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
| Requirement | Standard | Authority |
|---|---|---|
| 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
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.
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.
Trauma-informed response recognizes that behaviors stem from unmet needs and past experiences. Therapeutic responses replace punitive reactions in all caregiving situations.
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:
Admission Criteria
Children are admitted to the MBH package when all of the following conditions are met:
| Criterion | Requirement |
|---|---|
| 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
| Requirement | Standard |
|---|---|
| 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
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)
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)
| Component | Requirement |
|---|---|
| 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
Documents clinical indicators supporting continued stay:
Documents administrative indicators:
Service Plan Components
At each 90-day review, the service plan must be updated to reflect current status across all domains:
| Domain | Content 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
| Service Type | Requirement | Notes |
|---|---|---|
| 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 Area | Coordination 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.
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.
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
| System | Coordination 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 Component | Hours | Timing |
|---|---|---|
| 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 |
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
| Requirement | Standard |
|---|---|
| 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
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.
Contact Requirements
| Period | Contact Frequency | Mode |
|---|---|---|
| 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 Area | Activities |
|---|---|
| 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 Area | Activities |
|---|---|
| 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.
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
| Position | Ratio | Per |
|---|---|---|
| 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
| Position | Requirements |
|---|---|
| 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 Area | Requirement |
|---|---|
| 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
| Reference | Topic |
|---|---|
| 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 Name | ID | Purpose |
|---|---|---|
| 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
| Document | Relationship |
|---|---|
| FC-MH-01 MBH Support Services Policy | Governing policy for this package |
| FC-CSR-01 Continued Stay Review Policy | Governs 90-day CSR policy |
| FC-CSR-01.1 Continued Stay Review Procedure | Full dual Director confirmation steps (Sections 4.1–4.5) |
| FC3-01.1 Individual Service Planning Procedure | ISP development; 90-day CSR; MBH-specific CANS 3.0 cycle |
| FC-04 Crisis Management Policy | 24/7 crisis policy |
| FC-04.1 Crisis Management Procedure | MH-specific crisis protocols; response timelines; post-crisis documentation |
| FC-AF-01 Aftercare Services Policy | Mandatory 6-month aftercare policy |
| FC-AF-01.1 Aftercare Services Procedure | Twice-monthly contact; MH aftercare planning and delivery |
| FC7-01 Family Connections and Engagement Policy | Family engagement in treatment; aftercare family engagement |
| FC-STAR-01.1 STAR Health Coordination Procedure | Psychiatric authorization; MAT; service denial management (Section 9) |
| FC-16 Staff and Caregiver Training Policy | Section 4.3: MBH 4-hour foster parent training; staff training |
| FC14-01 Discharge and Permanency Planning Policy | Discharge process; therapeutic transition summary |
| FC-CRED-01.1 Foster Family Home Credentialing Procedure | Dual credential verification and annual compliance review |
| FC-HT-01 Human Trafficking Prevention Policy | Universal screening requirement |
| FC2-01.1 Admission Assessment Procedure | CANS 3.0 initial assessment at placement |
| FC6-01 Admission Matching & Criteria Policy | MBH placement matching |