Subchapter L: Foster Care Services: Emergency Behavior Intervention
Division 1, Definitions
§749.2001. What do certain terms mean in this subchapter?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 1, Definitions
April 2022
These terms have the following meaning in this subchapter:
Transitional hold – The use of a temporary restraint technique that lasts no longer than one minute as part of the continuation of a longer personal restraint.
Triggered review – A review of a specific child's placement, treatment plan, and orders or recommendations for intervention, because a certain number of interventions have been made within a specified period of time.
Division 2, Types of Emergency Behavior Intervention That May Be Administered
§749.2051. What types of emergency behavior intervention may I administer?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 2, Types of Emergency Behavior Intervention That May Be Administered
January 2007
(a) If permitted in your policies and you meet the requirements of this subchapter, a caregiver may administer the following types of emergency behavior intervention to a child in your care:
Short personal restraint [Medium-High];
Personal restraint [Medium-High]; and
Emergency medication. [Medium-High]
(b) You may never administer chemical restraints, mechanical restraints, or seclusion. [High]
(c) Protective and supportive devices, used appropriately, are not considered emergency behavior interventions. For information on protective and supportive devices, see Divisions 9 and 10 of Subchapter J of this chapter (relating to Foster Care Services: Medical and Dental).
§749.2053. Who may administer emergency behavior intervention?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 2, Types of Emergency Behavior Intervention That May Be Administered
January 2007
Only a caregiver qualified in emergency behavior intervention may administer any form of emergency behavior intervention, except for the short personal restraint of a child. [Medium-High]
§749.2055. What actions must a caregiver take before using a permitted type of emergency behavior intervention?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 2, Types of Emergency Behavior Intervention That May Be Administered
September 2010
(a) Before using a permitted type of emergency behavior intervention, the caregiver must:
Attempt less restrictive behavior interventions that prove to be ineffective at defusing the situation [Medium-High]; and
Determine that the basis for the emergency behavior intervention is [Medium-High]:
(A) An emergency situation; or
(B) A need for a personal restraint to administer intra-muscular medication or other medical treatments prescribed by a licensed physician, such as administering insulin to a child with diabetes.
(b) A child's active attempt to run away may be considered an emergency situation when the following is a factor:
The child is developmentally or chronologically under six years old;
The child is suicidal;
The operation is located near a high traffic area;
Adverse weather conditions pose a clear safety risk to the child; or
Other clear safety risks are present.
§749.2059. What is the appropriate use for a short personal restraint?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 2, Types of Emergency Behavior Intervention That May Be Administered
September 2010
Generally, a short personal restraint is used in urgent situations, such as:
To protect the child from external danger that causes imminent significant risk to the child, such as preventing the child from running into the street or coming into contact with a hot stove. The restraint must end immediately after the danger is averted.
To intervene when a child under the age of five (chronological or developmental age) demonstrates disruptive behavior, if other efforts to de-escalate the child's behavior have failed;
When a child over five years old demonstrates behavior disruptive to the environment or milieu, such as disrobing in public, provoking others that creates a safety risk, or to intervene to prevent a child from physically fighting; or
When a child is significantly damaging property, such as breaking car windows or putting holes into walls.
