TITLE 26. HEALTH AND HUMAN SERVICES

§306.501. Purpose.

This subchapter establishes rules to ensure proper care and treatment of an adolescent with high acuity receiving services in the Terrell Center for Youth.

§306.503. Application.

This subchapter governs the admission of an adolescent to, treatment at, and discharge or transition from the Terrell Center for Youth and establishes the responsibilities of the entities involved in those processes.

§306.505. Definitions.

The following terms in this subchapter have the following meanings, unless the context clearly indicates otherwise.

(1) Adolescent--An individual in the managing conservatorship of DFPS who is at least 13 years of age but younger than 18 years of age.

(2) Calendar day--Any day, including weekends and holidays.

(3) Conservatorship case worker--A DFPS or SSCC staff member with assigned responsibility for an adolescent's care while in DFPS managing conservatorship.

(4) Court appointed special advocate--A volunteer appointed by a judge to advocate for a child's best interest. The Court appointed special advocate may also be the guardian ad litem.

(5) DD--Developmental disability. A disability that meets the criteria described in Texas Health and Safety Code §531.002(15).

(6) DFPS--The Texas Department of Family and Protective Services.

(7) DFPS case manager--A DFPS staff member who serves as a liaison between DFPS, SSCC, and TCY staff involved with the adolescent's treatment, and the adolescent's local authority.

(8) DFPS managing conservatorship--When a judge legally appoints DFPS to be responsible for a child under Texas Family Code Chapters 262 or 263. The rights and duties of DFPS managing conservatorship are described in Texas Family Code §153.371. DFPS managing conservatorship includes a temporary or permanent managing conservatorship or a joint managing conservatorship.

(9) Discharge--The release of an adolescent from the continuing treatment and care of TCY.

(10) Guardian ad litem--A person appointed to represent the best interest of a child in accordance with Texas Family Code §107.001.

(11) HHSC--The Texas Health and Human Services Commission.

(12) High acuity--A need for high levels of care or monitoring due to a condition that cannot be easily managed.

(13) ID--Intellectual disability. A disability that meets the criteria in Texas Health and Safety Code §591.003.

(14) LAR--Legally authorized representative. The person legally authorized by state law to act on behalf of an adolescent with regard to a matter described in this subchapter. For purposes of this subchapter, the LAR may be:

(A) the DFPS case manager assigned to TCY; or

(B) a joint managing conservator with DFPS who has the right to consent to medical treatment.

(15) Least restrictive setting--As defined in Texas Health and Safety Code §571.004 and §591.005.

(16) Local authority--An entity designated by the HHSC executive commissioner as a:

(A) local mental health authority (LMHA) as provided in Texas Health and Safety Code §533.035(a);

(B) local behavioral health authority (LBHA) as provided in Texas Health and Safety Code §533.0356(a); or

(C) local intellectual and developmental disability authority (LIDDA) as provided in Texas Health and Safety Code §533A.035(a).

(17) Ombudsman for Children and Youth in Foster Care--The ombudsman program established by HHSC under Texas Government Code §523.0357 to provide support and information services to children and adolescents in foster care.

(18) Placement--This term:

(A) includes:

(i) a family foster home;

(ii) a non-licensed kinship home;

(iii) an adoptive home;

(iv) a licensed residential operation; or

(v) a specialized treatment facility; and

(B) excludes:

(i) an emergency shelter facility as defined by Texas Human Resources Code §42.041; and

(ii) any placement expected to last 30 calendar days or less.

(19) Recovery plan--A written, person-centered, individualized plan developed by treatment providers in collaboration with the adolescent, the conservatorship case worker, and the LAR. The plan:

(A) identifies the adolescent's strengths, capabilities, treatment goals, preferences, needs, desired outcomes, and discharge plans;

(B) identifies the evidence-based, best practice assessments and treatments the treatment providers will use in the adolescent's care; and

(C) is amended at any time based on the adolescent's needs.

(20) Recovery team--A group of treatment providers responsible for providing treatment and developing a discharge plan for an adolescent. The recovery team collaborates with the adolescent, the conservatorship case worker, and the LAR to coordinate mental health, substance use, ID, and DD services, and develop a discharge plan.

(21) SSCC--Single Source Continuum Contractor. An entity described under Texas Family Code §264.154 and contracted with DFPS to provide a comprehensive network of services for an adolescent in the managing conservatorship of DFPS who resides in an SSCC designated catchment area.

