11100, Overview of Heightened Monitoring

October 2021

Heightened Monitoring (HM) is an increase in oversight and tracking of residential child care operations that:

  • have a current contract with the Texas Department of Family and Protective Services (DFPS) or a Single Source Continuum Contractor (SSCC) to provide care to children in DFPS conservatorship; and
  • have demonstrated a pattern of contract or minimum standard violations during at least three of the last five years compared to other operations of the same care-type and size.

HM is a multi-agency, multi-division program delivered by both HHSC and DFPS. There are three primary features to HM:

  • HM Inspections/Visits;
  • HM Plan; and
  • HM FITS Meetings.

When an operation is on HM, it is referred to as an HM episode. There are three phases of an HM episode:

  • Pre-Plan Development;
  • Plan in Effect; and
  • Post-Plan Monitoring.

Heightened Monitoring is not an enforcement action. An HM plan complements, not replaces, any enforcement actions that CCR recommends or imposes on an operation.

 

11110 Identifying and Notifying an Operation for Heightened Monitoring

October 2021

To be eligible for Heightened Monitoring (HM), the operation must:

  • be a licensed residential child care operation; and
  • have a current contract with DFPS or a Single Source Continuum Contractor (SSCC) to provide care to children in DFPS conservatorship.

Operations are placed on HM only after the DFPS Data and Systems Improvement (DSI) team completes data analysis of all residential child care operations caring for children in DFPS conservatorship and identifies that the operation has a pattern of violations that meets the criteria for HM that is outlined in the federal court order for M.D. v Abbott litigation.

Heightened Monitoring is not an enforcement action; therefore, CCR staff may not recommend that an operation be placed on Heightened Monitoring.

 

11111 Heightened Monitoring Start Date

October 2021

Heightened Monitoring starts on the date HHSC or DFPS notifies the operation that it has been placed on heightened monitoring.

 

11112 Notifying the Operation and CCR Staff of Heightened Monitoring

October 2021

Procedure

No later than the business day after the initial FITS coordination meeting, the HM development team notifies the operation and inspector assigned to the operation that the operation is on HM and documents the notification as follows:

  1. The HHSC or DFPS HM director contacts the operation’s licensed administrator or chief executive officer to notify him or her that the operation is being placed on Heightened Monitoring;
  2. After contacting the operation, the HHSC or DFPS HM director sends a written notification to the operation;
  3. The lead HM program specialist emails notification that the operation is being placed on Heightened Monitoring to the:
    1. CCR inspector assigned to the operation;
    2. CCR supervisor;
    3. CCR program administrator; and
    4. CCR regional director;
  4. The lead HM program specialist saves a copy of the written notification in the operation’s file on the DFPS HM SharePoint site; and
  5. The lead HM program specialist documents a summary of the notification in a Chronology in CLASS (type Heightened Monitoring).

 

11120 Heightened Monitoring Team Roles and Responsibilities

October 2021

Health and Human Services Commission (HHSC) and Department of Family and Protective Services (DFPS) work jointly to coordinate activities for Heightened Monitoring (HM). The HM team for each operation will consist of members from the following HHSC and DFPS divisions:

  • HHSC Child Care Regulation Heightened Monitoring (CCR);
  • DFPS Child Protective Services (CPS);
  • DFPS Residential Child Care Contracts (RCC);
  • DFPS Child Care Investigations (CCI); and
  • DFPS Data and Systems Improvement (DSI).

The table below outlines the roles that comprise each HM development team and the duties that each role completes. Each agency/division determines which staff will be assigned to fill the roles on the operation’s HM development team.

