Reference Document

tac-749-part-04-training-rights

Refuge House, Inc.
Last updated: July 24, 2026 · Source: regulatory-references/markdown/tac-749-parts/tac-749-part-04-training-rights.md

Chapter 749: Minimum Standards for Child Placing Agencies

Subchapter F: Training and Professional Development

Division 1: Definitions

§749.801. What do certain words and terms mean in this subchapter?

Subchapter F, Training and Professional Development
Division 1, Definitions
April 2022

The words and terms used in this subchapter have the following meanings:

  1. CPR – Cardiopulmonary resuscitation.

  2. Hours – Clock hours.

  3. Instructor-led training - Training that is characterized by the communication and interaction that takes place between the student and the instructor. Instructor-led training does not have to be in person, but it must include an opportunity for the student to interact with the instructor to obtain clarifications and information beyond the scope of the training materials. For such an opportunity to exist, the instructor must be able to answer questions, provide feedback on skills practice, provide guidance or information on additional resources, and proactively interact with students. Examples of this type of training include classroom training, online distance learning, blended learning, video-conferencing, or other group learning experiences.

  4. Self-instructional training - Training designed to be used by one individual working alone and at the individual's own pace to complete lessons or modules. Lessons or modules commonly include questions with clear right and wrong answers. An example of this type of training is web-based training. Self-study training is also a type of self-instructional training.

  5. Self-study training - Non-standardized training where an individual reads written materials, watches a training video, or listens to a recording to obtain certain knowledge that is required for annual training. Self-study training is limited to three hours of annual training per year, as described in §749.935(d) of this subchapter (relating to What types of hours or instruction can be used to complete the annual training requirements?).


Division 2: Overview of Training and Experience Requirements

§749.811. What are the training and experience requirements for a caregiver?

Subchapter F, Training and Professional Development
Division 2, Overview of Training and Experience Requirements
June 2021

(a) A caregiver must complete the following training requirements, unless the caregiver meets the requirements of an exemption or a waiver for the training that is provided in this subchapter:

Type of training for caregivers: When must the training be completed?
(1) Orientation, as required by §749.831 of this subchapter (relating to What is the orientation requirement for caregivers and employees?). Prior to having contact with children.
(2) Pre-service training, as required by §749.863 of this subchapter (relating to What are the pre-service training requirements for a caregiver?). Varies with the type of training. See §749.863 of this subchapter.
(3) Pediatric first aid and CPR, as required by §749.911 of this subchapter (relating to Who must have pediatric first aid and pediatric CPR training?). One foster parent must be certified in pediatric first aid and pediatric CPR before you place a child in the home. Other caregivers, including a second foster parent, must be certified in first aid and CPR within 90 days after you place the child in the home.
(4) Annual training, as required by §749.930 of this subchapter (relating to What are the annual training requirements for a caregiver?). (A) Within 12 months after you verify the person as a foster parent or a caregiver begins providing care to a child; and
(B) As further required by §749.933 of this subchapter (relating to When must an employee or caregiver complete annual training?).

(b) You must ensure that a caregiver who provides care to a child receiving treatment services meets the pre-service experience requirements specified in §749.861 of this subchapter (relating to What are the pre-service experience requirements for caregivers?).


§749.813. What are the training requirements for an employee?

Subchapter F, Training and Professional Development
Division 2, Overview of Training and Experience Requirements
June 2021

An employee must complete the following training requirements, unless the employee meets the requirements of an exemption for the training that is provided in this subchapter:

Type of training for employees: When must the training be completed?
(1) Orientation, as required by §749.831 of this subchapter (relating to What is the orientation requirement for caregivers and employees?). Prior to beginning job duties.
(2) Pre-service training, as required by §749.864 of this subchapter (relating to What are the pre-service training requirements for an employee?). Within 90 days of beginning job duties.
(3) Annual training, as required by §749.931 of this subchapter (relating to What are the annual training requirements for an employee?). (A) Within 12 months after you hire the employee; and
(B) As further required by §749.933 of this subchapter (relating to When must an employee or caregiver complete annual training?).

Division 3: Orientation

§749.831. What is the orientation requirement for caregivers and employees?

Subchapter F, Training and Professional Development
Division 2, Overview of Training and Experience Requirements
January 2007

(a) Prior to beginning job duties or having contact with children in care, each caregiver or employee must have orientation that includes [Medium]:

  1. An overview of the relevant and applicable rules of this chapter [Medium];

  2. Your philosophy, organizational structure, policies, and a description of the services and programs you offer [Medium]; and

  3. The needs and characteristics of children that you serve. [Medium]

(b) You must document the completion of the orientation in the appropriate personnel record. [Medium-Low]


§749.833. When may a caregiver or employee be exempt from orientation?

Subchapter F, Training and Professional Development
Division 3, Orientation
June 2021

(a) A person who was a caregiver or employee at your agency during the past 12 months may be exempt from orientation if you meet the following requirements:

  1. You discuss with the person any changes in your services or programs that have occurred since the person was previously a caregiver or employee [Medium]; and

  2. If the person is an employee, you ensure the employee received training during the past 12 months from your agency on prevention, recognition, and reporting on child abuse, neglect, and exploitation. [Medium]

  3. If the person is acting as a caregiver, you do not allow the person to be the only caregiver for a group of children before you meet the requirement in paragraph (1) of this section [Medium].

(b) You must document the discussion and the previous training in the person's foster home record or personnel record. [Medium-Low]


Division 4: Pre-Service Experience and Training

§749.861. What are the pre-service experience requirements for caregivers?

Subchapter F, Training and Professional Development
Division 3, Orientation
January 2017

(a) For caregivers providing care to children only receiving child-care services and/or programmatic services, there are no pre-service experience requirements.

(b) Before a caregiver can provide care to a child receiving treatment services, you must ensure that the caregiver has the experience to care for the child's treatment need. If a caregiver does not have the necessary experience, your child-placement management staff must prescribe a regimen of specific child-care experience that the caregiver must complete before you place a child with treatment needs in the caregiver's home, including a minimum of eight hours of observations of interactions with children receiving similar treatment services as the prospective caregiver would be providing. [Medium-High]

(c) You must document the caregiver's experience and/or prescribed regimen in the home's record. [Medium]


§749.863. What are the pre-service training requirements for a caregiver?