(22) TCY--Terrell Center for Youth. A state hospital residential treatment facility for an adolescent in DFPS managing conservatorship.

§306.507. Memorandum of Understanding.

A memorandum of understanding (MOU) located on the TCY website further specifies roles and responsibilities between TCY and DFPS to implement the rules in this subchapter. The MOU identifies:

(1) communication and review processes between TCY, DFPS, and SSCCs; and

(2) the procedures for reviewing decisions for an adolescent who is denied admission to TCY.

§306.509. Eligibility and Admission Criteria.

(a) To be eligible for referral and admission to TCY, an adolescent must:

(1) be in DFPS managing conservatorship;

(2) not be an involuntary admission as defined in §306.153 of this chapter (Relating to Definitions);

(3) not require an inpatient psychiatric level of care and have one of the conditions listed in subparagraphs (A) - (D) of this paragraph, or one of the combination of conditions listed in subparagraphs (E) - (G) of this paragraph, as jointly determined by HHSC and DFPS:

(A) a mental health disorder;

(B) substance use disorder;

(C) ID;

(D) DD;

(E) co-occurring mental health and substance use disorder;

(F) ID or DD and co-occurring mental health disorder; or

(G) ID or DD and co-occurring substance use disorder; and

(4) not require treatment for a medical condition that is unstable or requires immediate surgery, advanced medical procedures, or extraordinary ongoing medical monitoring.

(b) DFPS in collaboration with TCY determines whether admission to TCY is the least restrictive appropriate setting for the adolescent.

(c) The HHSC deputy executive commissioner for the Health and Specialty Care System may approve an adolescent for admission to TCY on a case-by-case basis.

§306.511. Texas Department of Family and Protective Services Responsibilities.

(a) DFPS submits a referral application for an adolescent to TCY for review.

(b) DFPS provides all available information relevant to treating the adolescent to TCY, including:

(1) clinical documentation;

(2) history of sexual abuse and history of sexual aggression;

(3) placement history;

(4) educational and medical records; and

(5) the name of the adolescent's LAR.

(c) DFPS assigns a DFPS case manager to TCY who:

(1) coordinates the adolescent's admission with TCY and the adolescent's local authority;

(2) serves as a liaison between the conservatorship case worker, the adolescent's local authority, and TCY;

(3) participates in recovery team meetings and ensures the adolescent's overall needs are met;

(4) participates in discharge planning and coordinates the adolescent's potential intended placement following discharge;

(5) works with TCY on educational and medical referrals to meet the adolescent's post-discharge needs;

(6) helps obtain services and supports for the adolescent and family, if applicable, throughout the adolescent's treatment at TCY and before discharge;

(7) is present onsite during regular working hours and available after hours to participate in and coordinate discharge plans with all relevant parties, including TCY and the potential future placement;

(8) serves as the adolescent's LAR and medical consenter; and

(9) acts as a liaison between the adolescent and other persons as necessary.

(d) DFPS continuously searches for a less restrictive placement from the date of the adolescent's admission to TCY that meets the adolescent's identified needs and in consultation with the adolescent's recovery team.

(e) The DFPS case manager assigned to TCY may not delegate the role of LAR, but the assigned conservatorship case worker may serve as the adolescent's alternate medical consenter.

§306.513. Terrell Center for Youth Responsibilities.

(a) TCY reviews an adolescent's pre-admission application packet, in a meeting with DFPS, within 24 hours after receiving the pre-admission application packet, and determines if the adolescent meets the eligibility and admission criteria in §306.509 of this subchapter (relating to Eligibility and Admission Criteria).

(b) TCY admits the adolescent within 24 hours after determining the adolescent's eligibility, if a bed is available.

(c) TCY explains the following to the adolescent, orally and in writing, using developmentally appropriate language in the adolescent's primary language using a translator if needed:

(1) the adolescent may obtain additional information and resources from the Ombudsman for Children and Youth in Foster Care by calling 1-844-286-0769;

(2) the adolescent's rights described in Chapter 320, Subchapter A of this title (relating to Rights of Individuals Receiving Mental Health Services); and

(3) at admission and discharge, of the existence, purpose, telephone number, and address of the protection and advocacy system in Texas according to Texas Health and Safety Code §576.008.

