Refuge House, Inc. · Care Protocol

Mental & Behavioral Health Support Services

MBH Package · FC-MH-01 Active Blueprint: April 2026, pp. 78–95 · Revised May 2026
Anticipated LOS 12–18 months
ISP Deadline 30 days · HIGH WEIGHT
CSR Cycle Every 90 days
CANS 3.0 Every 90-day CSR
Therapy Minimum Weekly individual
Aftercare 6 months · twice-monthly
Foster Home Capacity Per TAC §749
CSR Sign-Off Dual Director — written
About This Protocol
This Care Protocol is the operational entry point for any child in the Mental & Behavioral Health (MBH) Support Services package. It presents the complete, unified set of requirements for treatment teams — from admission through aftercare. It is served by the Compliance API and fetched fresh from the knowbase whenever a child's record opens in Pulse.

Package Description

Mental & Behavioral Health Support Services provides trauma-informed foster care for children, youth, and young adults with mental health diagnoses who require specialized therapeutic support. Services are delivered through credentialed Foster Family Homes using Trust-Based Relational Intervention® (TBRI®) as the agency's evidence-informed treatment model, enhanced with clinical mental health interventions.

Critical Operational Thresholds

High-Weight Requirements
RequirementStandardAuthority
Initial Service Plan (ISP) Within 30 days of placement TAC §749.1301 — HIGH WEIGHT
90-Day CSR Sign-Off Written confirmation from BOTH Treatment Director AND Program Director Blueprint p. 87
CANS 3.0 Update Required at every 90-day CSR FC3-01.1; Blueprint p. 87
CSR Submission to SSCC/DFPS Within 15 business days of review FC-CSR-01.1
Weekly Individual Therapy Minimum — no exceptions without Treatment Director clinical justification Blueprint p. 78; FC-MH-01 §5.1
Service Denial Notification Notify SSCC/DFPS within 3 business days Blueprint p. 82; FC-STAR-01.1 §9
Crisis Response — Phone Within 15 minutes FC-04.1 §3.3
Post-Crisis Documentation Within 3 business days FC-04.1 §7
Mandatory Aftercare 6 months, twice-monthly contact throughout Blueprint p. 88; FC-AF-01

TBRI® Treatment Model Integration

Connecting Principles

Building trust and connection that supports mental health recovery. Healthy relationships are foundational to healing. Case managers and caregivers intentionally build felt safety with each child.

Empowering Principles

Addressing physical regulation needs that impact mental health — nutrition, sleep, sensory processing. Caregivers are coached to support regulation as a prerequisite to learning and connection.

Correcting Principles

Trauma-informed response recognizes that behaviors stem from unmet needs and past experiences. Therapeutic responses replace punitive reactions in all caregiving situations.

Clinical Enhancement

TBRI® principles are enhanced with individualized clinical mental health interventions — weekly therapy, psychiatric coordination, and safety planning — specific to the MBH package.

Dual Credentialing — The Foundation

The MBH package operates on a dual-credential model. The CPA and every placing Foster Family Home must hold both credentials simultaneously:

Credential Lapse Rule
Loss or lapse of either credential immediately suspends MBH service delivery for that home. Service cannot continue under the MBH credential alone. Remediation and reinstatement of both credentials is required before placement resumes.

Admission Criteria

Children are admitted to the MBH package when all of the following conditions are met:

CriterionRequirement
Diagnosis Diagnosed mental health condition requiring specialized therapeutic support beyond standard foster care
Service alignment Placement type and MBH package align with child's needs and strengths as demonstrated through CANS 3.0 Assessment
Setting appropriateness Child can be safely served in a family setting with appropriate therapeutic services in place
Pre-placement visit Conducted when applicable and appropriate; successful outcome documented
Admissions review CPA admissions staff have reviewed child's information and confirmed needs align with services offered
Credentialing verified CPA and placing Foster Family Home hold current credentials for both T3C Basic AND MBH packages
STAR Health Child enrolled in STAR Health; active MCO assignment confirmed before or at placement

Foster Family Home Credentialing

Credentialing Validity

RequirementStandard
Initial credential validity 4 years
Annual compliance review Required each year within the 4-year cycle
Child outcome data review Annual; part of compliance review
Re-credentialing assessment At end of each 4-year cycle
MBH-specific training before first placement 4 hours (see Foster Home tab)

Credentialing Assessment Components

Key Form
Foster Family Home Credentialing Assessment — FC-CRED-01. Dual credential status verified and logged in the Foster Home Credentialing Verification Log.

