State of Alabama

 

at; if: 
.- . . Department of Human Resources
S. Gordon .Persons Building
rt 50 Ripley Street
ROBERT BENTLEY 5040?? Nancy T. Buckner
Governor MOMSOMCVM Alabama 361304000 Commit-simm-

(354) 242?1510

gov

September IS. 2014

Mr. Steve McCabe, CEO

Hill Crest Behavioral Health Services
6869 Fifth Avenue South
Birmingham. Alabama 35212

RE: Contract: 33M Hill Crest Behavioral Health Services (Higdon)

Dear Mr. Steve McCabe:

Attached is the of?cial copy of the approved contract between your agency and the Alabama
Department of Human Resources from October 01. 2014 to September 30, mm. Also attached
and made part of this contract is an addendum b, which will provide terms of reimbursement for
the contract. If changes to the program are preposed at any time during the two year period.
approval must be obtained from your program analyst prior to implementation.

if you have any questions. please contact the Division of Resource Management at (334) 242?
I650.

Respectfully.

?tm Show: oil

Starr Stewart. Director
Division of Resources Management

SS: AR

Attachments

PC: Resource Management
Finance

An Allirmutive Action Equal Opportunity Employer
000648

 

 

State of Alabama

Department of Human Resources

5. Gordon Persons Building
50 Ripley Street

   

ROBER BENTLEY 3040"? Nancy T. Buckner
Governor Montgomery. Alabama 361304000 Cammiw'amr

(534) 242?1310



MEMORANDUM

TO: The Honorable Robert Bentley
Governor
Nancy T. Buckner. Commissioner

Department of Human Resources
SUBJECT: Contract: #3331 - Hill Crest Behavioral Health Services (Higdoni/
FY15 a FY16
DATE: August 18. 2014
Please see the attached contract listed above Th tai amount of this contract from October 1. 
2014 to September 30 2016 is $3 552, 660. 00. his contract was selected through RFP and will
allow the vendor to provide intensive Residential Services for Children throughout the state
if you have any questions. please contact John Hardy at (334) 242-1854.

Your signature indicating concurrence will be greatly appreciated.

NTB: JS
Attachm ts

Came/a:

Conitha King. SDHR Fiomnm?li irector

MKM

JSEIC. Marsh Deputy for
Administrative Services

Nancy Tiguckner. Commissioner

 

An Af?rmative Action [Equal Opportunity Employer
000649

 

 



 

Contract Review Permanent Legislative Oversight Committee
Alabama State House
Montgomery. Alabama 36130

EONTRACT BEEORT

(separate review report required for each contract)

Name of State Agency: Alabama Department of Human Resources
Name of Contractor: Hill Crest Behavioral Health Services {Mignon}

 

 

 

 

 

6869 Fi?h Avenue South Birminoham Am
Contractor?s Physical Street Address (No PO. Box) City ST
*ls Contractor organized as an Alabama Entity in Alabama? NO
*If not, has it quali?ed with the Alabama Secretary of State to do business in Alabama? YES NO

 

ls Act 2001-955 Disclosure Form Included with this Contract? YES N0
Dees Contractor have current member of Legislature or family member of Legislator employed? YES NO
Was a lobbyist/consultant used to secure this contract OR af?liated with this contractor? YES NO

If Yes, Give Name: 
Contract Number: C150163.33l

Contract/Amendment Total: 5 3.5 52.661000 (estimate if necessary)

State Funds: Federal Funds: 68,29 Other Funds: 

 

 

?Please Specify Source of Other Funds (Fees, Grants, etc.)
Date Contract Effective: 10! U2014 Date Contract Ends: 9f30/2016 

Type Contract: NEW: 5 RENEWAL: AMENDMENT:
If Renewal, was it originally Bid? No

 

END lcteAthrou 
(A) Original contract total

(B) Amended total prior to this amendment 3
(C) Amended total alter this amendment
Was Contract Secured through Bid Process? NO it Was lowest Bid accepted? Yes No_

Was Contract Secured through RFP Process? YES Date REP was awarded: August 14: 2014

Posted to Statewide RFP Database at http?frt?n coin. YES 3 NO
If no. please give a brief explanation:
Se.

Summary of Contract Sen/ices to be Provided: matte Reside

 

 

 

 

ti rovidcd in a co

 

     
  

     

    

    

ira 'lit ofunctl

or av' ans cm at at mteri?er wit 

Emily so ttigg outside of a residential environment.

Why Contract Necessary AN why this service cannot be performed by merit employeefi? abama artme 
atrium; R- urce does not have at 1 er ed facili res for .. 'n or th tretm ti oi?childr 

 

 

   
  

     

I certify that the above information is correct.

 

store of Agency Head

 

Fancy Buckner
Printed Name

Agency Contact: John Hardy

Printed Name
1 242-1354

Revised: 

000650

 

 

 

ADDITIONAL CONTRACT QUESTIONS FORM

(1) if this contract was not competitively Bid. explain why not:
Contracts were issued through the RFP process.

 

 

 

 

(2) If this contract was not competitively Bid because the contractor is a sole source
provider, please explain who made the sole source determination and on what basis:
Not applicable.

