Texas Health and Human Services Commission
Family Violence Program Shelter Center Provider Manual
Effective: September 1, 2008
Facility, Safety and Health
5100 Facility Codes
- Facility codes vary greatly from city to city and it is up to the organization to obtain this information. Each city will classify a structure differently, which will determine the applicable codes.
- For more information regarding facility code requirements of shelter centers, see the Texas Health and Human Services Commission (HHSC) Family Violence Program contract, Article 13, Section 13.06(hh).
5200 Compliance with the American with Disabilities Act (ADA)
ADA of 1990
- Family violence shelter centers are required to comply with the ADA of 1990, Title II, because of their contractual relationship with a state agency — HHSC. Additionally, family violence shelter centers must comply with the ADA of 1990 Title 3, because they meet the definition of public accommodation.
- The ADA prohibits discrimination on the basis of disability in federally assisted programs and activities against a client with a mental or physical disability. It provides that individuals with disabilities may not be denied full and equal access to the services, facilities, privileges, advantages and accommodations offered by the shelter center.
- The ADA requires that shelter centers remove architectural and communication barriers that are structural in nature in existing facilities or impede immediate evacuation when it is "readily achievable" to do so. Architectural barriers are physical elements of a facility that impede access by people with disabilities. "Readily achievable" means easily accomplishable and able to be carried out without too much difficulty or expense.
- Communication tools that are an integral part of the physical structure of the facility can be barriers. These might include conventional signage (inaccessible to individuals with visual impairments) and audible alarm systems (inaccessible to individuals with hearing impairments, including TDD relay systems).
- The ADA requires that all remodeling and new construction follow ADA accessibility guidelines.
- The ADA also requires that a shelter center allow the use of a service animal by an individual with a disability, unless it would jeopardize the safe operation of the facility.
- To reference ADA of 1990 Title 2, go to www.usdoj.gov/crt/ada/reg2.html.
- To reference ADA of 1990 Title 3, go to www.usdoj.gov/crt/ada/reg3a.html.
- For more information regarding facility compliance requirements of shelter centers, see the HHSC Family Violence Program contract, Article 13, Section 13.06(ii).
Common barriers to serving people with disabilities and possible solutions include the following:
- Budget a line item or fundraising goal specific to accessibility needs.
- Address perceived lack of victims with disabilities with outreach activities, recruitment and/or needs assessment in the community.
- Address staff misconceptions and fears with education and training.
- Address unintentional exclusions/rigid rules and policies with flexibility in rules and shelter center policies.
- Address multi-story building barriers with emergency evacuation assistance devices, such as a life slider (www.lifeslider.com) or evac-chair (www.evac-chair.com) that is accessible to employees and volunteers.
5300 Facility Requirements
- §379.501 Facility Requirements for a 24-Hour-a-Day Shelter Center
- §379.507 Types of Facilities Allowed by the Commission for a 24-hour-a-Day Shelter
- §379.508 Exceptions to Allowable Types of Facilities for a 24-Hour-a-Day
- §379.509 Additional Requirements if a Shelter Center Uses a Series of Safe Homes
- §379.510 Using a Motel as a Type of Shelter
A safe outdoor play area may be on the shelter center's property or on another property maintained by the shelter center that is considered a safe space.
It is recommended that shelter centers provide:
- a designated space for teenagers,
- at least one bathroom with accommodations for children, and
- furnishings for young children.
It is recommended that the shelter center's environment:
- reflect the ethnic/cultural diversity of residents and nonresidents,
- be comfortable and welcoming to people of all ages, and
- include such things as magazines, books and artwork for residents without children, including the elderly.
5400 Health and Hygiene
5410 Food Preparation
§379.502 Preparing, Providing and Serving Food to Residents
- According to the U.S. Department of Agriculture (USDA), a shelter center may apply to be an authorized Supplemental Nutrition Assistance Program (SNAP) retailer under the classification of "Shelter for Battered Women and Children." These regulations can be found in the Food Stamp Regulation Manual, §278.1, and can be accessed at www.fns.usda.gov/fsp/rules/regulations/pdfs/010803.pdf. Or for additional information, contact SNAP at www.fns.usda.gov/fsp/contact_info/contact_brd.htm.
- As stated in §379.502(5), the center cannot require residents to use SNAP to purchase shelter meals.
