Frequently Asked Questions 

General Questions

Answer: This is one of the most difficult questions to answer. First, use all your consumer education skills that you would use in any serious health care decision. Trust your judgment and impression of the people with whom you talk and your feelings about the setting. Ask the provider for any outcome reports about their services, accreditations, and community professionals familiar with their services.

A parent or child helper CAN NOT ask too many questions when selecting a provider to work with children. Provider responses should be clear and concise. Parents and child helpers should have an opportunity to visit the setting and to view the program in operation.

While national accreditations do not offer guarantees, they are an indication that the provider has been carefully reviewed by an independent organization. Child helpers may even want to call the accreditation organization to determine if the provider continues to be in good standing.

Every provider must be licensed to operate and the licensing authority is usually in the same city or county as the provider.

Child helpers may want to contact the licensing authority for information about the provider. Child helpers may also obtain information and opinions about providers from other professionals in their community to include physicians, psychologists, and social workers.

Finally, most effective providers encourage full participation from the family and other child helpers throughout treatment. Quality providers appreciate the value of this important and necessary involvement.

Answer:  This is a very difficult and often asked question from family members. The Placement Locator on this site can help you if you select “sliding fee scale” as one of the search criteria. The resulting list of providers will often work with families in need.

In general, children with very challenging problems are often difficult to place based solely on “sliding fee scale.” But with this in mind, families should not be discouraged from contacting the providers listed in the TNCinfo database. Many of these providers have a long and distinguished history of helping families with limited financial resources.

In addition, families working on behalf of children with severe mental health problems will often find a wide range of resources and assistance from their County Mental Health and Mental Retardation Center (MHMR). Many communities also support multi-agency collaboration groups (i.e. CRCG Teams) whose purposes include helping to support families with community resources and residential resources. Once again, local MHMR Centers and Mental Health Associations will have information if one of these groups is operating in your community.

 

Texas DFPS Service System Questions

Answer: DFPS expects contract providers to use qualified licensed therapists for children needing individual, group, and family therapy. These expectations are contained within the Service System standards and in other DFPS communications to providers. Service System corrective action plans only pertains to how the provider will deliver these services to children. Plans by individuals to obtain a license to provide therapy which may take months or years does not constitute a corrective action plan for this issue.

Providers may bill Medicaid for therapeutic activities for children eligible for this benefit and who need Moderate, Specialized or Intense services. The current definition used by DFPS for qualified therapists are listed below for your reference.

  • Psychiatrist (MD)
  • Licensed Psychologist
  • Registered Nurse (RN) (primary service requires RN)
  • Licensed Master’s Social Worker
  • Licensed Professional Counselor (LPC)
  • Licensed Professional Counselor – Temporary (LPC-T)
  • Licensed Marriage and Family Therapist
  • Alcohol and Drug Abuse Counselor (primary diagnosis is substance abuse)
  • Occupational Therapist (primary service requires an OT)

Answer: Answer: (Simple Response)

YFT has no authority or responsibility to define, develop or maintain the Texas Service System. These functions are the sole responsibility of various Texas state agencies.

(Complex Response)

This overview describes the Texas Level of Care (LOC) Service System that existed in Texas from September 1, 1988, until August 31, 2003. During FY ’03, this system was substantially revised by the Texas Department of Family and Protective Services (formerly the Texas Department of Protective and Regulatory Services). The Texas Service System changes went into effect on September 1, 2003. Copies of the revised Texas Service System standards are available from the DFPS Residential Contract Managers.

A state agency called the Health and Human Services Coordinating Council was established in 1983 to coordinate planning and policy making for 19 health and human services agencies in Texas. The Council was chaired by the Governor; the Lieutenant Governor and Speaker of the House served as co-chairs. Council membership included State Senators, representatives, Board Chairs of State agencies, and members of the general public.

In 1984, the Legislative Budget Board required that the Council undertake a study of residential contract child care in Texas. The Council appointed a Public-Private Policy Group to work toward development of a “continuum of care” for children and youth that had to include the following components.

1.A common application form for agencies to use when placing children in residential care facilities that includes a mechanism to determine the appropriate level of care for each child.

2.A system of services to children that would include definitions and standards for various levels of care and an interagency monitoring process to evaluate implementation of this system by contract residential providers.