 

 

 

(3) if contract was awarded by RFP. what process was used? Was it competitive. how many
vendors were contacted, and how many proposals were received?
A review team evaluated the proposals and scored them base on the oualitv? of
services and the price offered bv the vendor. The contractor with the hiahest overall
score was awarded a contract. DHR announced the RFP on the statewide-database;
mailed notices to vendors registered in class 952?Humen Services (subclasses: l5. 
13, 20. 21. 43. 47, 59. 67. 85. 38. 92. and 95} with State Purchasina on 06.
4.

(4) 1f contract was awarded by RFP, was it awarded to the person or company with the
lowest monetary proposal? If not, explain why not.
The 2014 Residential Services RFPs were issued with fixed rates. Multiple contracts
were awarded to multiple vendors statewide. None ol? the selected vendors exceeded 
the ?xed rates.

(5) if contract was awarded by RFP, how and by whom were the proposals evaluated?
A DHR review team evaluated the proposals and scored them based on the Quality of
services and the price offered bv the vendor. The contractor with the highest overall 
score was awarded a contract.

(6) If this contract was not awarded through either Bid or RFP process, explain why not:
Not applicable.

 

 

If this contract was not awarded through either Bid or RF process. how was it awarded?
Not applicable.

 

 

(8) Did agency attempt to hire a State Employee? If so who from the State Personnel

Department did you talk to?
T10 

 

 

(9) How many additional contracts does contractor have with the State of Alabama and

which agencies are they With?
Signatur%%ifgency/Departrnent Head 

Hill Crest Residential 
000651

 

 

20 I4 Family Services - Residential Services

 

 

CONTRACT
BETWEEN
THE ALABAMA DEPARTMENT OF HUMAN RESOURCES
AND
HILL CREST BEHAVIORAL HEALTH SERVICES (HIGDON)
CONTRACT NUMBER: 3331 (Intensive Residential)

THIS CONTRACT (hereinafter referred to as the ?Contract?) is hereby entered into by and between the Alabama
Draper-totem of Human Resources (hereinafter referred to as the and Hill Crest Behaving]
Health Services (Hi don) (Itereina?er referred to as the for the purpose of purchasing the
semi-,3 herein for individuals or families determined in accordance with this Contract to be eligible to

receive the said services pursuant to applicable federal and state regulations.

WHEREAS services may be purchased from other government or non-government agencies and organizations. or
from individuals; and.

WHEREAS suf?cient funds are currently available to the DEPARTMENT to enter into this Contract;

NOW, THEREFORE. the parties hereto. intending to be mutually bound by the terms and conditions set forth
herein, do hereby agree hereto as follows:

A. PERIOD OF AGREEMENT

1. This Contract shall become effective on the day of October, 2014. and shall remain in effect
through September 30. 2016, unless otherwise terminated earlier in accordance with its terms and
conditions.

2. The Contract may be renewed or extended by letter. or other written instrument. duly executed by

the parties hereto.
B. SERVICES TO BE PROVIDED

1. The services to be provided and the persons to be served under the Contract are set forth and
described hereinbelow and in Addendum A, which is attached hereto and is hereby incorporated
into and made a part of this Contract as if set forth herein verbatim. All references to Addendum
A in this Contract shall be deemed to refer collectively to Addendum A, and any exhibit
identi?ed therein and attached thereto, as amended in accordance with the terms of this Contract.

2. For purposes of this Contract. a subcontractor is considered to be any government or non?
government agency or organization. or any individual, with which the CONTRACTOR may
contract to perform a task to be paid for in whole or in part with funds paid to the
CONTRACTOR by the DEPARTMENT under this Contract. The term subcontractor may
includeI but is not limited to, service providers such as therapeutic foster parents, consultants,
dieticians, behavioral aides. and any other professionals utilized by the connector.

3. The DEPARTMENT shall have the right under this Contract to review and approve, prior to their
execution by the parties thereto. all subcontracts and all amendments and extensions thereto, as

1

000652

 

5.

 

applicable, perOSed by the CONTRACTOR for the purpose of canying out any task or
responsibility to be paid for in whole or in part with funds paid to the CONTRACTOR by the
DEPARTMENT under this Contract.

The services to be performed by the CONTRACTOR under this Contract shall not be
subcontracted, in whole or in part, without the DEPARTMENTS prior written consent. The
terms and conditions of this Contract, and such additional terms and conditions as the
DEPARTMENT may require, shall be included in all approved subcontracts. Approval by the
DEPARTMENT of a subcontract shall not relieve the CONTRACTOR of any responsibility for
the performance of services required under this Contract. The CONTRACTOR shall be solely
responsible to the DEPARTMENT for the performance, conformance and compliance of its
subcontractors.

a. The DEPARTMENT has the right to inspect, without prior notice, any facility,
including a therapeutic foster home, operated by the contractor or by a subcontractor and
to document or record, through any means, any such inspections.

l. Any facility or home operated by the contractor or its subcontractors shall be
subject to approval and inspection by the DEPARTMENT as part of the licensing
process.

b. The DEPARTMENT has the right to obtain, at no cost, copies of any records
maintained by the contractor. or any of its subcontractors, related to any services paid for
by the DEPARTMENT, including copies of the subcontracts between the contractor and
its subcontractors.

The Contractor must comply with any changes, amendments, or new/different procedures, that
the DEPARTMENT must implement to comply with any new or existing state or federal laws.
rules, or regulations.