Subchapter F, Training and Professional Development
Division 4, Pre-Service Experience and Training
June 2021

(a) A caregiver must complete the following applicable types of pre-service training within the noted timeframe:

Weight What type of pre-service training is required? What caregivers must receive the training? How many hours of training are required? When must the caregivers complete the training?
[Medium] (1) General Pre-Service Training (A) All caregivers (B) 8 hours (C)(i) One foster parent must complete the training before you place a child in the home; and
(ii) Other caregivers, including a second foster parent, must complete the training within 90 days after you place the child in the home.
[Medium] (2) Normalcy (A) Foster parents (B) 2 hours (C)(i) One foster parent must complete the training before you place a child in the home; and
(ii) A second foster parent must complete the training within 90 days after you place the child in the home.
[Medium-High] (3) Emergency Behavior Intervention, if you do not allow the use of emergency behavior intervention (A) Caregivers who care for children receiving:
(i) Only child care services or programmatic services; or
(ii) Treatment services for emotional disorders, intellectual disabilities, or autism spectrum disorder
(B) 8 hours (C)(i) One foster parent must complete at least four hours of training before you place a child in the home, and the remaining hours within 90 days after you place the child in the home; and
(ii) Other caregivers, including a second foster parent, must complete the training within 90 days after you place the child.
[Medium-High] (4) Emergency Behavior Intervention, if you allow the use of emergency behavior intervention (A) Caregivers who care for children receiving:
(i) Only child care services or programmatic services; or
(ii) Treatment services for emotional disorders, intellectual disabilities, or autism spectrum disorder
(B)(i) 8 hours for caregivers who only care for children described in subsection (a)(4)(A)(i) of this section; or
(ii) 16 hours for caregivers who care for children described in subsection (a)(4)(A)(ii) of this section
(C)(i) One foster parent must complete at least half of the hours of training before you place a child in the home, and the remaining hours within 90 days after you place the child in the home;
(ii) Other caregivers, including a second foster parent, must complete the training within 90 days after you place the child in the home; and
(iii) A caregiver may not administer any form of emergency behavior intervention before completing all the required training hours for emergency behavior intervention, except for administering a short personal restraint.
[Medium-High] (5) Safe Sleeping (A) Caregivers who care for children younger than two years of age (B) No specified hours (C)(i) One foster parent must complete the training before you place a child in the home; and
(ii) Other caregivers, including a second foster parent, must complete the training within 90 days after you place the child in the home.
[Medium-High] (6) Administering Psychotropic Medication (A) Caregivers who administer psychotropic medication (B) No specified hours (C) A caregiver must complete the training before administering a psychotropic medication.

(b) A caregiver who cares exclusively for children receiving treatment services for primary medical needs is exempt from the pre-service emergency behavior intervention training requirement.

(c) To meet the pre-service training requirements, the training must comply with the applicable curriculum requirements in Division 5 of this subchapter (relating to Curriculum Components for Pre-Service Training).

(d) You must document the completion of each training requirement in the appropriate foster home record or personnel record [Medium-Low].

Technical Assistance

The Department of Family and Protective Services, a single source continuum contractor, or your child-placing agency may require additional pre-service training.


§749.864. What are the pre-service training requirements for an employee?

Subchapter F, Training and Professional Development
Division 4, Pre-Service Experience and Training
June 2021

(a) An employee must complete the following applicable training types and hours within the noted timeframes:

What type of pre-service training is required? Who is required to receive the trainings? How many hours of training are required? When must the training be completed?
(1) Normalcy [Medium] Child-placing agency administrators, treatment directors, child placement staff, child placement management staff, and full-time professional service providers, excluding any employee who is exclusively assigned responsibilities related to adoption services 2 Hours Within 90 days of beginning job duties.
(2) Emergency Behavior Intervention [Medium] Child-placing agency administrators, treatment directors, child placement staff, child placement management staff, and full-time professional service providers, excluding any employee who is exclusively assigned responsibilities related to adoption services or the care of children receiving treatment services for primary medical needs 8 Hours Within 90 days of beginning job duties.

(b) To meet the pre-service training requirements, the training must comply with the applicable curriculum requirements in Division 5 of this subchapter (relating to Curriculum Components for Pre-Service Training).

(c) You must document the completion of each training requirement in the appropriate personnel record. [Medium-Low]


§749.865. Can time spent in orientation training count towards pre-service training?

Subchapter F, Training and Professional Development
Division 4, Pre-Service Experience and Training
January 2007

No, the orientation training must be separate from the pre-service hourly training requirement. [Medium-Low]

Technical Assistance

Orientation is focused on providing new employees and caregivers with information about your organization and how it operates. Pre-service training is focused on preparing new employees and caregivers to do their job competently. This is the reason that these requirements are separate in the minimum standards and that orientation may not be counted toward pre-service or annual training requirements.


§749.867. What caregivers or employees are exempt from certain pre-service training requirements?

Subchapter F, Training and Professional Development
Division 4, Pre-Service Experience and Training
June 2021

(a) A caregiver is exempt from completing the eight hours of general pre-service training if the caregiver has been a caregiver for a residential child-care operation during the past 12 months.

(b) A caregiver or employee is exempt from completing the two hours of normalcy training if the foster parent or employee has:

  1. Been a caregiver for or employed by a residential child-care operation during the past 12 months;

  2. Received training on normalcy during the past 12 months; and

  3. Can document that the training was received [Medium-Low].

(c) A caregiver or employee is exempt from completing the pre-service training for emergency behavior intervention if the caregiver or employee:

  1. Has been a caregiver for or employed by a residential child-care operation during the past 12 months;

  2. Has received emergency behavior intervention training during the past 12 months that meets the required curriculum components of the following applicable rule:

    (A) §749.887 of this subchapter (relating to If I do not allow the use of emergency behavior intervention, what curriculum components must be included in the pre-service training for emergency behavior intervention?); or

    (B) §749.889 of this subchapter (relating to If I allow the use of emergency behavior intervention, what curriculum components must be included in the pre-service training for emergency behavior intervention?); and

  3. Can demonstrate knowledge and competency of the training material in writing and, if the child-placing agency allows the use of emergency behavior intervention, in physical techniques.

(d) You must document the exemption factors in the appropriate foster home record or personnel record [Medium-Low].


§749.868. Can a child-placing agency waive pre-service training requirements for a foster parent?

