| (a) Definitions of Domains. The following words or
terms, when used in this section, shall have the following meanings
unless the context clearly indicates otherwise.
(1) Medical domain: The medical domain is related to
a child's physical health. It includes, but is not limited to, medication
management, medication monitoring, and management of acute and chronic
medical conditions.
(2) Safety and security domain: The safety and security
domain is characterized by the absence of harm to self and others
and safety to self, others, and community. This domain includes, but
is not limited to, self-harm, aggression, and destructive acts.
(3) Recreational domain: The recreational domain involves
the child's ability to choose and participate in age-appropriate
play and activities. This domain includes, but is not limited to,
hobbies and sports.
(4) Educational domain: The educational domain is related
to a child's performance, progress, and conduct in the most appropriate
and least restrictive academic or vocational setting.
(5) Mental/behavioral health domain: The mental/behavioral
health domain refers to the behavioral and emotional functioning of
the child, as well as any psychiatric symptomatology that may be present.
(6) Relationship domain: The relationship domain is
characterized by, but is not limited to, a child's ability to trust,
to form positive relationships, to function well as part of family
unit, as well as by the development and maintenance of age-appropriate
social relationships.
(7) Socialization domain: The socialization domain
is characterized by, but is not limited to, age-appropriate social
behavior, problem-solving, and social skills in various social settings.
(8) Permanence domain: The permanence domain is characterized
by a child moving out of a substitute care system and remaining in
the least restrictive environment in the community.
(9) Parent and child participation domain: The parent
and child participation domain involves, but is not limited to, both
the parent's and child's general satisfaction with services, their
relationship with service providers, their participation in the treatment
or service plan, and improvement in the relationship between the
child and the parents.
(b) Other Definitions.
(1) Contracting entity--a health and human services
agency (the Texas Juvenile Probation Commission and juvenile boards
that contract with the Texas Juvenile Probation Commission, Texas
Department of Mental Health and Mental Retardation and local mental
health and/or mental retardation authorities, and/or Texas Department
of Protective and Regulatory Services) that is responsible for implementing,
coordinating, and monitoring outcome standards for substitute care
services for children placed in a licensed foster families, foster
group homes, or 24-hour residential care facilities. This rule is
not applicable to contracts for persons residing in state-operated
facilities as listed in §532.001, Health and Safety Code, or
persons residing in HCS or ICF/MR facilities under contract with the
Texas Department of Mental Health and Mental Retardation under the
state's Medicaid program.
(2) Substitute care provider--a person who provides
residential care for children for 24 hours a day, including:
(A) a child-care institution, as defined by §42.002,
Human Resources Code;
(B) a child-placing agency, as defined by §42.002,
Human Resources Code;
(C) a foster group home or foster family home, as defined
by §42.002, Human Resources Code; and
(D) an agency group home or agency home, as defined
by §42.002, Human Resources Code, other than an agency group
home, agency home, or a foster home verified or certified by the
Texas Department of Protective and Regulatory Services.
(3) Individualized Treatment Plan--this term has the
same meaning as that set out in 25 TAC §402.53 (Definitions in
Continuity of Services--Mental Health).
(4) Service Plan--this term has the same meaning as
that set out in 40 TAC §700.1331 (Child's Service Plan).
(c) Individualized Treatment Plan or Service Plan.
A substitute care provider who receives funds from the state to provide
substitute care services to children under the care of the State shall
maintain an individualized treatment plan or service plan on each
individual child. The plan shall contain specific behavioral goals
that are appropriate to the child and the types of services to be
provided under the appropriate levels of care. The provider should
use the nine domains in subsection (a) of this section in setting
the behavioral goals. A child is not required to have a goal in each
domain; however, a child may have one or more different goals within
the same domain.
(d) Development of Goals. The responsibility of developing
goals in a child's individual treatment plan or service plan resides
with contracting entity in conjunction with the substitute care provider.
The child and family should be involved in the development of treatment
goals whenever possible. Once a child has met goal(s) identified in
the treatment or service plan, new goals should be developed for the
child.
(e) Measurement of Progress toward Goals.
(1) The staff, representative, or third party independent
agent of the contracting entity shall monitor the progress of the
child in achieving the goals. The frequency of monitoring shall be
based upon the current review period appropriate for that specific
child's level of care. A six-point scale measures the child's progress
towards the achievement of each goal. The staff, representative, or
third party independent agent also rates the child. Progress is rated
at given intervals on the following six-point scale:
(A) +3 Goal achieved and maintained;
(B) +2 Substantial improvement in behavior identified
in the goal;
(C) +1 Some improvement in behavior identified in the
goal;
(D) 0 No decline or improvement in behavior identified
in the goal;
(E) -1 Some worsening in behavior identified in the
goal; and
(F) -2 Substantial worsening in behavior identified
in the goal.
(2) The child's progress will be assessed on each identified
goal within the nine domains listed in subsection (a) of this section.
If the child has shown improvement in 50% or more of the identified
goal(s) as measured by a positive rating (+1, +2, or +3) during the
monitoring period, the child will be considered to be progressing
towards the goal(s).
(3) The outcome of a substitute care provider's service
delivery shall be measured by the percentage of children under its
care that are considered to have made progress towards their goals,
as defined in paragraph (2) of this subsection.
(4) When a contracting entity has an option in placing
a child in substitute care, the entity shall consider whether the
children in a particular substitute care provider's care are progressing
as defined in paragraph (2) of this subsection.
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