C. FINANCIAL AGREEMENTS

i.

in consideration of the services provided hereunder by the CONTRACTOR, and subject to the
terms and conditions of this Contract, the DEPARTMENT will reimburse the CONTRACTOR
for actual eligible and allowable costs associated with the provision of said services in an amount
estimated at mm . Said reimbursements shall further be made in such manner as is set
forth hereinbelow and in Addendum B. All references to Addendum under this Contract shall
be deemed to refer to Addendum as amended in accordance with the terms of this Contract.

CONTRACTOR understands and agrees that, in the course of performing the services required
under this Contract, if CONTRACTOR incurs less actual eligible and allowable costs or provides
less actual units of services. as applicable pursuant to Addenda A and B, than the maximum
amount authorized in Addendum B, CONTRACTOR shall not be entitled under this Contract to
receive the difference otherwise authorized therein.

The DEPARTMENT shall not be liable for the payment of any other costs incurred by
CONTRACTOR or its subcontractors in connection with this Contract in excess of the amount

speci?ed in Addendum B.

Reimbursements made to the CONTRACTOR by the DEPARTMENT under this Contract will
be made only in response to signed. original and correctly certi?ed statements of the total actual
eligible costs incurred or the total billable amount based on the actual total number of eligible
units of service provided, as applicable pursuant to Addendum during the designated billing
period. CONTRACTOR will submit said certi?ed statements to the DEPARTMENT on a

2

000653

 

 

10.

ll.

basis following the end of each month services are provided under this Contract.
CONTRACTOR will further submit said certi?ed statements in duplicate in accordance with such
format and instructions as may be required by the DEPARTMENT.

For purposes of this Contract, ?scal year means the twelve-month period. October through
September. The CONTRACTOR understands and agrees that the DEPARTMENT may be
unable to reimburse the CONTRACTOR for any certi?ed statement of expenditures received by
the DEPARTMENT more than 30 calendar days after the end of the ?scal year during which the
eligible costs were incurred, or more than 30 calendar days after the termination or expiration of
the Contract, whichever is earlier, and that all said certi?ed statements are subject to the
applicable policies and procedures of the Board of Adjustment for the State of Alabama.

in the event that Addendum sets forth a detailed Cost Reimbursement Budget, the
CONTRACTOR warrants and represents to the DEPARTMENT that disbursement of funds
received from the DEPARTMENT under this Contract shall be supported by invoices, cancelled
checks, lease agreements, and other supporting documentation which can be readily traced to the
service program and funding source(s) operating under this Contract. Purchase or lease of
materials. labor. services, equipment, supplies, or other personal property shall be at a cost
reasonable and necessary.

By requesting payment of funds by the DEPARTMENT under this Contract, the CONTRACTOR
warrants and represents to the DEPARTMENT that all terms and conditions of this Contract and
of all applicable federal and state laws, rules and regulations have been fully met and satis?ed.

The CONTRACTOR shall keep and maintain. to the DEPARTMENT's satisfaction, adequate
accounting and ?scal books, accounts, records and procedures to account for all funds provided
by any source to pay the cost of carrying out the services required under this Contract. The
CONTRACTOR shall further permit audit and examination of all such books, accounts, records
and procedures at any reasonable time by authorized personnel of the U. S. Department of Health
and Human Services. the Comptroller General of the United States, other pertinent federal
agencies, authorized personnel of the DEPARTMENT. Examiners of Public Accounts. other
pertinent state entities. or any authorized representative of said personnel. Furthermore, the said
personnel shall have the right of access to any books, accounts, records. documents, accounting
procedures, practices and any other items of the CONTRACTOR which are determined by the
DEPARTMENT to be directly or indirectly pertinent to the performance or payment of this
Contract in order to audit. examine and make excerpts of records.

The CONTRACTOR shall assume full ?nancial liability for any and all audit exceptions
determined by the DEPARTMENT or other personnel authorized hereunder to be ?nal and
chargeable to the CONTRACTOR and its subcontractors under this Contract. The
DEPARTMENT shall have the right under this Contract to withhold payment or reimbursement
to CONTRACTOR in order to satisfy any ?nancial chargeback made by any of the personnel
authorized hereunder to audit and examine the ?nancial books, records, procedures and accounts
of the CONTRACTOR and its subcontractors.

The CONTRACTOR shall maintain all records, accounts, ?nancial records, statistical records.
and other books and records under this Contract for the current ?scal year plus three (3)
additional years or until all pending matters are resolved, whichever is longer. This provision
shall survive the termination of the Contract.

To the extent allowed by applicable Alabama law, the CONTRACTOR will at all times
indemnify and save harmless the DEPARTMENT against any and all liabilities. losses, damages,
costs or expenses which the DEPARTMENT may hercatter sustain. incur, or be required or
ordered to pay: (I) by reason of any persons to be served under this Contract suffering a loss or

3

000654



 

E.

13.

I4.

15.

damage either while participating in or receiving from the CONTRACTOR the services to be
provided hereunder or while on premises owned, leased, or operated by the or
(2) by reason of any person suffering personal injury, death, or property loss or damage caused by
any of?cer, agent, employee or volunteer of the CONTRACTOR: or (3) by reason of any officer,
agent, employee or volunteer of the CONTRACTOR suffering personal injury, death. or property
loss or damage; provided. however. that the provisions of this paragraph shall not apply to
liabilities, losses, charges, costs, or expenses caused by or resulting from the acts or omissions of
the DEPARTMENT or any of its of?cers, employees, agents or representatives.