3.A child care facility cost report and database to assist in determining the median cost of care and to be responsible for reporting these costs to the legislature as the standard recommended payment rates.
During the next four (4) years, a group referred to as the Treatment and Care Work Committee developed a system of care that met the criteria established by the Legislative Budget Board. This system of care was called the Level of Care Service System. YFT assists DFPS with the implementation of this system of care.

  • Psychiatrist (MD)
  • Licensed Psychologist
  • Registered Nurse (RN) (primary service requires RN)
  • Licensed Master’s Social Worker
  • Licensed Professional Counselor (LPC)
  • Licensed Professional Counselor – Temporary (LPC-T)
  • Licensed Marriage and Family Therapist
  • Alcohol and Drug Abuse Counselor (primary diagnosis is substance abuse)
  • Occupational Therapist (primary service requires an OT)

Answer: The training records of selected direct caregivers (during the current calendar or fiscal year) are the primary source of information to determine compliance with the various training indicators. If training records do not support sufficient training hours for a caregiver during the current year, then YFT would examine the employee’s previous year’s record of training. If that particular caregiver had adequate training hours for the previous year, and there is an established written training plan to support training hours for the current year, that caregiver would be determined to have met the training requirement.

 

CPS Children’s Authorized Service Questions

Answer: The Department of Family and Protective Services (DFPS) contracts with Youth for Tomorrow (YFT) to assist in the implementation of the Texas Service System. These statewide services are provided according to procedures approved by DFPS.

Secondly, DFPS policy requires that caseworkers obtain an Initial Service Authorizaion for children prior to placement in residential care only if the child needs Moderate or higher services. This requirement does not pertain to emergency shelter placements.

CPS caseworkers need to forward the information listed below to YFT for an Initial service authorization ONLY for children in the conservatorship of DFPS and who will need services in a contract residential setting. Again, this service does not include children needing Basic services, which is assigned by CPS caseworkers. •IMPACT LOC Authorization Request Form
• Common Application, Form 2087
• Psychological or psychiatric report completed within 14 months
• Information on medical problems or disabilities
• Information describing any extenuating circumstances, incident reports, etc.

These materials may be mailed to YFT at:

Answer: The Department of Family and Protective Services (DFPS) contracts with Youth for Tomorrow (YFT) to assist in the implementation of the Texas Service System. These statewide services are provided according to procedures approved by DFPS which includes the use of service definitions.These definitions were developed by DFPS and approved by the DFPS Board of Directors on January 29, 2004.

YFT uses these definitions to determine a child’s service needs. Clinically trained professionals from YFT use these definitions to synthesize their knowledge about a child’s psychological and social functioning and then makes a service authorization (Basic, Moderate, Specialized, or Intense). The service authorization is determined in the context of a broad review of the clinical information submitted by the CPS caseworker about the child’s social and medical history, symptomatology, behaviors at home or alternate placements, behaviors in school, and interpersonal relationships with children and adults.

In addition, the service determination process considers the child’s developmental and chronological age in relation to various risk behaviors. For the most part, the process does not use a set of pre-defined behaviors to determine a child’s service needs. One of the problems with a pre-defined list is that all behaviors are NOT the same risk. For example, all runaway behaviors are not considered the same risk. A 16 year old adolescent who runs away once per month but returns by dinner time is not the same behavior as that of a 10 year old who runs away once a month and does not return voluntarily.

Generally, an Initial service authorization depends on the quality of clinical information submitted by the caseworker or provider, the duration of the presenting problems, and benefits of recent treatment services.

Answer: DFPS policy authorizes caseworkers to decrease a child’s billing authorization one (1) or two (2) levels with the Program Director’s approval. The authorized service level continues to be that determined by YFT.

If the CPS caseworker intends to place a child with an authorized service higher than the provider’s contract, then the caseworker is obligated to advise the provider that the billing level has been decreased for extenuating circumstances. However, the provider must agree to meet the needs of the child’s higher service needs.

CPS caseworkers may also decrease a child’s billing authorization one (1) or more levels as described above when the child has successfully completed treatment with a higher service provider. In this circumstance, the caseworker may simply adjust the child’s billing authorization to match that of a lower service provider which is consistent with the service needs of that child. For example, a CPS caseworker may decrease a child’s authorization from Specialized to a Moderate after the child has successfully completed treatment in a residential treatment center and then place the child in a foster home providing Moderate services.

Please review the DFPS Handbook, section 6346.21 for a complete explanation of this policy.

