T3C Treatment Foster Family Care Support Services

Service Package Summary

Service Package Description

A trauma-informed, highly-structured 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 highly-trained Foster Family Home Caregivers with skill in providing Time-limited, strength-based therapeutic services to children, youth, and young adults who may present with a DSM-5 diagnosis for an emotional, conduct, or behavioral disorder and for whom structured and frequent clinical intervention and complex case management is needed to support and manage day-to-day activities.

In addition to the DSM-5 diagnosis for an emotional disorder, the child may demonstrate two or more of the following:

• Major self-injurious actions, including a suicide attempt within the last 12 months;
• Difficulties that present a significant risk of harm to others, including frequent or unpredictable physical aggression; or
• An additional DSM-5 diagnosis of substance-related and/or addictive disorder with severe impairment.

The T3C Treatment Foster Family Care Support Services Package is designed to offer community-based, Time-Limited, concentrated treatment 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.

These services were designed to adhere to the model codified in the Texas Family Code Sec. 264.1073 and included in the Texas Administrative Code Rule §700.1335. Children, youth, and young adults receiving the T3C Treatment Foster Family Care Support Services Package require the highest level of clinical intervention offered in a family setting to perform day-to-day activities.

Due to the intensity of services offered, a foster home offering the Treatment Foster Family Care Support Services Package may have no more than two children in foster care placed in the home at the same time.

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, as well as wraparound services (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 Therapist, that specializes in providing therapy to children with a DSM-5 diagnosis for serious mental, emotional, and/or behavioral disorder(s), 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 an initial Service Plan is due within 30 days of admission, and Service Plan reviews must occur every 60 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, Promising Practice, or Evidence-based Treatment Model(s), specific to a Treatment Foster Care program and 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 that require the level of intervention required through services offered in the T3C Treatment Foster Family Care 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 T3C Treatment Foster Family Care 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/7 days 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 Therapist is always available to provide consultation and respond in person if needed.

• The child's CANS 3.0 Assessment must be administered in accordance with the requirements. Results of the CANS 3.0 Assessment must be used to inform the child's 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.

• Specialized Paid Intermittent Alternative Care Program with one (1) skilled Intermittent Alternative Care Caregiver available for every twenty (20) children receiving the T3C Treatment Foster Family Care Support Services Package. 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 T3C Treatment Foster Family Care Support Services Package referral, admission, and discharge data by child, youth, or young adult, broken out by referral source (whether SSCC or DFPS) by 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 the 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 home that aligns with plan necessary to keep all children safe in the home. Mandatory if there are 7 or more children in the home. 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 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 child welfare systems specific to children, youth, and young adults with serious emotional disturbance.

• 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 are required to participate in STAR Health Service Coordination (dependent and based on child, youth, or young adult's individual eligibility).

• Caregivers must participate in therapy and other services with the child as needed and must have the ability to attend multiple meetings per week, and respond immediately when there is a need, or the child is in crisis.

• 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.

Anticipated Length of Service

Length of service is individualized and based on the Child Placing Agency's Treatment Model for providing the T3C Treatment Foster Family Care Support Services Package, Guidelines for Admission, and Continued Stay Guidelines. The T3C Treatment Foster Family Care Support Services Package is a Time-limited Service lasting up to 274 days, with one extension of up to 91 days when necessary for the child to complete treatment. An individual child cannot be served under the T3C Treatment Foster Family Care Support Services Package for more than 365 days.

Although the maximum Length of Service guidelines for this Service Package have been established, the Child Placing Agency's policy must include an anticipated Length of Service for children, youth, and young adults served under the T3C Treatment Foster Family Care 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 T3C Treatment Foster Family Care Support Services Package.
• The 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.
• The Child Placing Agency must have a Treatment Director whose responsibilities include supervision of Licensed Therapists on staff.
• Treatment Director must either be:
  • A psychiatrist or psychologist; or
  • Have a master's degree in a human services field from an accredited college or university and three years of experience providing treatment services to children with emotional disorders, including one year in a residential setting; or
  • 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
  • Licensed Therapist to oversee treatment and service planning for children, youth, and young adults
  • Behavior Support Specialist or Mentor
  • Crisis Management Staff
  • 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 child's school, medical, dental, behavioral health, and other service needs. Must be well-versed in STAR Health and HHSC Behavioral Health services to ensure that children, youth, and young adults receiving T3C Treatment Foster Family Care Support Services maximize benefits based on eligibility and meeting medical necessity criteria 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 6 children being provided T3C Treatment Foster Family Care Support Services Package.
• 1 Licensed Therapist for every 11 children being provided T3C Treatment Foster Family Care Support Services Package.
• 1 Behavior Support Specialist or Mentor for every 6 children being provided T3C Treatment Foster Family Care Support Services.
• 1 Crisis Management Staff for every 25 children being provided T3C Treatment Foster Family Care Support Services Package.
• 1 Aftercare Case Manager for every 25 children being provided T3C Treatment Foster Family Care Support Services Package.

Staff to Child Ratio(s) may vary based on an operation's specific Research-supported or Evidence-based 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 the T3C Treatment Foster Family Care Support Services Package.

Desired Individual Outcome

• Child Placing Agency must have clearly articulated child-level outcome expectations that tie directly to the operation's T3C Treatment Foster Family Care Support Services Treatment Model, and supports 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, TAC Rule, 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 T3C Treatment Foster Family Care 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.
• A less-restrictive placement type/Service Package is not appropriate to meet the child's individual needs.
• Considering the most recent CANS 3.0 Assessment, and in conjunction with each 60-day Service Plan review, the Child Placing Agency's Program Director, and the Treatment Director responsible for the T3C Treatment Foster Family Care 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 T3C Treatment Foster Family Care Support Services Package.

This Service Package is Time-Limited, and an individual child cannot be served under the T3C Treatment Foster Family Care Support Services Package for more than 365 days.

Aftercare Services

• The T3C Treatment Foster Family Care 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 Child Placing 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, Education Portfolio, referrals for continued services, initial appointments set (if transition is needed), as well as a plan with times and dates set for weekly, transitioning to twice a month, follow-up calls and/or meetings for a period of 6 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.