Unless otherwise authorized in writing by the DEPARTMENT, the CONTRACTOR warrants
and represents to the DEPARTMENT that the funds received from the DEPARTMENT under
this Contract shall not be used to meet the matching requirements of? other federal grant programs.

The CONTRACTOR warrants and represents to the DEPARTMENT that no federal or state
funds, including but not limited to the funds received from the DEPARTMENT under this
Contract, have been paid or will be paid, either directly or indirectly, for any partisan political
activity or to further the election or defeat of any candidate for public of?ce. The
CONTRACTOR further agrees that if any other funds from any source are used for such purposes
as are described hereinabove in this paragraph, the CONTRACTOR shall immediately disclose
same in writing to the DEPARTMENT.

The CONTRACTOR warrants and represent: to the DEPARTMENT that no federal or state
funds, including but not limited to the funds received from the DEPARTMENT under this
Contract, have been paid or will be paid, either directly or indirectly, to lobby, in?uence or
attempt to in?uence any agency, any member of Congress or of any state legislature concerning
any state or federal statute, legislation, grant, loan, cooperative agreement or any other matter
pending before the Congress or before any state legislature. If any other funds from any source
are used for such purposes as are described hereinabove in this paragraph, the CONTRACTOR
shall immediately disclose same in writing to the DEPARTMENT.

The CONTRACTOR shall not impose any fees on eligible persons served under this Contract.

TERMINATION

1.

Either party may terminate Contract for any reason by providing written noti?cation by certi?ed
or registered mail, return receipt requested, thirty (30) days prior to the effective date of the said
termination if the said party is unable or unwilling to ful?ll its obligations, ?scal or otherwise.
Said noti?cation shall clearly state the reason(s) for the said termination.

The Contract is subject to immediate termination with written notice made by ?rst class mail
concurrent with the said termination, which clearly states the reason(s) for the said tennination, as

follows:

a. Either party may terminate the Contract for noncompliance with any of its terms and
conditions.

b. The DEPARTMENT may terminate the Contract in the event that funds should not be
appropriated for the continued payment of the Contract.

c. The DEPARTMENT may terminate the Contract in the event of the proration of the funds
from which payment under the Contract is to be made.

OTHER AGREEMENTS

000655

 

The CONTRACTOR represents and warrants to the DEPARTMENT that in administering the
funds received from the DEPARTMENT under this Contract there will be no discrimination
against any applicant for, or recipient of, aid, bene?ts, or services, or any employee or any other
persons on the basis of race, color, religion, sex, age {as speci?ed by the Age Discrimination Act
of l975}, or national origin. including but not limited to discrimination prohibited by Title Vi of
the Civil Rights Act of 1964, as amended, and any other applicable federal regulations. This
provision shall survive the termination of this Contract.

The CONTRACTOR represents and warrants to the DEPARTMENT that in administering the
funds received ?oor the DEPARTMENT under this Contract there will be no discrimination
against any handicapped or disabled applicant for. or recipient of, aid, bene?ts, or services, or any
employee or any other persons on the basis of physical or mental handicap or disability, in
accordance with the Rehabilitation Act of 1973, as amended, the Americans with Disabilities Act,
and any Department of Health and Human Services regulations applicable thereto.

The CONTRACTOR agrees that this Contract is subject to renegotiation as needed to comply
with the requirements of any applicable federal or state law or regulations.

The CONTRACTOR agrees that this Contract does not create an employer-employee relationship
with the DEPARTMENT or the State of Alabama and that the employees are
not entitled to receive any employment bene?ts. including but not limited to bene?ts under the
State of Alabama Merit System, from the DEPARTMENT or the State of Alabama under this
Contract.

it is agreed that the terms and commitments contained in this Contract shall not be constituted as
a debt of the State of Alabama in violation of Article Xi, Section 2l3 of the Constitution of
Alabama, 190i, as amended by Amendment Number 26. It is further agreed that if any provision
of this Contract shall contravene any statute or Constitutional provision or amendment. either
now in effect or which may, during the course of this Contract, be enacted, then that con?icting
provision in the Contract shall be deemed null and void. The sole remedy for
the settlement of any and all disputes arising under the terms of this Contract shall be limited to
the ?ling of a claim with the Board of Adjustment for the State of Alabama.

For any and all disputes arising under the terms of this Contract, the parties hereto agree, in
compliance with the recommendations of the Governor and Attorney General. when considering
settlement of such disputes. to appropriate forms of nonubinding alternative dispute
resolution including, but not limited to, mediation by and through the Attorney General?s Of?ce
of Administrative hearings or, where appropriate, private mediators.

The terms and conditions of the Connect may be amended only in writing duly executed by the
p??lts hereto. Notwithstanding this provision, the DEPARTMENT may, at its discretion,
approve changes to Addenda A and to this Contract by letter and all such amendments are
hereby incorporated by reference into this Contract and made a part hereof as if set forth herein
verbatim.