§749.2061. What precautions must a caregiver take when implementing a short personal restraint?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 2, Types of Emergency Behavior Intervention That May Be Administered
January 2007
(a) When a caregiver implements a short personal restraint, the caregiver must:
Minimize the risk of physical discomfort, harm, or pain to the child [Medium-High];
Use the minimal amount of reasonable and necessary physical force. [Medium-High]
(b) A caregiver may not use any of the following techniques as a short personal restraint:
A prone or supine restraint [High];
Restraints that impair the child's breathing by putting pressure on the child's torso, including leaning a child forward during a seated restraint [High];
Restraints that obstruct the airways of the child or impair the breathing of the child, including procedures that place anything in, on, or over the child's mouth, nose, or neck, or impede the child's lungs from expanding [High];
Restraints that obstruct the caregiver's view of the child's face [High];
Restraints that interfere with the child's ability to communicate or vocalize distress [High]; or
Restraints that twist or place the child's limb(s) behind the child's back. [High]
§749.2063. Are there any purposes for which emergency behavior intervention cannot be used?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 2, Types of Emergency Behavior Intervention That May Be Administered
January 2007
Emergency behavior intervention may never be used as:
Punishment [Medium-High];
Retribution or retaliation [Medium-High];
A means to get a child to comply [Medium-High];
A convenience for caregivers or other persons [Medium-High]; or
A substitute for effective treatment or habilitation. [Medium-High]
Division 3, Orders
§749.2101. Are written orders required to administer emergency behavior intervention, and if so, who can write them?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 3, Orders
January 2007
According to the following chart, written orders by certain professionals are required to administer certain emergency behavior intervention:
| Weight | Type of Emergency Behavior Intervention | (A) Are written orders required to administer the intervention for a specific child? | (B) Who can write orders for the use of the intervention for a specific child? |
|---|---|---|---|
| No Weight | (1) Short personal restraint | (A) NO. | (B) Not applicable. |
| No Weight | (2) Personal restraint | (A) NO. However, successive restraints, a restraint simultaneous with emergency medication, and/or a restraint that exceeds the maximum time limit all require orders as specified in this subchapter. PRN orders are also permitted under §749.2107 of this title (relating to Under what conditions are PRN orders permitted for a specific child?). | (B) Not Applicable. |
| (A) Medium-High (B) Medium-High |
(3) Emergency medication | (A) YES. | (B) A licensed physician. |
§749.2103. Must the written order be in a child's record before a caregiver can use an emergency behavior intervention on a child?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 3, Orders
January 2007
Yes, any type of written order that is required must be in the child's record before a caregiver can use emergency behavior intervention on that child. [Medium-High]
§749.2105. What information must a written order include?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 3, Orders
January 2007
(a) All written orders must include the following:
A statement that the particular type of emergency behavior intervention may only be used in an emergency situation [Medium-High];
Designation of the specific intervention and procedure or technique that is authorized [Medium-High];
Any specific measures for ensuring the child's health, safety, and well being, and the privacy of the setting that safeguards the child's personal dignity [Medium-High];
A complete description of the behaviors and circumstances under which the intervention may be used [Medium-High];
Instructions for observation or heightened observation of the child during the intervention [Medium-High];
The behaviors that indicate the child is ready to be released from the intervention [Medium-High];
The maximum length of time the child may be restrained regardless of behaviors exhibited [Medium-High];
The prescribing professional's consideration of any potential medical and/or psychiatric contraindications for the specific child, such as a history of physical or sexual abuse or victimization involving the type of intervention [Medium-High]; and
Clinical justification for the intervention. [Medium-High]
(b) For emergency medication, the written order must also include instructions on how to administer the medication. [Medium-High]
§749.2107. Under what conditions are PRN orders permitted for a specific child?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 3, Orders
April 2022
(a) PRN orders for certain emergency behavior interventions are permitted under the following conditions:
| Weight | Type of Emergency Behavior Intervention | Conditions: |
|---|---|---|
| [No-Weight] | (1) Short personal restraint | Not applicable, because short personal restraints do not require orders. |
| [Medium-High] | (2) Personal restraint | (A) Orders must originate from a licensed psychiatrist or psychologist and include the number of times a child may be restrained in a seven-day period. (B) If the orders allow more than three restraints within a seven-day period, the order must include a plan for reducing the need for emergency behavior intervention. (C) The licensed psychiatrist or psychologist must review PRN orders for personal restraint at least every 30 days. The review must include written clinical justification for the continuation of PRN orders and be documented in the child's record. (D) PRN orders may not be used to restrain a child beyond the maximum length of time for personal restraint, as described in §749.2281 of this chapter (relating to What is the maximum length of time that an emergency behavior intervention can be administered to a child?). |