Foster Home Capacity

The T3C Blueprint (April 2026, pp.79–89) does not specify a Package-specific foster home capacity limit for Mental & Behavioral Health Support Services. Standard TAC §749 base foster home capacity standards apply; the approved capacity is whatever is on each foster home's current verification.

Step-Down Planning

The dual-credential model supports step-down within the same foster family home. When a child no longer requires MBH services but remains in foster care, the child can remain with the same caregiver under the T3C Basic credential, avoiding a disruptive placement change. This continuity benefit should be considered in all discharge planning.

Initial Service Plan (ISP)

High-Weight Standard — TAC §749.1301
The ISP must be developed within 30 days of placement. This is a HIGH WEIGHT standard under Texas minimum standards. Missing this deadline is a significant compliance finding. Begin ISP development at or before the placement date.

The ISP is strength-based and individualized, incorporating CANS 3.0 findings and the child's permanency goal. It must address:

90-Day Continued Stay Review (CSR)

ComponentRequirement
CANS 3.0 Update Required at every 90-day CSR
Treatment Progress Assessment Required component — therapy engagement, medication management, symptom trajectory
Therapy Effectiveness Review Required — documented in service plan review
Step-Down Readiness Assessed at each 90-day review
Service Plan Adjustment Documented based on review findings
Submission to SSCC/DFPS Within 15 business days of review

Dual Director Written Confirmation — CSR Requirement

Critical — Blueprint p. 87
Every 90-day CSR requires written confirmation from both the Treatment Director and the Program Director before submission to SSCC/DFPS. One signature alone is insufficient. Verbal acknowledgment does not satisfy this requirement under any circumstance.
Treatment Director Confirmation

Documents clinical indicators supporting continued stay:

  • Current diagnoses and symptom severity
  • Crisis incidents during the review period
  • Medication management complexity
  • Therapy engagement and effectiveness
  • Reason a less restrictive placement is insufficient
  • Confirmation child is benefitting from the Treatment Model
Program Director Confirmation

Documents administrative indicators:

  • Placement stability and resource utilization
  • Permanency progress
  • Verification that both T3C Basic AND MBH credentials are current and in good standing for Refuge House and the placing foster home
  • If either credential has lapsed — does not sign; initiates remediation
Key Form
Enhanced Continued Stay Confirmation Form (90-Day) — dual PD + TD written confirmation. See FC-CSR-01.1 Sections 4.3 and 4.4 for full procedure steps.

Service Plan Components

At each 90-day review, the service plan must be updated to reflect current status across all domains:

DomainContent Required
Mental health treatment Therapy type, frequency, provider, goals, and engagement status; psychiatric services if applicable
Safety Updated Personal Safety Plan including current triggers, de-escalation strategies, crisis contacts
Education School enrollment, IEP/504 status, grade level, attendance, current supports
Health and STAR Health Active authorizations, pending requests, any denials, medication list
Family connections Visitation plan, contact frequency, family therapy participation
Permanency Current goal, progress toward goal, concurrent planning if applicable
Normalcy Current extracurricular/social activities, Reasonable and Prudent Parent Standard application
Discharge planning Step-down readiness, anticipated discharge timeline, transition plan

Therapeutic Services

Package Minimum Standard
Children in the MBH package receive a minimum of weekly individual therapy. This standard is required regardless of STAR Health authorization timelines — coordinate renewals proactively to prevent lapses in service.
Service TypeRequirementNotes
Individual Therapy Weekly minimum Addresses trauma history, mental health diagnoses, behavioral health needs, and presenting clinical concerns
Family Therapy As clinically indicated Includes Foster Family Home Caregivers; supports placement stability and caregiver integration of therapeutic goals
Group Therapy As clinically indicated Coordinated through STAR Health or community providers
Psychiatric Services As clinically indicated Psychiatric evaluations, medication management appointments; authorized and coordinated through STAR Health

Provider Qualifications

Therapy services must be provided by a Licensed Therapist specializing in providing therapy to children with DSM-5 diagnoses for serious mental, emotional, and/or behavioral disorders. Providers must be credentialed and contracted with the child's STAR Health managed care organization.