The CONTRACTOR shall comply with all federal, state and local laws, rules, regulations and
procedures applicable to receiving ?rnds from the DEPARTMENT and shall further comply with
all of the terms and conditions of this Contract, the Addenda attached hereto, the document
entitled "Contract Compliance Requirements," which is hereby incorporated into this Contract by
reference and made a part hereof as if set forth herein verbatim, and any additional forms,
disclosures, reports, procedures, timeliness standards and instructions pertaining thereto as may
be required by the DEPARTMENT. All references to the Contract Compliance Requirements
document in this Contract shall be deemed to refer to the Contract Compliance Requirements
document. as amended by the DEPARTMENT.

5

000656





 

 

10.

ll.

14.

 

The CONTRACTOR warrants and represents that the funds received item the DEPARTMENT
under this Contract shall not be used for the purchase, development or improvement of any real
property. including land. real estate and any appurtenance thereon. The CONTRACTOR further
warrants and represents to the DEPARTMENT that said funds shall not be used for the purchase
or deveIOprnent of any personal property of any type. whether tangible (such as equipment) or
intangible (such as copyrights and patents). without the prior w?tten consent of the
DEPARTMENT. Title to all personal property purchased or developed by the CONTRACTOR
with said funds under this Contract shall vest upon acquisition, or development. with the
DEPARTMENT. Said personal property shall be governed by the applicable laws. regulations
and procedures of the State of Alabama. The CONTRACTOR shall hold, maintain and insure all
said personal property during the term of this Contract. Upon termination of this Contract. for
any reason. the CONTRACTOR shall request from the DEPARTMENT instructions regarding
the disposition of said personal property.

The CONTRACTOR shall carry appropriate liability insurance. including but not limited to
liability insurance covering onupremises liability and o?lpremises liability for clams against the
CONTRACTOR by any and all service tecipients, employees and other persons. The
CONTRACTOR shall also cany appropriate liability insurance on all vehicles operated by the
CONTRACTOR used to transport clients. The CONTRACTOR shall maintain onsite at its legal
business address valid Certi?cates of insurance for all types of insurance coverage required in
this paragraph and shall further make available to the DEPARTMENT said Certi?cates of
insurance prior to transporting clients.

No employee. agent. consultant. servant. representative. of?cer. board member or other
governing member. volunteer. or elected or appointed of?cial. whether paid or unpaid. of the
CONTRACTOR. its subcontractors. the DEPARTMENT or any County Department of Human
Resources shall have any direct or indirect personal or ?nancial interest in. or bene?t from. this
Contract. or in any subcontract with respect thereto. or in any funds paid by the DEPARTMENT
under this Contract. either for the himself or herself or for those with whom he or she has family
or business ties. without the full and immediate written disclosure of such interest to the
DEPARTMENT. This requirement shall remain in full force and effect throughout the period
said individual remains in any capacity described hereinabove in this paragraph and for one year
thereafter.

Members of the CONTRACTORS Board of Directors. or other governing body. are expressly
prohibited under this Contract from requesting employment with the CONTRACTOR for any
person related to said member. if said relative applies for employment with the CONTRACTOR.
said relative may be employed only with the unanimous concurrence of the remaining Board
members. The related Board member shall recuse himself or herself from such vote.

The CONTRACTOR warrants and represents to the DEPARTMENT that neither the
CONTRACTOR nor- any of the trustees. of?cers. directors. agents. servants
and employees (whether paid or voluntary} is debarrcd or suspended or otherwise excluded from
or ineligible for participation in federal assistance programs under Executive Order 12549.
"Debarment and Suspension."

The CONTRACTOR agrees that the use or disclosure of information. by any party and for any
purpose. concerning applicants for or recipients of services under this Contract that is not
required in the course of. and directly connected with. the perfonnancc of services under this
Contract is prohibited. except as may be authorized in writing by the DEPARTMENT. in the
event such written authorization is given. the CONTRACTOR understands and agrees that
release of information forms. including the required written consent. must also be completed by
the client or the client?s authorized representative. as applicable. citing each agency or individual
to whom information regarding the client or service recipient is to be provided. except in life-

6

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15.

l7.

lB.

 

threatening situations when time does not permit obtaining a written release.

The DEPARTMENT may. at its discretion, perform consultation, technical assistance. training
and monitoring activities of such nature as to aid the CONTRACTOR in carrying out the services
required hereunder and to determine compliance herewith.

Any publicity given to the services provided under this Contract shall recognize the
DEPARTMENT as the funding source.

The CONTRACTOR shall conduct DHR. child abuse and neglect Central registry checks and,
pursuant to Alabama Act No. 2000-775 to the extent said Act is applicable, Alabama and
National FBI criminal history checks, with ?ngerprints. on all personnel. new and current,
including subcontractors, working in direct services positions with individuals or families in
which said personnel have unsupervised access to children or vulnerable adults, which for
purposes of this Contract shall mean having direct contact with children or vulnerable adults
being served. The CONTRACTOR shall further comply with the policies and
procedures for conducting and evaluating said checks as well as with any work rules for
personnel Covered by said policies and procedures as directed by the DEPARTMENT.