(d) TCY ensures the adolescent receives educational services according to Texas Health and Safety Code §554.002.

(e) TCY provides:

(1) treatment based on an evidence-based assessment;

(2) 24-hour residential treatment facility services;

(3) evidence-based trauma-informed treatment services; and

(4) treatment with psychotropic medication, if prescribed in accordance with Chapter 320, Subchapter B of this title (relating to Consent to Treatment with Psychoactive Medication) and based on the adolescent's clinical evaluation.

(f) TCY provides family visitation opportunities, when appropriate, with DFPS approval.

§306.515. Recovery Planning.

(a) An adolescent's recovery team must include:

(1) the conservatorship case worker;

(2) the DFPS case manager assigned to TCY;

(3) treatment providers;

(4) the adolescent;

(5) the adolescent's LAR;

(6) the adolescent's guardian ad litem, Court Appointed Special Advocate, and attorney ad litem as applicable;

(7) other participants requested by TCY and DFPS; and

(8) the adolescent's local authority in the adolescent's county of residence in accordance with §306.162(b) of this chapter (relating to Determining County of Residence).

(b) TCY invites members of the adolescent's recovery team and any other person authorized by the adolescent, to routine recovery plan meetings and any meetings specific to the adolescent's discharge plan. TCY notifies meeting participants, in writing, at least 24 hours before each scheduled recovery plan meeting.

(c) The recovery plan meetings must:

(1) be centered on the adolescent's identified strengths, needs, treatment goals, and discharge plans;

(2) begin discharge planning at the time of the adolescent's admission to TCY, and is reviewed at least monthly during recovery plan meetings; and

(3) help identify individualized services and supports for the adolescent, as recommended by the recovery team.

(d) TCY may transfer the adolescent to a higher level of care if clinically indicated, documented in the adolescent's medical record, and with the consent of the conservatorship case worker.

§306.517. Transition Services and Discharge.

(a) An adolescent may be discharged from TCY:

(1) when the recovery team determines the adolescent has completed treatment and no longer requires TCY services;

(2) when the DFPS case manager requests the adolescent's discharge from TCY; or

(3) in accordance with §306.203 of this chapter (relating to Discharge of an Individual Voluntarily Receiving Inpatient Treatment).

(b) TCY holds an adolescent's bed for up to 30 calendar days if the adolescent is:

(1) admitted to a hospital for medical or psychiatric care;

(2) placed in the custody of an adult criminal justice facility; or

(3) placed in the custody of a juvenile justice facility.

(c) When TCY holds the adolescents bed in accordance with subsection (b) of this section, TCY readmits the adolescent post-release if:

(1) the date of release is:

(A) within 30 calendar days; and

(B) before the date of the adolescent's 18th birthday; and

(2) the adolescent still meets the eligibility and admission criteria described in §306.509 of this subchapter (relating to Eligibility and Admission Criteria).

(d) TCY is not required to hold an adolescent's bed for up to 30 calendar days, as described in subsection (b) of this section, if TCY and DFPS become aware that the adolescent has no chance of returning to TCY within 30 calendar days.

(e) TCY does not discharge an adolescent before DFPS or the SSCC:

(1) secures the adolescent's post-discharge placement;

(2) obtains all needed approvals as identified in the discharge plan; and

(3) executes a plan for the direct transfer of the adolescent to the approved placement.

(f) TCY and the adolescent's local authority must meet the discharge requirements in §306.201 of this chapter (relating to Discharge Planning).

(g) An adolescent's recovery team communicates with DFPS or the SSCC concerning the progress made by DFPS or the SSCC in securing a suitable post-discharge placement, obtaining necessary approvals, and arranging the adolescent's direct transfer to the approved placement.

(h) TCY, DFPS or the SSCC, and the adolescent's local authority collaborate to identify, recommend, and help arrange the adolescent's access to needed services and resources after discharge, including specific clinical and non-clinical services and supports, such as:

(1) transportation;

(2) clinical and medical support;

(3) housing;

(4) employment;

(5) education resources;

(6) food assistance;

(7) clothing resources; and

(8) other applicable supportive resources or governmental benefits.

(i) Notwithstanding subsections (a) - (h) of this section, TCY must discharge an adolescent no later than the day before the adolescent's 18th birthday in accordance with Texas Health and Safety Code §321.002(d)(2).