Subchapter F, Training and Professional Development
Division 4, Pre-Service Experience and Training
April 2022

(a) A child-placing agency, including a single source continuum contractor, may waive any of the following pre-service training requirements for a foster parent if the agency determines that the requirement is not directly related to the ages and number of children the foster home will care for and the types of services the home will provide:

  1. General pre-service training;

  2. Normalcy; or

  3. Emergency behavior intervention.

(b) After waiving a pre-service training requirement for a foster parent, an agency must reevaluate the waiver if, within the first year, there is a change in the foster home's verification with respect to the ages or number of children the home can care for or the types of services the home can provide. If the agency determines that the waived pre-service training is directly related to the ages or number of children the home can care for, or the types of services the home can provide, the foster parent must complete the training. [Medium]

(c) You must document:

  1. Any determination that a waiver of pre-service is appropriate for a foster parent [Medium-Low]; and

  2. Any re-evaluation of the foster home due to changes to the ages or number of children the home can care for or the types of services the home can provide. [Medium-Low]


§749.869. How must pre-service training be conducted?

Subchapter F, Training and Professional Development
Division 4, Pre-Service Experience and Training
June 2021

(a) Instructor-led training and self-instructional training must include:

  1. Specifically stated learning objectives [Medium-Low];

  2. An evaluation or assessment tool to determine whether the person has obtained the information necessary to meet the stated objectives [Medium]; and

  3. A certificate, letter, or a signed and dated statement of successful completion from the training source [Medium-Low].

(b) Pre-service training must be provided by an instructor who [Medium]:

  1. Holds a generally recognized credential; or

  2. Possesses documented knowledge or experience relevant to the training the instructor will provide.

(c) Training on administering psychotropic medication must be instructor-led, as defined in §749.801(3) of this subchapter (relating to What do certain words and terms mean in this subchapter?). The instructor must be a health-care professional or pharmacist [Medium-High].

(d) Training on emergency behavior intervention must:

  1. Be instructor-led with each instructor certified in a recognized method of emergency behavior intervention [Medium-High] or otherwise able to document knowledge of:

    (A) Emergency behavior intervention [Medium-High];

    (B) The course material [Medium-High];

    (C) Methods for delivering the training, including physical techniques for restraints, if applicable [Medium-High]; and

    (D) Methods for evaluating and assessing a participant's knowledge and competency of the training material and physical techniques, if applicable [Medium-High];

  2. Be competency-based [Medium-High]; and

  3. At the end of the training, require each participant to demonstrate knowledge and competency of the training material:

    (A) In writing [Medium-High]; and

    (B) If the child-placing agency allows the use of emergency behavior intervention, by demonstrating the physical technique the participant is allowed to use [Medium-High].


Division 5: Curriculum Components for Pre-Service Training

§749.881. What curriculum components must be included in the general pre-service training?

Subchapter F, Training and Professional Development
Division 5, Curriculum Components for Pre-Service Training
June 2021

The general pre-service training must include the following curriculum components:

  1. Topics appropriate to the needs of children for whom the caregiver will be providing care, such as developmental stages of children, fostering children's self-esteem, constructive guidance and discipline of children, water safety, and strategies and techniques for monitoring and working with these children [Medium];

  2. Trauma informed care [Medium];

  3. The different roles of caregivers [Medium];

  4. Measures to prevent, recognize, and report suspected occurrences of child abuse (including sexual abuse), neglect, and exploitation [Medium-High];

  5. Procedures to follow in emergencies, such as weather related emergencies, volatile persons, and severe injury or illness of a child or adult [Medium-High]; and

  6. Preventing the spread of communicable diseases. [Medium-High]


§749.882. What curriculum components must be included in the pre-service training for normalcy?

Subchapter F, Training and Professional Development
Division 5, Curriculum Components for Pre-Service Training
June 2021

The pre-service training for normalcy must include the following curriculum components:

  1. A discussion of the definitions of normalcy and the reasonable and prudent parent standard [Medium-High];

  2. The developmental stages of children, including a discussion of the cognitive, social, emotional, and physical development of children [Medium];

  3. Age appropriate activities for children, including unsupervised childhood activities [Medium];

  4. The benefits of childhood activities to a child's well-being, mental health, and social, emotional, and developmental growth [Medium];

  5. How to apply the reasonable and prudent parent standard to make decisions [Medium-High]; and

  6. The child's and the caregiver's responsibilities when participating in childhood activities. [Medium-High]

Technical Assistance

A caregiver's specific responsibilities for a child that participates in unsupervised activities are listed at §749.2593(d) of this chapter (relating to What responsibilities does a caregiver have when supervising a child?).


§749.883. What curriculum components must be included in the pre-service training for safe sleeping?

Subchapter F, Training and Professional Development
Division 5, Curriculum Components for Pre-Service Training
June 2021

The pre-service training for safe sleeping must include the following curriculum components:

  1. Recognizing and preventing shaken baby syndrome and abusive head trauma [Medium-High];

  2. Understanding safe sleeping practices and preventing sudden infant death syndrome [Medium-High]; and

  3. Understanding early childhood brain development. [Medium]


§749.885. What curriculum components must be included in the pre-service training for administering psychotropic medication?

Subchapter F, Training and Professional Development
Division 5, Curriculum Components for Pre-Service Training
June 2021

The pre-service training for administering psychotropic medication must include the following curriculum components:

  1. Identification of psychotropic medications [High];

  2. Basic pharmacology (the actions and side effects of, and possible adverse reactions to, various psychotropic medications) [Medium-High];

  3. Techniques and methods of administering medications [Medium-High];

  4. Who is legally authorized to provide consent for the psychotropic medication [Medium]; and

  5. Any related policies and procedures. [High]

Technical Assistance

The online psychotropic medication training of the Child Protective Services Division of DFPS satisfies this general pre-service training requirement as long as caregivers also get instructor-led training that covers:

  • Policies and procedures on administering medication; and
  • Who may consent to using psychotropic medications for children who are not in the conservatorship of DFPS.

§749.887. If I do not allow the use of emergency behavior intervention, what curriculum components must be included in the pre-service training for emergency behavior intervention?