| [Medium-High] | (3) Emergency medication | The licensed physician must review PRN orders for emergency medication at least every 30 days. The review must include written clinical justification for the continuation of PRN orders and be documented in the child's record. |
(b) If you obtain a PRN order, you must provide the parent with a copy of the PRN order within 72 hours. [Medium]
Division 4, Responsibilities During Administration of Any Type of Emergency Behavior Intervention
§749.2151. What responsibilities does a caregiver have when implementing a type of emergency behavior intervention?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 4, Responsibilities During Administration of Any Type of Emergency Behavior Intervention
January 2017
(a) The use of emergency behavior intervention must be an appropriate response to the behavior demonstrated, and de-escalation must have failed. [Medium-High]
(b) The caregiver must act to protect the child's safety and consider the [Medium-High]:
Characteristics of the immediate physical environment [Medium-High];
Permitted types of emergency behavior intervention [Medium-High]; and
Potential risk of harm in using emergency behavior intervention versus the risk of not using emergency behavior intervention. [Medium-High]
(c) The caregiver must:
Initiate an emergency behavior intervention in a way that minimizes the risk of physical discomfort, harm, or pain to the child [Medium-High]; and
Use the minimal amount of reasonable and necessary physical force to implement the intervention. [High]
(d) The caregiver must make every effort to protect the child's:
Privacy, including shielding the child from onlookers [Medium]; and
Personal dignity and well-being, including ensuring that the child's body is appropriately covered. [Medium]
(e) As soon as possible after starting any type of emergency behavior intervention, the caregiver must:
Explain to the child the behaviors the child must exhibit to be released or have the intervention reduced, if applicable [Medium-High]; and
Permit the child to suggest actions the caregivers can take to help the child de-escalate. [Medium-High]
(f) If the child does not appear to understand what the child must do to be released from the emergency behavior intervention, the caregiver must attempt to re-explain it every 15 minutes until the child understands or is released from the intervention. [Medium-High]
§749.2153. When must a caregiver release a child from an emergency behavior intervention?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 4, Responsibilities During Administration of Any Type of Emergency Behavior Intervention
April 2022
A child must be released as follows:
| Type of Emergency Behavior Intervention | The caregiver must release the child if any of the following apply: |
|---|---|
| (1) Short personal restraint | (A) Immediately when an emergency health situation occurs during the restraint. The caregiver must obtain treatment immediately [High]; or (B) Within one minute, or sooner if the danger is over or the emergency situation no longer exists. [Medium-High] |
| (2) Personal restraint | (A) Immediately when an emergency health situation occurs during the restraint. The caregiver must obtain treatment immediately [High]; (B) Within one minute of the implementation of a prone or supine transitional hold [High]; (C) As soon as the child's behavior is no longer a danger to himself or others [Medium-High]; (D) As soon as the medication is administered [Medium-High]; or (E) When the maximum time allowed for personal restraint is reached. [Medium-High] |
| (3) Emergency medication | Not applicable. |
Division 5, Additional Responsibilities During Administration of a Personal Restraint
§749.2201. Who must monitor a personal restraint?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 5, Additional Responsibilities During Administration of a Personal Restraint
January 2017
During any personal restraint, a caregiver qualified in emergency behavior intervention must:
Monitor the:
(A) Personal restraint to make sure it is being performed appropriately [High]; and
(B) Child's breathing and other signs of physical distress [High]; and
Take appropriate action to ensure adequate respiration, circulation, and overall well-being. [High]
§749.2203. What is the appropriate action for a caregiver to take to ensure the child's adequate respiration, circulation, and overall well-being?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 5, Additional Responsibilities During Administration of a Personal Restraint
January 2017
Appropriate action includes responding prudently to a potentially life-threatening situation, for example, releasing a child when a child is unresponsive or indicates the child cannot breathe and immediately seeking medical assistance from a health-care professional. The caregiver must take into account that a child may thrash about more violently as the child struggles to breathe.
Technical Assistance
Signs of distress:
Circulation – Are the child's extremities cold to the touch? Are the child's extremities turning blue or is the child turning blue around the mouth?
Respiration – Is the child's breathing rapid and shallow? Is there an absence of breathing? Is the child saying he or she cannot breath?
Neurological – Is the child disoriented? Is he or she having a seizure?
Gastrointestinal – Is the child vomiting or losing control of his or her bowels?
Muscular-Skeletal – Is there apparent bruising, swelling, and/or complaints of pain?