STAR Health Coordination — MBH Requirements

Service AreaCoordination Requirement
Individual Therapy Verify STAR Health authorization before services begin; track renewal dates; coordinate renewal before lapse
Psychiatric Services Authorize and coordinate psychiatric evaluations, medication management appointments, and inpatient/partial hospitalization referrals through STAR Health MCO
Family & Group Therapy Maintain records of authorization status; include in authorization tracking
Medication-Assisted Treatment (MAT) Where applicable for co-occurring substance use, coordinate MAT authorization and prescriber communication through STAR Health
HHSC Behavioral Health Coordinate for services not covered by STAR Health, including Community Mental Health services and crisis stabilization resources
Service Denial Documentation Document any denial in case record (date, service type, denial reason, appeal status); notify SSCC/DFPS within 3 business days

Service Documentation and Cost Coverage

In collaboration with the Medical Consenter, all services the child receives through STAR Health, HHSC Behavioral Health, Early Childhood Intervention (if applicable), the education system, and other county, community, or state agencies must be documented in the case record.

Cost Coverage Commitment — Blueprint p. 82
When community resources are not available and STAR Health does not cover needed services consistent with this package and Service Plan, Refuge House will ensure delivery of, and cover the cost of, the needed services and related supports. Document all steps taken before invoking agency cost coverage.

Service Denial Documentation Requirements

When a needed service is unavailable or the child is found ineligible, document in the case record:

CANS 3.0 Assessment

The CANS 3.0 Assessment is conducted by licensed clinical staff at every 90-day CSR for children in the MBH package. Results directly inform the ISP and service plan modifications. Assessment findings must be integrated into the ISP within required timeframes per TAC §749.1301.

Key Forms
CANS 3.0 Assessment Form · Personal Safety Plan · Mental Health Crisis Safety Plan Template · STAR Health Coordination Checklist (FC-STAR-01.1 §9)

Foster Home Support Requirements

Foster Family Home Caregivers serving children in the MBH package provide four categories of support in accordance with court orders and the Service Plan. The therapy-coordination and mental-health-crisis-response demands of this package require heightened caregiver capability.

Logistical Support

Transportation

Service Coordination

Documentation and Record Keeping

Multi-System Navigation

SystemCoordination Scope
STAR Health Medicaid managed care — therapy, psychiatric, medical, dental, vision, and behavioral health authorizations
HHSC Behavioral Health Specialized mental health supports beyond STAR Health coverage, crisis stabilization resources
Education system School enrollment, IEP/504 advocacy, special education coordination, attendance monitoring
ECI Early Childhood Intervention for eligible children ages 0–3
Child welfare system DFPS/SSCC caseworker coordination, court involvement, permanency planning
Health care Primary care, specialty medical, dental, vision; Medical Consenter collaboration

Training Requirements

Training ComponentHoursTiming
TBRI® foundational training Before first T3C placement
Understanding mental health diagnoses in youth; Creating therapeutic home environment 4 hours (MBH initial) Before first MBH placement
Trauma-informed response to behaviors; Recognizing signs of mental health crisis
Crisis response and de-escalation
Medication management and safety
Working with the treatment team; Supporting therapy engagement
Normalcy and Reasonable and Prudent Parent Standard
Annual refresher (MBH-specific updates and case discussion) 2 hours Annually
References
FC-16 Staff and Caregiver Training Policy · FC-16.1 Staff and Caregiver Training Procedure · FC-CRED-01.1 Credentialing Procedure

Normalcy Activities

Foster Family Home Caregivers must actively support children's participation in age-appropriate normalcy activities — clothing, hygiene products, hair care, birthdays, holidays, graduations, extracurricular activities, sports, enrichment programs, social activities, cultural events, and employment activities for eligible youth. All decisions are made consistent with the Reasonable and Prudent Parent Standard (Texas Family Code §264.125; Human Resources Code §42.042; TAC §749.1291).

CPA staff coach and support caregivers in applying this standard with particular sensitivity to children whose trauma histories and mental health needs may require individualized pacing or adaptation of normalcy activities.

