. Must be well-versed in STAR Health services to ensure that children, youth, and young adults in need of the Substance Use Support Services Package maximize benefits based on eligibility and meeting medical necessity for the service(s).

Depending on the size of the Child Placing Agency, and subject to Minimum Standards and SSCS/DFPS Contract requirements, the identified personnel responsible for some of the tasks listed above may serve more than one function and may be under contract with the Child Placing Agency (as opposed to being employed staff of the Child Placing Agency).

If the Child Placing Agency chooses to contract for or enter into a written agreement for provision of any of the tasks, the contracted personnel must be trained in, practice, and remain current with delivery of the Child Placing Agency's Evidence-informed Treatment Model.

All Treatment Director and Case Management functions must be performed by actual employees of the Child Placing Agency.

Generally Appropriate Staff to Child Ratio

• 1 Child Placing Agency Case Manager for every 15 children being provided Substance Use Support Services.
• 1 Crisis Management Staff for every 25 children being provided Substance Use Support Services.
• 1 Licensed Chemical Dependency Counselor (LCDC) or Qualified Credentialed Counselor (QCC) for every 13 children being provided Substance Use Support Services.
• 1 Aftercare Case Manager for every 25 children being provided Substance Use Support Services.

Staff to Child Ratio(s) may vary based on an operation's specific Evidence-informed Treatment Model and dependent on the complexity of the caseload.

Hours of Operation

Admissions and placement staff on-call/available 365 days per year, 24 hours per day, to screen and admit children, youth, and young adults requiring Substance Use Support Services.

Desired Individual Outcome

• Child Placing Agency must have clearly articulated child-level outcome expectations that tie directly to the operation's Substance Use Support Services Treatment Model, and support the following at a minimum:
  • Child Safety,
  • Child's Permanency Goal, and
  • Child's Well-Being.
• Child Placing Agency must have infrastructure in place to collect, track, and evaluate/analyze child outcomes (both during placement and as a part of Aftercare Services), including being able to analyze outcomes based on individual foster family homes.

Admission Guidelines

In addition to, and/or consistent with Statutory and Minimum Standards Requirements:

• Placement type and Service Package aligns with the child's needs and strengths as demonstrated through the CANS 3.0 Assessment (if administered prior to need for admission), Application for Placement, and/or based on the knowledge and professional judgment of the child's Service Planning team.
• A Pre-Placement visit has been conducted (when applicable and appropriate) and was successful.
• Child Placing Agency admissions staff have reviewed the child's information and determined that the child's needs align with services offered by the Child Placing Agency and selected Caregivers.
• The Child Placing Agency and Foster Family Home are Credentialed to provide the Substance Use Support Services Package.

Quality Assurance and Continued Stay Guidelines

Quality Assurance and Continued Stay Guidelines incorporated in the provider's policy and procedures, that include:

• On-going review and adjustment of services based on subsequent CANS 3.0 Assessment and on the Service Plan.
• The primary reason the child met the Admission Guidelines continues to require on-going services or are replaced with other service needs that align to the Credentialed Service Package offered and meet Admission Guidelines.
• The services continue to support the child's individual need for safety, improved well-being, and permanency in accordance with the child and family Service Plans.
• The child, youth, or young adult's needs continue to require a level of intervention that cannot be offered under the less-restrictive T3C Basic Foster Family Home Service Package.
• Considering the most recent CANS 3.0 Assessment, and in conjunction with each 90-day Service Plan review, the Child Placing Agency's Program Director, and the Treatment Director responsible for the Substance Use Support Services Package, must review the child's goals and services to ensure they align with child's custom strengths, needs, and permanency plan. The Program Director and Treatment Director must provide written confirmation that the child, youth, or young adult continues to meet criteria for and is benefitting from the Evidence-informed Treatment Model offered through the program, and that the less-restrictive T3C Basic Foster Home Service Package is not appropriate to meet the child's custom needs. Written confirmation should be documented in the Child Placing Agency's case record for the child, and a copy should be provided to the SSCC or DFPS (in areas that have not transitioned to CBC) caseworker within 15 business days of review and confirmation.
• The Child Placing Agency and Foster Family Home continue to maintain the Credential necessary to provide the Substance Use Support Services Package.

Aftercare Services

• The Substance Use Support Services Package requires the planning and provision of Aftercare Services.
• Funding to support the Aftercare Services has been built into the Child Placing Agency's daily foster care rate while the child is in care, the agency will not receive a separate payment for the provision of the required Aftercare Services.
• Upon discharge (both successful and unsuccessful), the child, youth, or young adult will exit placement with a robust Aftercare Services plan (which may be incorporated as a part of the Service Plan) that at a minimum, includes the name and contact information for the STAR Health Service Coordinator (if assigned) and the Child Placing Agency's Aftercare Services Case Manager, referrals for continued services, Education Portfolio, initial appointments set (if transition is needed), as well as a plan with times and dates set for twice a month follow-up calls and/or meetings for a period of 6 consecutive months. Additional in-person or virtual ad-hoc meetings/staffings, as well as referrals for new or additional services, may be required during the 6-month aftercare period.
• The Child Placing Agency must maintain written documentation of all contacts or attempted contacts, referrals, and other case management support provided during the Aftercare Service period in the Child Placing Agency's case record for the child. A copy of the documentation should be provided to the SSCC or DFPS caseworker at the end of each month during the Aftercare Service period.