Role Duties
CCR HM Inspector
  1. Conducts weekly unannounced inspections at the operation in coordination with the DFPS HM visit team
  2. Monitors for compliance with the Heightened Monitoring (HM) Plan tasks
  3. Escalates concerns to the supervisor and the assigned RCCR inspector
CCR HM Supervisor
  1. Supervises the HM inspectors
  2. Manages assignments of HM operations to appropriate HM inspector
  3. Manages assignments of weekly unannounced visits
  4. Ensures weekly visits are completed timely and accurately
  5. Escalates concerns to the CCR HM program specialist and CCR HM director
  6. Provides support to the HM managers and director
CCR HM Program Specialist
  1. Completes data analysis for each operation placed on HM
  2. Participates in all Facility Intervention Team Staffings (FITS) meetings
  3. Tracks compliance with the HM plan tasks
  4. Reports on progress during future staffing meetings
  5. Recommends HHSC HM visit location for each operation assigned
  6. Uploads documents from CCR (Risk Analysis/QA report/CCR FITS analysis document)
  7. Communicates with CCR regarding plan compliance
CCR HM Manager
  1. Supervisors the HM program specialist staff
  2. Manages assignments of HM operations to the HM program specialist
CCR HM Director
  1. Participates in the HM FITS meetings
  2. Assists in the development of an operation’s HM plan
  3. Serves as the HHSC CCR approver for all HM plans
DFPS HM Visit Team Conducts weekly unannounced visits in coordination with the CCR HM inspector as follows:
  1. CPS HM safety specialists conduct unannounced visits at GROs and foster homes
  2. DFPS HM residential contract managers conduct weekly unannounced visits at GROs, CPAs and foster homes
DFPS Program Specialist
  1. Participates in all FITS meetings
  2. Uploads documents submitted from the operation to the operation folder on the DFPS HM SharePoint site under the HM development team link
  3. Uploads documents from their respective areas (Risk Analysis/QA report/CCR FITS analysis document)
  4. Communicates with their respective divisions regarding plan compliance
Lead HM Program Specialist
This can be an HHSC or DFPS program specialist.

 

  1. Schedules the initial coordination meeting
  2. Schedules ongoing FITS meetings
  3. Schedules plan development meeting
  4. Schedules the quarterly evaluation meeting
  5. Facilitates meetings
  6. Takes notes and/or identifies someone to take the notes
  7. Uploads meeting minutes to the operation’s folder on the DFPS HM SharePoint site under HM Development Teams link
  8. Uploads documents submitted from the operation to the operation folder on the DFPS HM SharePoint site under the HM development team link
  9. Drafts the HM plan and HM quarterly evaluation
  10. Serves as primary point of contact for the operation while it is on HM

Lead HM Director
This can be an HHSC or DFPS director.

  1. Notifies the operation that it is on HM
  2. Is the primary point of contact for providers to contact with questions and concerns
  3. Participates in ongoing FITS meetings for operations when the director’s division is the lead division
  4. Reviews and approves quarterly reviews
  5. Participates in quarterly reviews with operations, as necessary

11121 HM Inspector Responsibilities After Being Assigned an Operation

October 2021

Procedure

Upon assignment, the assigned HM inspector reviews and becomes familiar with:

  1. the conditions, restrictions, services and capacity on the operation’s license;
  2. the operation’s treatment model;
  3. the operation’s license;
  4. the operation’s treatment modalities; and
  5. the characteristics of children accepted by the operation.

This information may be obtained by reviewing one or more of the following:

  1. CLASS;
  2. IMPACT;
  3. Youth for Tomorrow’s website (www.yft.org); and
  4. Operation’s website, if applicable.

The assigned HM Inspector may also contact the operation and speak with the provider.

 

11121.1 Steps When the HM Inspector Identifies Health or Safety Concerns

October 2021

If the HM inspector identifies a health or safety concern when assessing the operation’s compliance history or when conducting a Heightened Monitoring inspection, the HM inspector:

  • discusses these concerns with the operation; and
  • consults with his or her supervisor for further guidance.

 

11130 Lead Heightened Monitoring Division Assignment

October 2021

Procedure

When an operation is placed on Heightened Monitoring (HM), the HM directors select a lead division. The lead HM director, lead HM manager, and lead HM program specialist are staff from the lead HM division.

 

11131 Lead Heightened Monitoring Division Responsibilities

October 2021

The lead Heightened Monitoring (HM) division is responsible for:

  • coordinating and documenting subsequent Facility Intervention Team Staffings (FITS) meetings;
  • gathering all required documents and filing them in the appropriate locations; and
  • documenting the Heightened Monitoring plan and any subsequent updates/evaluations to the plan.

The lead HM division and lead HM program specialist will be identified prior to the initial FITS coordination meeting.