Subchapter F, Training and Professional Development
Division 5, Curriculum Components for Pre-Service Training
June 2021

If you do not allow the use of emergency behavior intervention, the pre-service training for emergency behavior intervention must focus on early identification of potential problem behaviors and strategies and techniques for less restrictive interventions, including the following curriculum components [Medium]:

  1. Developing and maintaining an environment that supports positive and constructive behaviors [Medium];

  2. The causes of behaviors potentially harmful to a child, including aspects of the environment [Medium];

  3. Early signs of behaviors that may become dangerous to a child or others [Medium-High];

  4. Strategies and techniques a child can use to avoid harmful behaviors [Medium-High];

  5. Teaching a child to use the strategies and techniques of your agency's de-escalation protocols to avoid harmful behavior, and supporting the children's efforts to progress into a state of self-control [Medium-High];

  6. Less restrictive strategies caregivers can use to intervene in potentially harmful behaviors [Medium-High];

  7. Less restrictive strategies caregivers can use to work with an oppositional child [Medium];

  8. Addressing circumstances when all de-escalation strategies fail [Medium]; and

  9. The risks associated with the use of prone or supine restraints, including positional, compression, or restraint asphyxia. [Medium-High]


§749.889. If I allow the use of emergency behavior intervention, what curriculum components must be included in the pre-service training for emergency behavior intervention?

Subchapter F, Training and Professional Development
Division 5, Curriculum Components for Pre-Service Training
June 2021

(a) If you allow the use of emergency behavior intervention, at least 75 percent of the pre-service training for emergency behavior intervention must focus on early identification of potential problem behaviors and strategies and techniques for less restrictive interventions, including the curriculum components listed in §749.887 of this division (relating to If I do not allow the use of emergency behavior intervention, what curriculum components must be included in the pre-service training for emergency behavior intervention?) [Medium-High].

(b) The training does not have to address the use of any type of emergency behavior intervention that your policies do not allow.

(c) The other 25 percent of the pre-service training curriculum for emergency behavior intervention must include the following components:

  1. Different roles and responsibilities of caregivers qualified in emergency behavior intervention, versus employees or volunteers who are not qualified in emergency behavior intervention [Medium-High];

  2. Escape and evasion techniques to prevent harm to the child and caregiver without requiring the use of an emergency behavior intervention [Medium-High];

  3. Safe implementation of the restraint techniques and procedures that are appropriate for the age and weight of children served and permitted by the rules in this chapter and your policies and procedures [Medium-High];

  4. The physiological impact of emergency behavior intervention [Medium-High];

  5. The psychological impact of emergency behavior intervention, such as flashbacks from prior abuse [Medium-High];

  6. How to adequately monitor the child during the administration of an emergency behavior intervention to prevent injury or death [High];

  7. Monitoring physical signs of distress and obtaining medical assistance [High];

  8. Health risks for children associated with the use of specific techniques and procedures [Medium-High];

  9. Drawings, photographs, or videos of each personal restraint permitted by your policy [Medium-High]; and

  10. Strategies for re-integration of children into the environment after the use of emergency behavior intervention, including the debriefing of caregivers and the child [Medium].


Division 6: Pediatric First Aid and Pediatric CPR Certification

§749.911. Who must have pediatric first aid and pediatric CPR training?

Subchapter F, Training and Professional Development
Division 6, Pediatric First Aid and Pediatric CPR Certification
June 2021

(a) Each caregiver must have a current certificate of training with an expiration or renewal date in pediatric first aid with rescue breathing and choking. This training may be through instructor-led training or self-instructional training. [High]

(b) Each caregiver must have a current certificate of training with an expiration or renewal date in pediatric CPR [Medium-High]. The pediatric CPR training:

  1. Must adhere to the guidelines for CPR for a layperson established by the American Heart Association, and consist of a curriculum that includes use of a CPR manikin and both written and hands-on skill-based instruction, practice, and testing [Medium-High]; and

  2. May be provided through blended learning that utilizes online technology, including self-instructional training, as long as the criteria in paragraph (1) of this subsection is met.

(c) One foster parent must be certified in pediatric first aid and pediatric CPR before you place a child in the home. Other caregivers, including a second foster parent, must be certified in pediatric first aid and pediatric CPR within 90 days after you place the child in the home [Medium-High].

(d) In lieu of either or both certifications, a caregiver may provide documentation of the following:

  1. Training as a health professional that includes the knowledge covered in either pediatric first aid or pediatric CPR, or both; and

  2. The caregiver's employment as a health professional requires that the relevant skills remain current.


§749.913. Are there any exemptions from pediatric first aid and pediatric CPR certification?

Subchapter F, Training and Professional Development
Division 6, Pediatric First Aid and Pediatric CPR Certification
June 2021

(a) If a caregiver is absent from the home on an extended basis as a condition of the caregiver's employment or military service, the caregiver is exempt from obtaining current certification in pediatric first aid and pediatric CPR during this time of absence. The caregiver must obtain pediatric first aid and pediatric CPR certifications within 90 days after returning home [Medium-High].

(b) A child-placement staff member who meets the definition of a caregiver only because the staff member provides transportation for children in foster care, must obtain pediatric first-aid certification, but is exempt from pediatric CPR certification.


§749.915. What documentation must I maintain for pediatric first-aid and pediatric CPR certifications?

Subchapter F, Training and Professional Development
Division 6, Pediatric First Aid and Pediatric CPR Certification
June 2021

(a) You must document the caregiver's completion of each training requirement in the appropriate foster home record or personnel record. The documentation may be a certificate, letter, or a signed and dated statement of successful completion from the training source. You may maintain a photocopy of the original pediatric first-aid or pediatric CPR certificate or letter in the foster home record or personnel record, as long as the caregiver can provide an original document upon request by Licensing. [Medium-Low]

(b) The documentation must include:

  1. The participant's name [Medium-Low];

  2. Date of the training [Medium-Low];

  3. Title or subject of the training [Medium-Low];

  4. The trainer's name and qualifications [Medium-Low];

  5. The expiration date of the certification as determined by the organization providing the certification [Medium-Low]; and

  6. Length of the training in hours [Medium-Low].


Division 7: Annual Training

§749.930. What are the annual training requirements for a caregiver?