Answer: The Department of Family and Protective Services (DFPS) contracts with Youth for Tomorrow (YFT) to assist in the implementation of the Texas Service System. These statewide services are provided according to procedures approved by DFPS that includes the use of the service definitions. These definitions were developed DFPS and approved by the DFPS Board of Directors on January 29, 2004.

YFT uses these definitions to determine a child’s current service needs. Clinically trained professionals from YFT use these definitions to synthesize their knowledge about a child’s psychological and social functioning and then assign a single service rating (basic, moderate, specialized, or intense). The service authorization is determined in the context of a broad review of the clinical information submitted by the provider about the child’s social functioning, behaviors while in placement, behaviors while in school, medical conditions, and interpersonal relationships with children and adults.

Typically, the provider’s clinical records include:
• Current treatment plan
• Individual, group, and family therapy records
• Daily charting
• Medical reports and charting
• School reports
• Recreation charting
• Incident reports
The determination process considers the child’s developmental and chronological age in relation to various risk behaviors. For the most part, the process does not use a set of defined behaviors or a checklist to determine a child’s service needs. For example, all runaway behaviors are not considered the same risk. That is, a 16 year old adolescent who runs away once per month but returns by dinner time is not the same behavior as that of a 10 year old who runs away once a year and does not return voluntarily.

The review period for determining the current services needed by a child while in placement is the previous 30 days if the child has been in care for more than 30 days. Finally, YFT authorizes Moderate services for 12 months and Specialized or Intense services for 3 months.

Answer: Generally, the payer or conservator has the primary responsibility to monitor service authorizations. Often, this is a shared responsibility with the provider. In those instances in which the conservator is the Texas Department of Family and Protective Services (DFPS) and as long as a child remains in the same residential program, Youth for Tomorrow (YFT) will review that child’s service needs on a regularly scheduled basis which prevents the expiration of service authorization.

If a DFPS child moves to a new program, the service authorization may expire prior to YFT’s next regularly scheduled review. Since providers may be at risk for not getting payment or at least delayed payment for those days a child’s service is not authorized, it is a good idea for them to determine when the authoriztion will expire upon admission. If the service authoriztion is scheduled to expire prior to the next regularly scheduled YFT review, it would benefit the provider to request a current authorization for services directly from YFT.

Answer: The YFT contract does not contain any incentives that pertain to increases or decreases in authorized services. YFT does not benefit from high percentages of decreased service authorizations nor are there penalties for high percentage of increased authorized services.

The contract is a cost-reimbursement contract based on a line-item budget which is negotiated and approved by the DFPS each fiscal year. The contract is competitively re-bid every four (4) years according to the State of Texas competitive procurement procedures.

Answer: (Simple Response)

YFT has no authority regarding reimbursement rates. These functions are the sole responsibilities of various Texas state agencies.

(Complex Response)

This section describes the Texas Level of Care (LOC) Service System that existed in Texas from September 1, 1988, until August 31, 2003. During FY ’03, this system was substantially revised by the Texas Department of Family and Protective Services (formerly the Texas Department of Protective and Regulatory Services). The Texas Service System changes went into effect on September 1, 2003. Copies of the revised Texas Service System standards are available from the DFPS Residential Contract Managers.

A state agency called the Health and Human Services Coordinating Council was established in 1983 to coordinate planning and policy making for 19 health and human services agencies in Texas. The Council was chaired by the Governor; the Lieutenant Governor and Speaker of the House served as co-chairs. Council membership included State Senators, representatives, Board Chairs of State agencies, and members of the general public.

In 1984, the Legislative Budget Board required that the Council undertake a study of residential contract child care in Texas. The Council appointed a Public-Private Policy Group to work toward development of a “continuum of care” for children and youth that had to include the following components.

1. A common application form for agencies to use when placing children in residential care facilities that includes a mechanism to determine the appropriate level of care for each child.
2. A system of services to children that would include definitions and standards for various levels of care and an interagency monitoring process to evaluate implementation of this system by contract residential providers.
3. A child care provider cost report and database to assist in determining the median cost of care and to be responsible for reporting these costs to the legislature as the standard recommended payment rates.

During the next four (4) years, a group referred to as the Treatment and Care Work Committee developed a system of care that met the criteria established by the Legislative Budget Board. This system of care was called the Level of Care Service System. YFT assists DFPS with the implementation of this system of care.