- Another food and nutrition program the center may be eligible for is the Child and Adult Care Food Program (CACFP). CACFP reimburses qualified programs for providing meals and snacks. Programs are provided both a cash reimbursement per meal or snack, as well as commodities or cash-in-lieu of commodities. For more information, go to www.fns.usda.gov/cnd/care/CACFP/aboutcacfp.htm.
- Because USDA only classifies shelters as authorized SNAP retailers, SNAP benefits may be accepted only from residents, not nonresidents.
- To reference food preparation in the Health and Safety Code Title 6, go to http://tlo2.tlc.state.tx.us/statutes/hs.toc.htm.
It is recommended that shelter centers:
- offer alternative food items to respect individual dietary preferences, and
- comply with the Public Health Measures Relating to Food, found in Chapter 438 of the Health and Safety Code. To reference the code, go to http://tlo2.tlc.state.tx.us/statutes/hs.toc.htm.
If the center chooses to accept SNAP for the purchase of meals, then it is recommended that written policies and procedures be developed to ensure compliance with USDA SNAP regulations.
5420 Hygiene Distribution
§379.506 Providing Hygiene Items to Residents
- Shelter centers are encouraged to provide ethnic-specific cosmetics and hair products.
- Shelters centers are encouraged to use plastic covers on mattresses and pillows.
Health and Safety Code — A shelter center with a physician on site should be aware that Health and Safety Code §161.004 requires every physician to review the immunization history of any child under 18 years. Physicians are then required to either administer the needed immunizations or make referrals for the immunizations, unless exempt under this section.
- If a client wishes to obtain an exemption from immunizations for reasons of conscience, they may obtain the form to do so at www.dshs.state.tx.us/immunize/school/school_exclusion.shtm.
- For more information, refer to the HHSC Family Violence Program contract, Article 13, Section 13.06(jj).
It is recommended that the shelter center call its local or regional health department or the Department of State Health Services (DSHS) Immunization Division to develop an immunization plan to ensure that families have information about how and where to get immunized.
5440 Communicable Diseases
Health and Safety Code — Chapters 81, 84 and 87 govern the control and reporting of communicable diseases. These chapters outline regulations regarding notifiable conditions and reportable diseases.
- To reference the DSHS website containing a list of notifiable conditions and reporting forms, go to www.dshs.state.tx.us/idcu/investigation/conditions/default.asp.
- If a resident discloses that she or he has a communicable disease, the primary responsibility for reporting that to DSHS is for medical professionals and school administrators. However, there may be some situations in which the center is obligated to report communicable diseases directly to DSHS. If you have specific questions regarding whether or not to report a communicable disease, it is advised that you obtain a release from the resident before calling the local health authority for case-specific information.
- For more information about when and where to report, go to www.dshs.state.tx.us/idcu/ or call the DSHS Infectious Disease Control Unit at 512-458-7455.
- For more information about these procedures in the Communicable Disease Prevention and Control Act under the Health and Safety Code, Chapter 81, §81.042, see http://tlo2.tlc.state.tx.us/statutes/docs/HS/content/htm/hs.002.00.000081.00.htm. Also, see Texas Administrative Code, Title 25, Chapter 97 at http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=25&pt=1&ch=97.
- To reference the Health and Safety Code, go to http://tlo2.tlc.state.tx.us/statutes/hs.toc.htm.
- For more information, refer to the HHSC Family Violence Program contract, Article 13, Section 13.06(jj).
- It is recommended that the shelter center contact the local or regional health department or DSHS for free information, posters and brochures on the subjects of Acquired Immune Deficiency Syndrome (AIDS), Human Immunodeficiency Virus (HIV) and sexually transmitted infections (STIs).
- It is recommended that shelter centers attempt to have each resident screened for tuberculosis because of the close living situation common to most shelters. Potential clients should be assured that they will in no way be refused services as a result of answering these questions. It is recommended that this screening occur following admission to shelter and after initial intake procedures.
- Some vaccinations may result in a false positive; it is recommended that a shelter center consult the county health department for assistance and resources. The county health department may offer this test at a reduced cost.
5450 Smoking Regulations
Pro-Children Act of 2001
- The shelter must comply with all applicable federal, state, local and HHSC regulations regarding smoking. Individual cities may also adopt ordinances that are stronger than the Pro-Children Act of 2001. Check locally to see if any further smoking ordinances apply.