§749.2205. What personal restraint techniques are prohibited?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 5, Additional Responsibilities During Administration of a Personal Restraint
January 2007
(a) The following personal restraint techniques are prohibited:
Restraints that impair the child's breathing by putting pressure on the child's torso, including restraints that obstruct the child's lungs from expanding such as leaning a child forward during a seated restraint [High];
Restraints that obstruct the child's airway, including procedures that place anything in, on, or over the child's mouth, nose, or neck [High];
Restraints that obstruct a caregiver's ability to view the child's face [High];
Restraints that interfere with the child's ability to communicate or vocalize distress [High]; or
Restraints that twist or place the child's limb(s) behind the child's back. [High]
(b) Prone and supine restraints are also prohibited as a short personal restraint. [High]
(c) Prone and supine restraints are also prohibited as a personal restraint except:
As a transitional hold that lasts no longer than one minute [High];
As a last resort when other less restrictive interventions have proven to be ineffective [High]; and
When an observer meeting the following qualifications ensures the child's breathing is not impaired:
(A) Trained to identify risks associated with positional, compression, or restraint asphyxia [High]; and
(B) Trained to identify risks associated with prone and supine holds. [High]
Division 6, Combinations of Emergency Behavior Intervention
§749.2231. May a caregiver successively use emergency behavior interventions on a child?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 6, Combinations of Emergency Behavior Intervention
January 2017
(a) A caregiver may successively use emergency behavior interventions on a child only if:
Allowed by your policies [Medium-High];
Permitted by rules of this subchapter for both types of emergency behavior intervention [Medium-High]; and
Written orders specifically allow the combination. [Medium-High]
(b) The written orders must include clinical justification for the successive use of emergency behavior interventions that goes beyond the justification for the use of a single intervention. The licensed physician ordering the emergency medication must provide clinical justification for the combination of emergency medication and personal restraint. [Medium]
(c) A caregiver must allow the child:
Bathroom privileges as needed and at least once every two hours [Medium-High];
An opportunity to drink water at least once every two hours [High];
Regularly prescribed medications unless otherwise ordered by the licensed physician [Medium-High];
Regularly scheduled meals and snacks served in a safe and appropriate manner [Medium-High]; and
An environment that is adequately ventilated during warm weather, adequately heated during cold weather, appropriately lighted, and free of safety hazards. [Medium-High]
§749.2233. May a caregiver simultaneously use emergency medication in combination with personal restraint?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 6, Combinations of Emergency Behavior Intervention
January 2007
(a) A caregiver may simultaneously use emergency medication in combination with personal restraint only if:
Allowed by your policies [High];
Permitted by the rules of this subchapter for both types of emergency behavior intervention [High]; and
Written orders specifically allow the combination. [High]
(b) The written orders must include clinical justification for the combination of emergency medication with personal restraint that goes beyond the justification for the use of a single emergency behavior intervention. If they are different people, both the licensed physician ordering the emergency medication and the professional ordering the personal restraint must provide the clinical justification for the combination. [Medium-High]
Division 7, Time Restrictions for Emergency Behavior Intervention
§749.2281. What is the maximum length of time that an emergency behavior intervention can be administered to a child?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 7, Time Restrictions for Emergency Behavior Intervention
April 2022
The maximum length of time that certain emergency behavior interventions can be administered to a child is as follows:
| Types of Emergency Behavior Intervention | The maximum length of time is: |
|---|---|
| (1) Short personal restraint | One minute. [Medium-High] |
| (2) Personal restraint | (A) For a child of any age, 30 minutes. [High] (B) A prone or supine personal restraint transitional hold may not exceed one minute. [High] |
| (3) Emergency medication | Not applicable. |
§749.2283. Can a caregiver exceed the maximum length of time that an emergency behavior intervention can be administered to a child?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 7, Time Restrictions for Emergency Behavior Intervention
February 2017
A caregiver may exceed the maximum length of time for certain emergency behavior interventions as follows:
| Types of Emergency Behavior Intervention | The maximum length of time is: |
|---|---|
| (1) Short personal restraint | May not be exceeded. [Medium-High] |
| (2) Personal restraint | May not be exceeded. [Medium-High] |
| (3) Emergency medication | Not applicable. |
Division 8, General Caregiver Responsibilities, Including Documentation, After the Administration of Emergency Behavior Intervention
§749.2301. What follow-up actions must caregivers take after the child's behavior no longer constitutes an emergency situation?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 8, General Caregiver Responsibilities, Including Documentation, After the Administration of Emergency Behavior Intervention