Subchapter F, Training and Professional Development
Division 7, Annual Training
June 2021

(a) A caregiver must complete the number of annual training hours described in the following chart:

Weight A caregiver who cares for children receiving: Must complete the following number of annual training hours:
[Medium-High] (1) Only child-care services, programmatic services, or treatment services for primary medical needs, or a combination of these services 10 hours
[Medium-High] (2) Treatment services for emotional disorders, intellectual disabilities, or autism spectrum disorder 25 hours

(b) For a home with two foster parents, the foster parents may combine their individual training hours to meet the total number of required annual training hours. If each foster parent is required to complete 10 hours, they must collectively complete 20 hours. If each foster parent is required to complete 25 hours, they must collectively complete 50 hours. [Medium-High] But the foster parents do not have to split the total number of required hours equally, if:

  1. Each foster parent completes each of the required annual training hours noted in subsection (c) of this section; and

  2. They complete the combined total number of required hours for annual training.

(c) For the annual training hours described in subsection (a) of this section, each caregiver must complete the following specific types of training and hours:

Weight Type of Training Hours
[Medium-High] (1) Emergency Behavior Intervention (A) 4 hours for a caregiver who cares only for children receiving:
  (i) Child-care or programmatic services; or
  (ii) Treatment services for primary medical needs in addition to children receiving child-care or programmatic services.
(B) No hours for a caregiver who cares exclusively for children receiving treatment services for primary medical needs.
(C) 8 hours for a caregiver who cares for children receiving treatment services for emotional disorders, intellectual disabilities, or autism spectrum disorder.
[Medium-High] (2) Trauma Informed Care 2 hours
[Medium-High] (3) Normalcy 1 hour
[Medium-High] (4) Administering Psychotropic Medication, if the caregiver administers psychotropic medication No specified hours

(d) To meet the mandated annual training requirements in subsection (c) of this section, the training must comply with the applicable curriculum requirements in Division 8 of this subchapter (relating to Topics and Curriculum Components for Annual Training).

(e) After completing the type of annual training required in subsection (c) of this section, any remaining number of annual training hours must be in areas appropriate to the needs of children for whom the caregiver provides care, as required by §749.941 of this subchapter (relating to What areas or topics are appropriate for annual training?).

Technical Assistance

The Department of Family and Protective Services, a single source continuum contractor, or your child-placing agency may require additional annual training.


§749.931. What are the annual training requirements for an employee?

Subchapter F, Training and Professional Development
Division 7, Annual Training
April 2022

(a) Each type of employee in the chart must complete the following number of annual training hours:

Weight Type of Employee Hours of Annual Training
[Medium-High] (1) Child placement staff with less than one year of child-placing experience 30 hours
[Medium] (2) Child placement staff with at least one year of child-placing experience; all child placement management staff, except those exclusively assigned to provide adoption services 20 hours
[Medium] (3) Executive directors, treatment directors, and full-time professional service providers who do not hold a relevant professional license 20 hours
[Medium] (4) Child-placing agency administrators, executive directors, treatment directors, and full-time professional service providers who hold a relevant professional license 15 hours

(b) For the annual training hours described in subsections (a)(1), (2), and (3) of this section, each employee must complete the following specific types of training and hours:

Weight Type of Training Hours
[Medium-High] (1) Prevention, Recognition, and Reporting on Child Abuse, Neglect, and Exploitation 1 hour
[Medium-High] (2) Trauma Informed Care 2 hours
[Medium-High] (3) Normalcy 1 hour

(c) The annual training hours for an employee described in subsection (a)(4) of this section:

  1. Must include one hour of training on prevention, recognition, and reporting on child abuse, neglect, and exploitation [Medium]; and

  2. May include annual training hours that the employee completes to maintain a relevant professional license, if the hours include the necessary components of subsection (c)(1) of this section or the employee completes those components separately.

(d) There are no annual training requirements for emergency behavior intervention. However, the employee must be retrained whenever there is a substantial change in techniques, types of intervention, or agency policies for emergency behavior intervention [Medium-High].

Technical Assistance

Your child-placing agency may require additional annual training.


§749.932. What exemptions or waivers may apply to the annual training requirements for a caregiver?

Subchapter F, Training and Professional Development
Division 7, Annual Training
June 2021

(a) If a caregiver is absent from the home on an extended basis as a condition of the caregiver's employment or military service, you must prorate the caregiver's annual training requirements based on the number of months out of the year that the caregiver will be at the home. If a caregiver is absent for an entire year, the caregiver is exempt for the annual training hours for that year.

(b) A child-placing agency, including a single source continuum contractor, may waive certain annual training requirements for a foster parent or for a foster home as described in subsection (c) of this section if:

  1. The foster parent or foster home has been verified by the child-placing agency the previous two years; and

  2. During that timeframe, the child-placing agency was not cited for any deficiencies related to the foster parent or the foster home and there are no pending allegations related to the foster parent or the foster home.

(c) For a foster parent or foster home that meets the requirements described in subsection (b) of this section, the agency may waive the following types of training upon determining that the training is not directly related to the care of any foster child in the home:

  1. Emergency behavior intervention;

  2. Trauma informed care; or

  3. Normalcy.

(d) A child-placing agency that waives certain annual training requirements for a foster home under subsection (c) of this section may waive the training for one or both foster parents and any other caregiver in the home.

(e) A child-placing agency may not waive a foster parent's annual training for emergency behavior intervention, trauma informed care, or normalcy during consecutive years [Medium].

(f) You must document the basis of the exemption, proration, or waiver in the appropriate foster home record or personnel record [Medium-Low].


§749.933. When must an employee or caregiver complete the annual training?

Subchapter F, Training and Professional Development
Division 7, Annual Training
June 2021

(a) Each person must complete the annual training:

  1. Within 12 months from when [Medium]:

    (A) You hire the person as an employee, including employees hired or acting as a caregiver;

    (B) You verify the person as a foster parent; or

    (C) A caregiver in the home, that is not an employee or foster parent, begins providing care to a child; and

  2. During each subsequent 12-month period after the anniversary date of hire, verification, or beginning the provision of care [Medium].

(b) Alternatively, you have the option of prorating the person's annual training requirements from the date of hire or verification to the end of the calendar year or the end of the agency's fiscal year and then beginning a new 12-month period that coincides with the calendar or fiscal year.

(c) Whether an agency uses subsection (a) or (b) of this section as your method for completing annual training requirements, you must use the method consistently throughout your agency [Medium-Low].


§749.935. What types of hours or instruction can be used to complete the annual training requirements?