The CONTRACTOR agrees to abide by the Department of Human Resources Notice of Privacy
Practice Policy. (See Addendum C)

The CONTRACTOR will:

A. Not use or further disclose the Protected Health lnfon-nation other than as permitted or
required by the Contract or as required by law;

B. Use appropriate safeguards to prevent a use or disclosure of the Protected Health
Information other than as provided for in the Contract;

C. Report to the Covered Entity any use or disclosure of the Protected Health
information not provided for by its Contract of which it becomes aware;

D. Ensure that any agents, including a subcontractor, to whom it provides Protected Health
Information received from, or created or received by the Business Associate on behalf of,
the Covered Entity agrees to the same restrictions and conditions that apply to the

Business Associate with respect to such information;

E. Make available Protected Health Information in accordance with 45 C.F.R. Section
[64524; (See Addendum D)

F. Make available Protected Health Information for amendment and incorporate any
amendments to Protected Health Information in accordance with 45 CPR. Section
164.526; (See Addendum D)

0. Make available Protected Health Information required to provide an accounting of
disclosures in accordance with 45 CPR Section 164.528: (See Addendum D)

H. Make its internal practices. books, and records relating to the use and disclosure of
Protected Health information received from or created or received by the business
associate on behalf of the Covered Entity available to the Secretary for purposes of
determining the Covered Entity?s compliance with this subpart; and

1. Upon termination of the Contract. for any reason, return or destroy all Protected Health

7

000658

 

 

20.

2L

Information received from. or created or received by the Business Associate on behalf of
the Covered Entity unless unfeasible or illegal to do so or that the Business Associate
for any ether re?ason decides not to return or destroy the PHI. This provision shall apply
to Protected Health Information that is in the possession of subcontractors or agents of
Business Associates.

Extend the protections of this ContraCI to such Protected Health Information for so long as
Business Associate maintains such Protected Health Information.

K. Assure that in order for this Contract and Addenda to be consistent with and in
compliance with HIPAA, agree that this Contract may be amended from time to time upon
written notice from the DEPARTMENT to the CONTRACTOR as to any revisions
required to make this Contract consistent with and in compliance with HIPPA.

L. Authorize termination of the Contract by the Covered Entity if the Covered Entity
determines that the Business Associate has violated the material tenns of the contract.

By signing this contract, the contracting parties af?rm, for the duration of the agreement. that
they will not violate federal immigration law or knowingly employ, hire for employment, or
continue to employ or subcontract an unauthorized alien within the State of Alabama.
Furthermore. a contracting party found to be in violation of this provision shall be deemed in
breach of the agreement and shall be responsible for all damages resulting therefrom. The
CONTRACTOR shall participate in the E-Verify program and verify every employee that is
required to be veri?ed according to the applicable federal rules and regulations. The
CONTRACTOR shall provide documentation to the Department establishing that the
CONTRACTOR is enrolled in the E-Verify program. Said documentation must be received by
the prior to the beginning date of this contract. The CONTRACTOR shall also
complete and sign the Certificate of Compliance with the Beason?Hammcn Alabama Taypayer
and Citizen protection Act (ACT 2011-535. as amended by Act 2012-491}. (See Addendum E)

The CONTRACTOR acknowledges, understands and agrees that this Contract is not effective
until it has received all requisite state government approvals. and the CONTRACTOR shall not
begin perfonning work under this Contract until noti?ed to do so by the DEPARTMENT. The
CONTRACTOR is not entitled to compensatitm for work performed prior to the effective date of
the Contract or the extension amendment.

000659

 

IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed by their of?cials thereumo
duly authorized.

FOR THE DEPARTMENT: F070 R:
Am mm 550

NauEy?T. Joiner. Commissioner ?ve Mic-Cabe. CEO
Alabama apartment of Human Resources Hill Crest Behavioral Health Services (Higdon)

APPROVED AS TO PROGRAM CONTENT:
Division Director
Alabama Department of Human Resources



Robert Bentley, Governor
State of AlabTia 

14+

 

Rewewed by Co it'act

Rev ow Co.r itggf?ggj/

Contract - 

 

000660

 

 

 

ADDENDUM A

1.0 INTENSIVE RESIDENTIAL SERVICES

Intensive placement services are for children with a DEM-V diagnosis within the range of290-3 lo requiring
active treatment which means implementation of a professionally developed and supervised individtIal plan of
care for individuals who have been prior approved and certi?ed by an independent team (CON) as meeting
medical necessity for this level of care. Facilities must be certi?ed to participate in Medicare/Medicaid
programs, be in compliance with Title Vi and VII, seclusion and restraint requirements of 42 CFR, Part 483,
staf?ng and medical record requirements and have an approved utilization review plan. Intensive residential
placements should be limited to children whose needs cannot be met in their own home, traditional foster home,
therapeutic foster care, intensive or moderate residential care, or children whose treatment goals cannot be met

in a less restrictive setting.

Children eligible for this program level must have a Diagnostic Statistical Manual, Filth Edition (DSM-V)
diagnosed mental illness or be identi?ed by a mental health professional as having serious emotional andfor
behavioral problems and be in need of treatment in a highly-structured, therapeutic environment. These
problems must pose a severe level of impairment to overall ?tnctioning in multiple areas. These children have
been unwilling or unable to commit to a healthier lifestyle and who need intensive support andr?or interventions
to cultivate new, more appropriate methods of coping and behaving.

hose children may be delinquent, chronic runaways, display manipulative behaviors. have dif?culty
maintaining self?control, display poor self-esteem, and have dif?culty in accepting authority. Children with
signi?cant substance abuse needs, which require intensive treatment, are also eligible. This population may
ex hibit signi?cant disruptive behaviors such as persistent or unpredictable aggression, and moderate to serious

risk of causing harm to themselves or others.