24/7 Crisis Availability

RequirementStandard
Staff availability 24 hours/day, 7 days/week, 365 days/year
On-call level Case Manager or above
Phone response Within 15 minutes
In-person response Within 1 hour if phone consultation is insufficient
Treatment Director consultation Available during and after business hours for complex clinical situations

Mental Health-Specific Crisis Protocols

In addition to standard crisis response, MBH cases require protocols for:

Post-Crisis Documentation

3-Business-Day Requirement — FC-04.1 §7
All of the following must be completed within 3 business days of a crisis event:
Key Forms
Personal Safety Plan · Mental Health Crisis Safety Plan Template · Crisis Incident Documentation Form (FC-04.1)

STAR Health — Health Care Coordination

Active Enrollment

Verify STAR Health active enrollment and MCO assignment at placement. Coordinate all authorizations before services begin and renew all authorizations before lapse.

Medical Consenter Collaboration

All health service documentation is coordinated in collaboration with the child's Medical Consenter. Medical records and health history are maintained in the child's case file. Specialty referrals are coordinated through the Medical Consenter and STAR Health.

Services Not Covered by STAR Health

Human Trafficking Prevention

Universal Human Trafficking Prevention screening applies to all children in the MBH package per FC-HT-01 and the Human Trafficking Prevention Training Implementation Plan.

Mandatory — Blueprint p. 88
Aftercare services are mandatory for ALL children discharged from MBH Support Services. Services continue for a minimum of 6 months following discharge, regardless of discharge reason. The Aftercare Case Manager is assigned at or before discharge.

Contact Requirements

PeriodContact FrequencyMode
Month 1 Twice monthly (minimum) — in-person preferred In-person preferred; phone acceptable with documentation of barrier
Months 2–6 Twice monthly (minimum) In-person or phone; flexible scheduling
Crisis availability 24/7 throughout full 6-month period Phone; in-person if warranted

Aftercare Content — Youth Contacts

Focus AreaActivities
Mental health stability Therapy attendance monitoring, psychiatric stability check, medication compliance
Service continuity Continued therapy coordination and STAR Health authorization support
Medication support Monitoring, prescriber coordination if applicable
Crisis prevention Safety plan updated, 24/7 crisis line access provided and reinforced
Community connection Connection to community mental health resources and peer support

Aftercare Content — Family/Caregiver Contacts

Focus AreaActivities
Minimum contact Twice monthly with family/caregivers in the receiving placement throughout the 6-month period
Clinical coaching Aftercare Case Manager consults with caregivers on mental health-informed responses to youth behaviors and crisis triggers
Therapeutic implementation Verify implementation of therapeutic coping strategies in the home environment
Support gap identification Identify caregiver support gaps and arrange targeted coaching or training
Community connection Connect families to community mental health family support resources and peer family groups

Documentation

Document all contacts and attempted contacts — date, mode, duration, content summary, and next steps. Document caregiver contacts in the Family Engagement Log. Submit monthly documentation to SSCC/DFPS caseworker by the end of each month.

Key Forms
Therapeutic Transition Summary Form · Contact Documentation Form · Family Engagement Log (MH Aftercare) · Monthly SSCC/DFPS Aftercare Report Template (FC-AF-01.1 §5.2)

5-Month Completion Assessment

At the 5-month mark, the Aftercare Case Manager and Treatment Team conduct a completion assessment reviewing:

The Program Director approves service completion, extension (with clinical justification), or transfer to adult services before the 6-month deadline. Reference: FC-AF-01.1 §6.1

Staff-to-Child Ratios

PositionRatioPer
Case Manager 1:15 Children receiving MBH services
Licensed Therapist 1:14 Children receiving MBH services
Behavior Support Specialist / Mentor 1:15 Children receiving MBH services
Crisis Management Staff 1:25 Standard T3C ratio
Aftercare Case Manager 1:25 Children in aftercare

Administrative Leadership

PositionRequirements
LCPAA Full-time, dedicated to single CPA
Program Director May serve as LCPAA; bachelor's degree OR 5 years residential childcare experience
Treatment Director Must meet T3C Blueprint qualifications; responsible for clinical oversight and supervision of Licensed Therapists; provides Treatment Director written confirmation at each 90-day CSR

Staff Training

Training AreaRequirement
TBRI® foundational training Required for all direct service staff
T3C and MBH service delivery requirements Required for all case managers and clinical staff
Multi-system navigation (STAR Health, HHSC BH, ECI, education) Required for all case managers
Mental health crisis protocols (psychiatric emergencies, suicidal ideation, escalation) Required for all staff with on-call responsibility
Annual continuing education Per FC-16 Staff and Caregiver Training Policy

Hours of Operation

Admissions and placement staff on-call and available 365 days per year, 24 hours per day.