- Smoking is prohibited inside centers under the Pro-Children Act of 2001 since all centers receive a portion of federal funds. To reference the act, go to www.ed.gov/policy/elsec/leg/esea02/pg56.html.
- For more information regarding smoking regulations for shelter center facilities, see the HHSC Family Violence Program contract, Article 13, Section 13.06(kk).
- It is recommended that the organization develop policies that protect minors from accessing cigarettes from volunteers, staff or other residents or nonresidents. The Health and Safety Code offers a comprehensive approach to reducing children's access to tobacco products, and provides for educating the public regarding the dangers of the use of tobacco. To reference Health and Safety Code §161.083, go to http://tlo2.tlc.state.tx.us/statutes/hs.toc.htm.
- The organization with outside-designated smoking areas should consider all the safety issues, such as safe and well-lit smoking areas and safe re-entry.
- The organization's outdoor smoking policies should balance the right to smoke and the right to a smoke-free environment.
5500 Health Care Resources
Children's Health Insurance Program (CHIP)
CHIP is a national program designed to provide low-cost health insurance for minors in families that are income eligible and do not qualify for Medicaid. The state of Texas developed TexCare Partnership to provide this service in Texas.
- Many shelter center residents and nonresidents may qualify for CHIP for their children. Because of this, shelter centers are required to have policies and procedures for providing written information about government-funded health programs to residents and nonresidents. For more information, see the HHSC Family Violence Program contract, Article 13, Section 13.06(jj)(3)(D).
- To refer to CHIP, go to www.texcarepartnership.com/CHIP-About-TexCarePartnership.htm.
Shelter centers are encouraged to network with health professionals to establish on-site free health screening services and to offer on-site woman, child, well baby and nutrition programs.
5600 Health Reporting Requirements and Confidentiality
5610 Health Insurance Portability and Accountability Act (HIPAA)
- Health Insurance Portability and Accountability Act of 1996
- Texas Medical Records Privacy Act
- A shelter center collecting any health or medical information could be subject to HIPAA.
- While a shelter center would not normally consider itself a health care provider and might not be under the federal HIPAA legislation, some shelter centers might be under the Texas Medical Records Privacy Act. Also, the parameters of HIPAA for the state of Texas have been expanded through the Health and Safety Code, Chapter 181, Medical Records Privacy Act.
- To determine if the shelter center is considered a "covered entity" under HIPAA, go to www.cms.hhs.gov/HIPAAGenInfo/02_TheHIPAALawandRelated%20Information.asp#TopOfPage.
- To reference information regarding the requirement to report notifiable conditions and compliance with HIPAA, contact your local health department or go to www.dshs.state.tx.us/hipaa/default.shtm.
5710 Security System
§379.503 Security System
When determining the security system for and the layout of the shelter facility, it is recommended that shelter centers consider stalking issues associated with batterers.
5720 Security System
- §379.504 Security Policies and Procedures
- The Family Violence Prevention and Services chapter of U.S. Code Title 42, Chapter 110, §10402(a)(2)(E)
- Confidentiality of Shelter Locations — The Family Violence Prevention and Services chapter of U.S. Code requires the shelter center to guarantee the confidentiality of its shelter location(s) unless it obtains written authorization of the person or persons responsible for the operations of the shelter.
- HHSC interprets "person or persons responsible for the operations of the shelter" as the board of directors and the executive director.
- To reference the code, go to http://frwebgate.access.gpo.gov/cgi-bin/usc.cgi?ACTION=BROWSE&TITLE=42USCC110.
- If the shelter center decides to have a confidential location, be aware that even though most property appraisal records are considered public information and available on the Internet, shelter centers have the right to confidentiality of location and can have these records barred from public access, including the Internet. This right is found in the Property Tax Code §25.026. To reference the code, go to www.window.state.tx.us/taxinfo/proptax/tc04/ch25.htm#25.026.
- When determining whether to have the shelter facility be either a public location or a confidential location, the shelter center should weigh all of the philosophical concerns regarding safety and security issues.
- Because of the rapid advancement of technologies, a shelter center and survivors are at greater risk of stalking and breaches of confidentiality. A shelter center should consider addressing the security of technologies used within the organization and by survivors, such as cell phones, cordless telephones, computer databases, Internet access and e-mail.
- Information about disaster preparedness in Texas (U.S. Region 6) can be found on the Federal Emergency Management Agency (FEMA) website at www.fema.gov/.