These children have not responded successfully to less intensive interventions and therapy, or have been denied
admission or been discharged from various placements because of their emotional and behavioral problems.
There is a need for constant adult supervision and intense treatment, which could include the use of
medication. Children that receive medication should be monitored and maintained
on the townst dosage of medication. The provider will follow the Federal Drug protocol in
regards to the appropriate use and monitoring of medications. DHR staff will provide diligent and
thoughtful oversight of medical care, particularly in regard to the use of medication.

Vendors are required to present a positive discipline approach to their program. A troubled youth's ability of
teaming and moving forward is always greatest when he or she is in a structured environment with
professionals who care about their success. The behavior management programs need to provide the youth with
options to make positive choices. Positive behavior Supports need to be the focus of the program with the
discipline consequences as secondary. The supports need to be individualized for each child on their

developmental level.

Ineligible children include those who are actively homicidal, actively suicidal, or those children who have
a not controlled with medication or a diagnosis that Is In the exclusionary category from DMH
licensed facilities Autism Spectrum). Youth who have displayed major acts of violence or aggression
such as rape, arson, and assault with deadly weapon, murder, and attempted murder within the past six
months are also Ineligible for the program. Children or youth who have a need for treatment for
sexual aggression or reactive behaviors should not be served In this category.

an one level of service at a single location, must provide each level of

Vendors, who propose to provide more th 
identi?ed separate wing closed off from other wings providing a

service in a separate building or a clearly
Page 1 are

000661


 

 

different level of service. There must be adequate staff to serve the different levels of service, and statl? may not
be shared during the same work shift. SDI-1R must approve the plan if the services are to the provided within
the same physical building.

Note: All placements in facilities categorized as ?Intensive? will require prior approval of State DHR,
Family Services and must have a completed certi?cate of need.

1.1 PLANNING RESPONSIBILITY

The State Office or County Department of Human Resources that has planning responsibility for a child has the
responsibility to provide appropriate documentation including services relating to the Individual Service Plan
(ESP). Ali services provided man be authorised an an ISP. Its service authorization document is not
provided within ten (10) days from the date of placement, the vendor should notify the State DHR?Division of
Resource Management of such de?ciencies. 

1.2 PROGRAM REQUIREMENTS
Vendors must:
A. Be licensed by DHR or the Department of Mental Health.
B. Complete the Certi?cate of Need (CON) on emergency placements.

C. Screen referrals to ensure referral is within acceptable diagnosis range of 290-316 to ensure they meet the
criteria listed in Section 3.9. All children meeting the criteria shall be considered for placement.
Rejections shall be reported to the county and to SDHR-Dlvislon of Resource Management on a
weekly basis.

D. Assess each child?s mental, behavioral and emotional functioning in its living environment, school and
community using a standardized assessment tool on admission, quarterly thereafter and upon discharge.
Submit or share the assessment with the Dl-iR social worker for the ISP process, to develop goals and
strategies to speci?cally address the preparation of the child for discharge into a less restrictive living
environment.

E. Fully participate andlor provide meaningful input in the ISP process with the family, DHR and other
providers, including to schedule and coordinate the child?s treatment plan in conjunction with the
family's and the child's Individual Education Program the discharge plan to be developed at
the time of placement; and. the initial treatment plan to be developed within ten (1 0) days from the date
of placement and a review to be held every thirty [30) days. The treatment plan must include goals that
are measorable and address the reduction of duration. frequency. and intensity of smptoms, and what
interventions will be used to meet each goal.

F. Create a behavioral management plan for the child or youth with input and collaboration with the family's
Team; implement and monitor the child?s behavior management plan. The plan should be
individualized and positive and promote developmentally appropriate behavior growth.

(3. When the treatment plan includes the use of medication, informed consent is required.
informed consent requires that the prescribing physician inform the child and legal guardian (county
DHR worker) of the risks and benefits of the proposed treatments and the risks and bene?ts of alternative
treatments, including no treatment. This includes information about the potential bene?ts of the
mcdi cation, the possible risks, and the range of doses. information about serious adverse effects and how
to contact the physician must bediscussed. Staff and DHR workers should be given ample time for

questions and discussion before consent is requested.
H. Ensure that staff (rotating and awake) will be available for children 7 days a week, 24 hours a day.

I. Offer staff the training recommended in Minimum Standards for Residential Child Care Facilities on
pages 18-19. The Minimum Standards for Residential Chiid Care Facilities are available on the

P8902 of6

000662


 

Departments website at click on Foster Care under Quick Links. then Services and
Resource Management Division. Additional staff training provided by the facility 
medications, diagnoses of mentally/behaviorally disturbed children and adolescents, positive
reinforcement of behaviors, etc.) must be documented in personnel ?les.

I. Provide reports to referring county DHR describing services provided during the month and the
child?s progress toward achieving the goals outlined in the treatment plan. Progress notes shall be
received by the 15'h day of the following month outlining goals achieved from the previous month?s
treatment plan.