Subchapter F, Training and Professional Development
Division 7, Annual Training
April 2022

(a) If the training complies with the other rules in this division (relating to Annual Training), annual training may include hours or Continuing Education Units earned through:

  1. Workshops or courses offered by local school districts, colleges or universities, or Licensing;

  2. Conferences or seminars;

  3. Instructor-led training, as defined at §749.801(3) of this subchapter (relating to What do certain words and terms mean in this subchapter?);

  4. Self-instructional training, as defined at §749.801(5) of this subchapter;

  5. Planned learning opportunities provided by child-care associations or Licensing;

  6. Planned learning opportunities provided by a child-placing agency administrator, professional contract service provider, professional service provider, treatment director, child placement management staff, child placement staff, contractor, or caregiver who meets minimum qualifications in the rules of this chapter; or

  7. Completed college courses for which a passing grade is earned, with three college credit hours being equivalent to 50 clock hours of required training. College courses do not substitute for required CPR or first aid certification or required annual training on emergency behavior intervention or psychotropic medication.

(b) For annual training hours, you may count:

  1. The hours of annual training that a person received at another residential child-care operation if the person [Medium]:

    (A) Received the training within the time period you are using to calculate the person's annual training; and

    (B) Provides documentation of the training;

  2. Pediatric first aid and pediatric CPR;

  3. Any hours of pre-service training that the person earned in addition to the required pre-service hours, although you may not carry over more than 15 hours of a person's pre-service training hours for use as annual training hours during the upcoming year [Medium];

  4. Half of the hours spent developing initial training curriculum that is relevant to the population of children served, but no additional credit hours for training curriculum development are permitted for repeated training sessions [Medium]; and

  5. One-fourth of the hours spent updating and making revisions to training curriculum that is relevant to the population of children served. [Medium]

(c) For annual training hours, you may not count:

  1. Orientation training [Medium-Low];

  2. Required pre-service training [Medium-Low];

  3. The hours involved in case staffings and conferences with the supervisor [Medium-Low]; or

  4. The hours presenting training to others. [Medium-Low]

(d) No more than 80 percent of the required annual training hours may come from self-instructional training as defined at §749.801(5) of this subchapter. No more than three of those self-instructional hours may come from self-study training as defined at §749.801(6) of this subchapter. [Medium-Low]

(e) If a person earns more than the minimum number of annual training hours required during a particular year, the person can carry over to the next year a maximum of 15 annual training hours [Medium-Low].

Technical Assistance

Here are two examples to clarify (b)(3): (1) if a person completes a total of 35 hours of pre-service training and is required to complete a total of 18 hours of pre-service training, then that person may only carry over a maximum of 15 of the hours toward the annual training requirements even though the person completed 17 extra hours of non-required, pre-service training; and (2) if a person completes a total of 35 hours of pre-service training and is required to complete a total of 26 hours of pre-service training, then that person may only carry over 9 hours toward the annual training requirements because the person completed 9 extra hours of non-required, pre-service training.


§749.937. Does Licensing approve training resources or trainers for annual training hours?

Subchapter F, Training and Professional Development
Division 7, Annual Training
June 2021

We do not approve or endorse training resources or trainers for training hours.


§749.939. How must annual training be conducted?

Subchapter F, Training and Professional Development
Division 7, Annual Training
June 2021

(a) Instructor-led training and self-instructional training, excluding self-study training, must include:

  1. Specifically stated learning objectives [Medium-Low];

  2. A curriculum that includes experiential or applied activities [Medium-Low];

  3. An evaluation or assessment tool to determine whether the person has obtained the information necessary to meet the stated objectives [Medium]; and

  4. A certificate, letter, or a signed and dated statement of successful completion from the training source [Medium-Low].

(b) Training on emergency behavior intervention and administering psychotropic medication must be instructor-led, as defined at §749.801(3) of this subchapter (relating to What do certain words and terms mean in this subchapter?) [Medium].

(c) Training on emergency behavior intervention must:

  1. Be led by an instructor who is certified in a recognized method of emergency behavior intervention [Medium-High] or otherwise able to document knowledge of:

    (A) Emergency behavior intervention [Medium-High];

    (B) The course material [Medium-High];

    (C) Methods for delivering the training, including physical techniques for restraints, if applicable [Medium-High]; and

    (D) The methods for evaluating and assessing a participant's knowledge and competency of the training material and physical techniques, if applicable [Medium-High];

  2. Be competency-based [Medium-High]; and

  3. At the end of the training, require each participant to demonstrate knowledge and competency of the training material:

    (A) In writing [Medium-High]; and

    (B) If the child-placing agency allows the use of emergency behavior intervention, by demonstrating the physical techniques that the participant may use [Medium-High].

(d) A health-care professional or a pharmacist must lead the training in administering psychotropic medication. The trainer must assess each participant after the training to ensure that the participant has learned the course content. [Medium-High]


Division 8: Topics and Curriculum Components for Annual Training

§749.941. What areas or topics are appropriate for annual training?

Subchapter F, Training and Professional Development
Division 8, Topics and Curriculum Components for Annual Training
June 2021

(a) Other than the mandated topics, annual training for caregivers must be in areas appropriate to the needs of children for whom the caregiver provides care [Medium], which may include:

  1. Developmental stages of children;

  2. Constructive guidance and discipline of children;

  3. Fostering children's self-esteem;

  4. Positive interaction with children;

  5. Strategies and techniques for working with the population of children served;

  6. Supervision and safety practices in the care of children, including making reasonable and prudent parenting decisions for a foster child's participation in childhood activities;

  7. Preventing the spread of communicable diseases;

  8. Water safety;

  9. Administration of medication;

  10. Medical-related training to help children receiving treatment services for primary medical needs;

  11. Helping children experience grief or loss;

  12. Prevention, recognition, and reporting of child abuse, neglect, and exploitation; or

  13. Safe sleeping as specified in §749.883 of this subchapter (relating to What curriculum components must be included in the pre-service training for safe sleeping?).

(b) Other than mandated topics, annual training for employees must be in areas appropriate to the needs of children for whom the child-placing agency provides care [Medium], which may include:

  1. The areas listed in subsection (a) of this section and;

  2. Emergency behavior intervention.

Technical Assistance

A person should attempt to attend trainings in new topic areas every year and whenever the person believes there is a need for improvement or additional knowledge. A person should avoid attending the same training every year, unless there is a specific need for information on that topic.

Here are some examples of annual training topics:

  • Helping children cope with separation, such as from parents, family, and placement;
  • Helping or preparing children for re-integration into a family, community, or subsequent placement;
  • Stages of child development, including normal behavioral reactions to stress at the various ages of children served by the agency;
  • Healthy personal boundaries and professional relationship boundaries;
  • Protecting self and others from false allegations;
  • Training to perform special tasks such as the care of gastric tubes or lifeguard certification training, if applicable;
  • For a caregiver who provides care to children receiving treatment services for emotional disorders, training on cognitive distortions and how they apply to the children; or
  • Special needs of children in care, which may include areas such as sexualized behavior, trauma, medical needs, and/or developmental disorders.