September 2010
(a) The caregivers must take appropriate actions to help the child return to routine activities. The follow-up actions of the caregivers must include [Medium]:
Providing the child with an appropriate transition and offering the child an opportunity to return to regular activities [Medium-High];
Observing the child for at least 15 minutes [Medium]; and
Providing the child with an opportunity to discuss the situation that led to the need for emergency behavior intervention and the caregiver's reaction to that situation. The discussion must be held in private as soon as possible and no later than 48 hours after the child's use of an emergency medication or release from any emergency behavior intervention. [Medium]
(b) Caregivers involved in the emergency behavior intervention must conduct a post-emergency behavior intervention discussion. The goal of the discussion is to allow the child and caregiver to discuss [Medium]:
The child's behavior and the circumstances that constituted the need for an emergency behavior intervention [Medium];
The strategies attempted before the use of the emergency behavior intervention and the child's reaction to those strategies [Medium];
The emergency behavior intervention itself and the child's reaction to the emergency behavior intervention [Medium];
How caregivers can assist the child in regaining self-control in the future to avoid the administration of an emergency behavior intervention [Medium]; and
What the child can do to regain self-control in the future to avoid the administration of an emergency behavior intervention. [Medium]
(c) Caregivers involved in the emergency behavior intervention must:
Debrief with child placement staff concerning the incident as soon as possible after the situation has stabilized [Medium]; and
Make reasonable efforts to debrief with children in care who witness the incident. [Medium]
(d) The child placement staff must review the use of the emergency behavior intervention within 72 hours of the intervention. [Medium-Low]
(e) The caregivers do not have to return the child to previous activities or place the child in current activities that the group is participating in if the caregivers deem the child's participation is not in the best interests of the child or the other children in the group. However, caregivers must engage the child in an alternative routine activity.
(f) This rule does not apply to short personal restraint.
§749.2303. What must the caregiver document after discussing with the child the use of the emergency behavior intervention?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 8, General Caregiver Responsibilities, Including Documentation, After the Administration of Emergency Behavior Intervention
September 2010
The caregiver must document the following after discussing with the child the use of the emergency behavior intervention:
The date and time the caregiver offered the discussion [Medium-Low];
The child's reaction to the opportunity for discussion [Medium-Low];
The date and time the discussion took place, if applicable [Medium-Low]; and
The content of the discussion, if applicable. [Medium]
§749.2305. When must a caregiver document the use of an emergency behavior intervention, and what must the documentation include?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 8, General Caregiver Responsibilities, Including Documentation, After the Administration of Emergency Behavior Intervention
January 2017
(a) As soon as possible, but no later than 24 hours after the initiation of the intervention, the caregiver must document in the child's record the following information [Medium]:
The child's name [Medium];
A description and assessment of the circumstances and specific behaviors that caused the basis for the emergency behavior intervention [Medium];
The de-escalation attempted before and during the use of the emergency behavior intervention and the child's reaction to those strategies [Medium];
The specific emergency behavior intervention administered [Medium];
The date and time the intervention was administered [Medium];
The length of time the child was restrained [Medium];
The name of the caregiver(s) that participated in the incident that led to the intervention, and who administered the intervention [Medium];
The name of the person(s) who observed the child [Medium];
The names of any witnesses to the emergency behavior intervention, including child witnesses in the home [Medium];
All attempts to explain to the child what behaviors were necessary for release from the intervention [Medium];
The child's condition following the use of the medication or release from the intervention, including any injury the child sustained as a result of the intervention or any adverse effects caused by the use of the intervention. If the child received medical assistance or treatment, the caregiver must document the name of the person(s) who provided medical assistance or treatment [Medium]; and
The actions the caregiver(s) took to facilitate the child's return to normal activities following the end of the intervention. [Medium-High]
(b) The child placement staff must document their review of the use of the emergency behavior intervention within 72 hours of the incident. [Medium]
(c) If personal restraint is used, documentation must also include the specific restraint techniques used, including a prone or supine restraint used as a transitional hold. [Medium]
(d) If emergency medication is used, documentation must also include the specific medication used and the dosage administered to the child. [Medium-High]
(e) This rule does not apply to short personal restraints.