Continuous Quality Improvement

CPA maintains infrastructure to collect, track, and analyze child outcomes — both during placement and through aftercare — including the ability to analyze outcomes by individual foster family home.

CQI Activities

Desired Child Outcomes

The CPA has clearly articulated child-level outcome expectations that tie directly to the MBH Treatment Model, supporting at minimum:

Regulatory References

ReferenceTopic
TAC §749.1301 30-day Service Plan timeline — HIGH WEIGHT STANDARD
TAC §749.1335 Service Plan Review requirements; Foster Family Home support services
TAC §749.339 Crisis response and restriction of privileges
TAC §749.901 Emergency behavior intervention
TAC §749.1309 Personal Safety Plan requirements
TAC §749.361 Aftercare services (mandatory, 6 months)
TAC §749.673 Quality improvement
TAC §749.665 Program Director responsibilities
TAC §749.131 Records and documentation
TAC §749.1291 Normalcy activities
Texas Family Code §264.125 Reasonable and Prudent Parent Standard
Human Resources Code §42.042 Normalcy activities (licensing authority)
RCC Contract Term 7 Placement and service requirements; aftercare
T3C Blueprint (April 2026), pp. 78–95 MBH Support Services requirements
T3C Blueprint (April 2026), p. 82 Service Documentation and Cost Coverage
T3C Blueprint (April 2026), p. 87 90-day CSR; dual Director written confirmation
T3C Blueprint (April 2026), p. 88 Mandatory 6-month aftercare; twice-monthly contact

Forms

Form NameIDPurpose
Enhanced Continued Stay Confirmation Form (90-Day) Dual PD + TD written confirmation for 90-day CSR
Service Plan T3C Supplement Form FC3-03 90-day service plan review and continued stay evaluation
CANS 3.0 Assessment Form Required at every 90-day CSR
Personal Safety Plan Crisis trigger identification, de-escalation strategies, safety protocols
Mental Health Crisis Safety Plan Template MH-specific expanded safety planning
Therapeutic Transition Summary Form Clinical handoff documentation at discharge
Contact Documentation Form Record of all aftercare contacts with youth and family
Family Engagement Log (MH Aftercare) Tracks twice-monthly family/caregiver contacts during aftercare
STAR Health Coordination Checklist Tracks STAR Health authorizations, denials, and appeals
Crisis Incident Documentation Form Post-crisis documentation per FC-04.1 §7
Monthly SSCC/DFPS Aftercare Report Template Required monthly aftercare reporting
Aftercare Completion Assessment Tool 5-month completion review
Foster Home Credentialing Verification Log Tracks dual credential status (T3C Basic + MBH)
Service Denial Response Form FC-SDR-01 Documenting and responding to service denials

All forms available at previewforms.refugehouse.org and in Radius.

Related Policies and Procedures

DocumentRelationship
FC-MH-01 MBH Support Services PolicyGoverning policy for this package
FC-CSR-01 Continued Stay Review PolicyGoverns 90-day CSR policy
FC-CSR-01.1 Continued Stay Review ProcedureFull dual Director confirmation steps (Sections 4.1–4.5)
FC3-01.1 Individual Service Planning ProcedureISP development; 90-day CSR; MBH-specific CANS 3.0 cycle
FC-04 Crisis Management Policy24/7 crisis policy
FC-04.1 Crisis Management ProcedureMH-specific crisis protocols; response timelines; post-crisis documentation
FC-AF-01 Aftercare Services PolicyMandatory 6-month aftercare policy
FC-AF-01.1 Aftercare Services ProcedureTwice-monthly contact; MH aftercare planning and delivery
FC7-01 Family Connections and Engagement PolicyFamily engagement in treatment; aftercare family engagement
FC-STAR-01.1 STAR Health Coordination ProcedurePsychiatric authorization; MAT; service denial management (Section 9)
FC-16 Staff and Caregiver Training PolicySection 4.3: MBH 4-hour foster parent training; staff training
FC14-01 Discharge and Permanency Planning PolicyDischarge process; therapeutic transition summary
FC-CRED-01.1 Foster Family Home Credentialing ProcedureDual credential verification and annual compliance review
FC-HT-01 Human Trafficking Prevention PolicyUniversal screening requirement
FC2-01.1 Admission Assessment ProcedureCANS 3.0 initial assessment at placement
FC6-01 Admission Matching & Criteria PolicyMBH placement matching