§749.943. What curriculum components must be included in the annual training for normalcy?

Subchapter F, Training and Professional Development
Division 8, Topics and Curriculum Components for Annual Training
June 2021

(a) The annual training for normalcy must include the curriculum components covered in the pre-service training for normalcy, see §749.882 of this subchapter (relating to What curriculum components must be included in the pre-service training for normalcy?) [Medium-High].

(b) Subsequent annual training for normalcy should include curriculum components that further develops and refines the employee's knowledge and understanding of normalcy, including how to implement normalcy [Medium].


§749.944. What curriculum components must be included in the annual training for employees on the prevention, recognition, and reporting of child abuse, neglect, and exploitation?

Subchapter F, Training and Professional Development
Division 8, Topics and Curriculum Components for Annual Training
June 2021

The annual training for the prevention, recognition, and reporting of child abuse, neglect, and exploitation must include the following curriculum components:

  1. The factors indicating a child is at risk for abuse, neglect, or exploitation [Medium-High];

  2. The warning signs indicating a child may be a victim of abuse, neglect, or exploitation [Medium-High];

  3. The procedures for reporting child abuse, neglect, or exploitation [High]; and

  4. A list of community organizations that have training programs available to child-placing agency staff members, children, and parents [Medium].


§749.945. What curriculum components must be included in the annual training for administering psychotropic medication?

Subchapter F, Training and Professional Development
Division 8, Topics and Curriculum Components for Annual Training
June 2021

The annual training for administering psychotropic medication must include the curriculum components identified in §749.885 of this subchapter (relating to What curriculum components must be included in the pre-service training for administering psychotropic medication?) [Medium].

Technical Assistance

The online psychotropic medication training of the Child Protective Services Division of DFPS satisfies this annual training requirement as long as caregivers also get instructor-led training that covers:

  • Policies and procedures on administering medication; and
  • Who may consent to using psychotropic medications for children who are not in the conservatorship of DFPS.

§749.947. What curriculum components must be included in the annual training for emergency behavior intervention?

Subchapter F, Training and Professional Development
Division 8, Topics and Curriculum Components for Annual Training
June 2021

(a) The annual training for emergency behavior intervention must include curriculum components that:

  1. Reinforce basic principles covered in the pre-service training identified in §749.887 of this subchapter (relating to If I do not allow the use of emergency behavior intervention, what curriculum components must be included in the pre-service training for emergency behavior intervention?) and §749.889 of this subchapter (relating to If I allow the use of emergency behavior intervention, what curriculum components must be included in the pre-service training for emergency behavior intervention?) [Medium-High]; and

  2. Develop and refine the caregiver's skills [Medium-High].

(b) You may determine the content of the training based on your evaluation of your emergency behavior intervention programs.

(c) The training may repeat pre-service training components, including training in the proper use and implementation of emergency behavior intervention.

Technical Assistance

Annual emergency behavior intervention training is not intended to be an exact replica of pre-service emergency behavior intervention training. While some review of previous content may be needed to ensure that caregivers retain necessary skills, you are expected and encouraged to use your emergency behavior intervention data to craft annual training that can most effectively improve the use of de-escalation techniques and emergency behavior interventions in your foster homes. This may include techniques caregivers can use to proactively avoid crisis situations and any necessary actions once all de-escalation attempts have failed.


§749.949. What documentation must I maintain for annual training?

Subchapter F, Training and Professional Development
Division 8, Topics and Curriculum Components for Annual Training
June 2021

(a) You must keep documentation verifying completion of annual training in the appropriate foster home record or personnel record. The documentation may be a certificate, letter, or a signed and dated statement of successful completion from the training source. The documentation may also be a transcript from an accredited college or university. [Medium-Low]

(b) The documentation for training other than college courses must include the following information:

  1. The participant's name [Medium-Low];

  2. Date of the training [Medium-Low];

  3. Title or subject of the training [Medium-Low];

  4. The trainer's name and qualifications, or the source of the training for self-instructional training [Medium-Low]; and

  5. Length of the training in hours. [Medium-Low]


Subchapter G: Children's Rights

§749.1001. How must I protect the rights of children served by my child-placing agency?

Subchapter G, Children's Rights
January 2007

(a) You must protect the rights of children while they are in foster care or in adoptive placement prior to the consummation of the adoption. [Medium-High]

(b) You must ensure that a caregiver or an adoptive parent, prior to consummation of the adoption, does not restrict or deny a child's rights. [Medium-High]

(c) You are responsible for removing a child from a situation where abuse, neglect, or exploitation exists. [High]


§749.1003. What rights does a child in care have?

Subchapter G, Children's Rights
January 2017

(a) A child's rights are cumulative of any other rights granted by law or other Licensing rules. [Medium-Low]

(b) The following categories include the child's rights that you must adhere to:

1. Safety and care, including:

2. Family contacts, including:

3. Living a normal life, including:

4. Discipline, including:

5. Plans for the child while in care, including:

6. Medical care and records, including:

7. Complaints, including:


§749.1005. How must I inform a child and the child's parents of their rights?

Subchapter G, Children's Rights
January 2017

(a) Within seven days after you admit a child into your agency, you must review the child's rights with the child and a child's parent, unless the parent's consent is not required. You must also provide the child and a child's parent with a written copy of the child's rights. [Medium]

(b) Child rights must be written in:

  1. Simple, non-technical terms [Medium]; and

  2. English, unless the person does not understand English. The child's rights must be written in the person's primary language, if possible. [Medium]

(c) If the person you are informing has a visual or auditory impairment, you must explain the child's rights in a manner that is understandable to the person. [Medium]

(d) The person you are informing of the child's rights must sign a statement indicating that the person has read and understands these rights. A copy of a timely signed "CPS Rights of Children and Youth in Foster Care" will meet this standard. You must put the signed copy in the child's record. [Medium]


§749.1007. What are a child's rights regarding education?