§749.2307. What notice must I provide to the parent when I use an emergency behavior intervention with a child in care?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 8, General Caregiver Responsibilities, Including Documentation, After the Administration of Emergency Behavior Intervention
April 2022
(a) As soon as possible, but no later than 72 hours after the initiation of the intervention, you must provide written notice to the parent that includes [Medium]:
The child's name [Medium];
The specific emergency behavior intervention administered [Medium];
The length of time the child was restrained [Medium];
The child's condition following the use of the medication or release from the intervention, including:
(A) Any injury the child sustained as a result of the intervention or any adverse effects caused by the use of the intervention [Medium]; and
(B) If the child received medical assistance or treatment, the name of each person who provided the medical assistance or treatment [Medium];
If a personal restraint was used, the specific restraint technique used, including a prone or supine restraint used as a transitional hold [Medium]; and
If emergency medication was used, the specific medication used and the dosage administered to the child. [Medium]
(b) A copy of the documentation provided to the parent must be maintained in the child's record. [Medium]
(c) This rule does not apply to short personal restraints.
Technical Assistance
Regarding subsection (a), if the incident report has the information required by this subsection and constitutes what was provided to the parents, a copy of the incident report in the child's record will suffice.
Division 9, Triggered Reviews
§749.2331. What circumstances trigger a review of the use of emergency behavior intervention for a specific child?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 9, Triggered Reviews
February 2017
(a) The following circumstances trigger a review for certain emergency behavior interventions:
| Types of Emergency Behavior Intervention | Circumstances that trigger a review: |
|---|---|
| (1) Short personal restraint | Not applicable, because short personal restraints are not monitored. |
| (2) Personal restraint | Except as provided by subsection (b) of this section: (A) The same child is personally restrained [Medium-High]: (i) four times within a seven-day period; or (ii) more than 12 times in a single 30-day period; or (B) The same child is personally restrained more often than the written order or service planning team recommendation allows. [Medium-High] |
| (3) Emergency medication | Emergency medication is used on the same child three times in a 30-day period. [Medium-High] |
(b) You may exceed the number of restraints otherwise allowed in (2) Personal restraint of Figure: 40 TAC §749.2331(a) for a child if a licensed psychiatrist or psychologist issues a written order or if a service planning team makes a recommendation allowing you to do so and you ensure the following:
If applicable, the recommendation from the service planning team includes the same written information as an order, as specified in §749.2105 of this title (relating to What information must a written order include?); and
At least one triggered review is conducted in accordance with §749.2337 of this title (relating to What must the triggered review include and what must be documented in the child's record?) every 30 days that personal restraints in excess of the threshold are authorized.
§749.2333. When must a triggered review occur?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 9, Triggered Reviews
January 2007
(a) A triggered review must occur as soon as possible, but no later than 30 days after the review is triggered. [Medium-High]
(b) The regularly scheduled review of the child's service plan can serve as the triggered review if it meets the requirements in §749.2337 of this title (relating to What must the triggered review include and what must be documented in the child's record?) and takes place no later than 30 days after the review is triggered. [Medium-High]
§749.2335. Who must participate in the triggered review?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 9, Triggered Reviews
February 2017
(a) The service planning team must participate in the triggered review. [Medium-High]
(b) You must invite the child, as appropriate, and the parents to the review, so they may have the opportunity to participate and provide input into the content of the review. However, you are not required to delay a review because a parent or child is unable to participate in the review at its scheduled time. [Medium-High]
§749.2337. What must the triggered review include and what must be documented in the child's record?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 9, Triggered Reviews
February 2017
(a) Except in cases in which the regularly scheduled review of the child's service plan also addresses the requirements of a triggered review in accordance with §749.2333(b) of this title (relating to When must a triggered review occur?), a triggered review is not a full review of the child's service plan and is focused on the requirements identified in subsection (c) of this section.