Subchapter G, Children's Rights
January 2017

(a) A child must have an appropriate education through participation in an educational/vocational program in the most appropriate and least restrictive educational settings, for example: attending regular classes conducted in an accredited elementary, middle, or secondary school within the community or home schooling. [Medium-Low]

(b) Foster parents and caregivers must, as applicable:

  1. Attend and participate in school staffings, conferences, and education planning meetings [Medium-Low];

  2. Make reasonable efforts to allow the child to participate in extracurricular activities [Medium-Low]; and

  3. Make reasonable efforts to allow the child to participate in school extracurricular activities to the extent of his interests and abilities and in accordance with his service plan. [Medium-Low]


§749.1009. What right does a child have regarding contact with a parent?

Subchapter G, Children's Rights
January 2007

(a) You must allow contact between a child and his parent whose parental rights have not been terminated according to [Medium]:

  1. Your policies [Medium-Low]; and

  2. The provisions of a court order or any visitation agreement. [Medium]

(b) You must document in the child's record:

  1. Any plans for contact between the child and a parent [Medium-Low]; and

  2. Any decision to limit contact with a parent. [Medium]

(c) Before you can temporarily restrict ongoing contacts or communication between the child and a parent, your child placement management staff must:

  1. Explain the reasons for the restrictions to the child and the child's parent [Medium-Low]; and

  2. Document the reasons in the child's record. [Medium-Low]

(d) Restrictions imposed by you that continue more than 30 days must be re-evaluated monthly by your child placement management staff, who also must [Medium]:

  1. Explain the reasons for the continued restrictions to the child and the child's parents [Medium-Low]; and

  2. Document the reasons in the child's record. [Medium-Low]

(e) If you limit communications or visits with a parent for practical reasons, such as geographical distance or expense, you must discuss the limits with the child and the child's parents. You must document the limits in the child's record. [Medium-Low]


§749.1011. What right does a child have regarding contact with siblings?

Subchapter G, Children's Rights
January 2017

(a) A child must have a reasonable opportunity for sibling visits and contacts in an effort to preserve sibling relationships. [Medium]

(b) You must address plans for sibling visits and contacts in the child's record. [Medium-Low]

(c) When you restrict sibling contact, you must include justification in the child's record. Restrictions imposed by you that continue for more than 60 days must be re-evaluated every 60 days by your child placement management staff, who also must [Medium]:

  1. Explain the reasons for the continued restrictions to the child [Medium]; and

  2. Document the reasons in the child's record. [Medium-Low]

(d) If barriers to visits exist, such as unavoidable geographic distance and expense issues, the agency must make provisions for sibling contact through letters, telephone calls, or some other means. [Medium]


§749.1013. What right to privacy does a child have with respect to his contact with others?

Subchapter G, Children's Rights
September 2010

(a) Except as determined by child placement management staff or the child's parent, you may not:

  1. Open or read the child's incoming or outgoing mail, including electronic mail, unless necessary to assist the child with reading or writing [Medium]; or

  2. Listen to or screen the child's telephone calls unless the child needs assistance with using the telephone. [Medium]

(b) You must document in the child's record:

  1. Any reason for restrictions on the child's mail or telephone calls that you impose [Medium-Low]; and

  2. A listing of the mail or telephone calls that you restrict. [Medium-Low]

(c) You must inform the child and parent about restrictions that you place on the child. [Medium-Low]

(d) Restrictions imposed by you that continue for more than 30 days must be re-evaluated monthly by your child placement management staff, who also must [Medium]:

  1. Explain the reasons for the continued restrictions to the child [Medium-Low]; and

  2. Document the reasons in the child's record. [Medium-Low]

Technical Assistance

Minimum standards §§749.1009, 749.1011, and 749.1013 apply only to contact restrictions imposed by you. Limitations or restrictions on contact imposed by the court or by the child's parent(s) are not subject to the explanation, documentation, and re-evaluation requirements in these rules. However, it is recommended that you retain written notice of any contact restrictions imposed by the court or parent(s), so that you will have documentation of who imposed the restrictions.


§749.1015. Under what circumstances may I conduct a search for prohibited items or items that endanger a child's safety?

Subchapter G, Children's Rights
January 2007

(a) A child's possessions must be free of unreasonable searches and unreasonable removal of personal items. [Medium-Low]

(b) You may search a child, his possessions, or his room only when you have reasonable suspicion [Medium-Low]:

  1. Of the presence of a prohibited item or an item that endangers the child's safety;

  2. That the child made suicidal threats or threatened to hurt himself or others; or

  3. That the child or children was involved in theft.

(c) Only a caregiver may conduct searches that involve the removal of clothing, other than outer clothing, such as coats, jackets, hats, gloves, shoes, or socks. [Medium]

(d) If a search of a child who is five years old or younger involves the removal of clothing (other than outer clothing), another adult must witness the search. [Medium-High]

(e) If a search of a child who is over the age of five involves the removal of clothing (other than outer clothing), an adult of the same gender must witness the search. [Medium-High]

(f) The caregiver must ensure that other children do not witness a search that involves the removal of clothing, other than outer clothing. [Medium-High]


§749.1017. May a caregiver conduct a body cavity search of a child in care?

Subchapter G, Children's Rights
January 2007

With the exception of a child's mouth, a caregiver may not conduct a body cavity search of a child in care. [High]


§749.1019. What must a caregiver document regarding a search?

Subchapter G, Children's Rights
January 2007

A caregiver must document the following in the child's record when conducting a search if it results in the removal of personal items or clothing worn by the child [Medium-Low]:

  1. The date of the search [Medium-Low];

  2. The name of the child [Medium-Low];

  3. Reason for the search [Low];

  4. A description of what was searched [Low];

  5. The articles of clothing removed, if applicable [Medium-Low];

  6. The name of the person conducting the search [Medium-Low];

  7. The name of the witness, if applicable [Medium-Low];

  8. The results of the search [Low]; and

  9. The resolution of the issue with the child or children involved. [Medium-Low]


§749.1021. What techniques am I prohibited from using on a child?

Subchapter G, Children's Rights
January 2017

Certain techniques must not be used on a child, including:

  1. Chemical restraints, mechanical restraints, and seclusion. For more information on emergency behavior intervention, see Subchapter L of this chapter (relating to Foster Care Services: Emergency Behavior Intervention) [Medium-High];

  2. Aversive conditioning, which includes, but is not limited to, any technique designed to or likely to cause a child physical pain, the application of startling stimuli, and the release of noxious stimuli or toxic sprays, mists, or substances in proximity to the child's face [Medium-High];

  3. Pressure points [Medium-High];

  4. Rebirthing therapy [Medium-High]; and

  5. Hug and/or holding therapy. [Medium-High]


Revised: November 2025