(b) Other than the requirements in this section and in §749.2335 of this title (relating to Who must participate in the triggered review?), the notification, participation, implementation, and documentation requirements in Division 4 of Subchapter I (relating to Admission, Service Planning, And Discharge) do not apply to a triggered review.
(c) The following must be included in a triggered review and documented in the child's record:
A review of the records and orders of the emergency behavior interventions [Medium-High];
A review and documentation of any potential medical or psychiatric reason for not using emergency behavior interventions on the child, including the prescribing professional's consideration of any potential medical and/or psychiatric contraindications for the specific child, such as a history of physical or sexual abuse or victimization involving the type of intervention [Medium-High];
An examination of identified behaviors and patterns, any significant events leading up to the use of emergency behavior intervention, and all attempted de-escalation methods, whether successful or unsuccessful [Medium-High];
Identification of alternatives to manage the child's behavior and more effectively prevent the use of emergency behavior intervention in the future [Medium-High]; and
A written plan for reducing the need for emergency behavior intervention. [Medium-High]
§749.2339. What if there are four triggered reviews within a 90-day period?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 9, Triggered Reviews
January 2007
If there are four triggered reviews within a 90-day period:
A licensed psychiatrist, psychologist, clinical social worker, professional counselor, or marriage and family therapist must examine the child [Medium-High]; and
The licensed professional must make service plan recommendations regarding the use of emergency behavior interventions. You must document these recommendations in the child's record. [Medium-High]
Division 10, Overall Agency Evaluation
§749.2381. What is an overall agency evaluation?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 10, Overall Agency Evaluation
January 2007
(a) The overall agency evaluation is an annual review regarding:
The use and effectiveness of emergency behavior interventions at your agency [Medium]; and
Your emergency behavior intervention policies and procedures, including the training policy and curriculum. [Medium]
(b) The objectives of the evaluation are to:
Develop and maintain an environment that supports positive and constructive behaviors of children in care [Medium];
Use any type of emergency behavior intervention safely, appropriately, and effectively [Medium]; and
Eliminate or reduce physical injuries and any other negative side effects on the child's behavior or emotional development resulting from the emergency behavior interventions. [Medium]
(c) One focus of the evaluation must be on:
The frequency, patterns, and effectiveness of the types of emergency behavior intervention techniques that are used for all children in your foster homes [Medium];
Strategies to reduce the need for emergency behavior interventions for all children in your foster homes [Medium]; and
Specific strategies to reduce the need for use of specific types of emergency behavior intervention techniques for all children in your foster homes. [Medium]
(d) The results of each overall agency evaluation must be made available to us for review. [Medium]
§749.2383. What data must be collected?
Subchapter L, Foster Care Services: Emergency Behavior Intervention
Division 10, Overall Agency Evaluation
April 2022
(a) Quarterly, you must collect, document, and review aggregate numbers of emergency behavior interventions by type of intervention except for short personal restraints. [Medium]
(b) This information must be reported to us no later than 15 days after the end of each quarter. [Medium]
(c) You must maintain the data for five years. [Medium]
Technical Assistance
You must use the provider login section of the HHSC Child Care Regulation web site to report quarterly emergency behavior intervention statistics to Licensing. Please note that you are expected to submit a report even if no emergency behavior interventions were used within your operation during the quarter.
The quarterly data on emergency behavior interventions is due to CCR at the end of each quarter. Since the current minimum standards went into effect on January 2007, this is when the data collection was expected to begin. The quarterly reports are based on this start date. Therefore, quarterly reports should represent the following time frames each calendar year:
Quarter 1 – January through March
Quarter 2 – April through June
Quarter 3 – July through September
Quarter 4 – October through December
Document Version: November 2025
Source: Texas Health and Human Services Commission
Chapter: 749 - Minimum Standards for Child Placing Agencies
Part: 07 of 13