K. Complete the Length of Stay over 300 day form each month and send to Division of Resource
Management-Of?ce of Resource Development and Utilization at SDHR.

L. Ensure that children are receiving needed educational services, including homework assistance (not
tutoring), participation in and follow-up on children?s weekly contact with the schools of the
residents, site visits with the schools of residents, transportation to school, and access to
alternative educational settings as identi?ed in the ISP. (This only applies to off campus school).

M. Ensure that child receives routine and emergency medical care. Please see DER responsibility #4 for
additional information.
. Submit outcome data in a format prescribed by SDHR, as required.

0. Complete a survey (at discharge) with the child, family, and DHR social worker to assess satisfaction
with services, care and treatment. At six weeks, the survey must be repeated with the same individuals.
The surveys must be maintained in the individual child's ?le at the facility. A quarterly summary of
survey results must be submitted and include any program changes instituted as a result of the survey.

2

1.3 CORE SERVICES FOR INTENSIVE RESIDENTIAL PROGRAMS

Vendors must:
A. Provide ongoing medical, social and educational assessment.

B. Provide a diagnosis from these ongoing assessments.

C. Provide local transportation to appointments identi?ed in the ISP physicians, family visits,
extracurricular activities, etc). The county DER is responsible for transportation that is not local.
The county DHR ls responsible for the progress or lack of progress of family visits. If a
provider is supervising visits the worker should be reviewing the reports attire and
periodically observe the interactions themselves due to required court testimony to support any

recommendation made by the county.
D. Provide treatment planning with a treatrnent team.
. Provide an active treatment program in a therapeutic milieu.
F. Provide services! medication management following the DHR 
MedicationiMonitoring policy.

G. Provide clinical therapy service
anger management, social skills, relationships, coping skills, creative expression,

esteem.

H. Provide routine medical care.
Provide education program for the child/youth including GED preparation if high school graduation is no

longer in the ISP plan. .
. Provide vocational and recreational therapy which teaches the youth to participate in organized groups and

learn a valuable trade or craft.

[1'1

5, including family metapy and any behavioral programming such as
forgiveness and self-

Pagea of 6

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K. Provide independent living skills.

L. Provide a minimum of per week allowance based on the child?s age and the ISP. Allowances
may not be used to recoup for damages or restitution. If additional monies are earned, recoupment
for damages and payments for restitutlon may be made from them.

M. Provide up to $50.00 per month for special needs and occasions, e.g. haircuts, feminine hygiene
products, oral and body hygiene products, over-the-counter medications, gifts for birthdays, Christmas or
other special occasions, etc. Anything above $50.00 per month must be paid by the county DHR of?ce.

N. Provide supportive services to the family as agreed in the ISP, i.e. parenting training and education. This
may include but not limited to supervision of family visitation, providing space where the family can visit
comfortably, and flexibility of pregram structure that allows family contact at times that work for them.
Agree to follow all policies developed by DHR regarding family contact and visitation. (See for
additional information about family visits.)

0. Provide State DHR, Of?ce of Licensing any incident report on a child in DHR custody. The incidents
listed below shall be reported to that Of?ce of Licensure within 24 hours after occurrence or the ?rst
work day following the occurrence, whichever is sooner. This includes reports that are made to DMl-i
from an approved licensed facility.

. Any injury requiring professional medical treatment of any child or staff person while at the
facility or away from the facility activities.
In Any illness occurring at the facility or during away from the facility activities which requires
emergency medical treatment.

Any death occurring at the facility or during away from the facility activities.

Major damage to the facility.

Any litigation involving the facility.

Any traffic accident involving facility children using transportation provided by the facility.

Any arrest or conviction of the licensee or any staff person.

Final disposition of any child abuscineglect investigation involving the facility. the licensee, or

any staff person.

I Any incident occurring which places the health, welfare or safety of a child at risk.

A written explanation is to be provided to the Department within ?ve (5) days.

P. Any staff person is required by law to report any known or suspected child abuse or neglect allegations to
the County Department of Human Resources or the local chief of police or county sheriff. The report
shall be made immediately by telephone or direct oral communication, followed by a written report,
containing all known information.

The Executive Director of the facility shall advise the Alabama Department of Human Resources, Of?ce
of Licensure, about the report no later than the first work day following the alleged incident.

For more information regarding items 0 and P, please see the Minimum Standards for Residential Child
Care Facilities.

Q. Encourage the child?s relationship with family, peers and other signi?cant persons, including, but not
limited to, the supervisioa of family visitation as agreed in the plan, including the family?s
participation in treatment planning, providing a space for quality visitation at the facility, ensuring that
the structure ofthc treatment program does not limit family contact unless identi?ed in the ISP, agreeing
to follow all policies developed by DHR regarding family contact and visitation, etc..

R. Consistent with the 131?, provide a minimum of two (2) hours per week of tutoring by a person quali?ed
to offer specialized assistance in a certain subject; monitor the tutoring for the achievement of outcomes
in the child?s educational setting.

Note: All services provided above and beyond the core services listed, must be authorized by the ISP
Page 4 of 6

 

000664

 

and on a DER-18 78 to authorize payment of such service .

All services billed ELIE be in compliance with Chapter 33 of the Medicaid Provider Man not

The parties understand and acknowledge that the vendor may, in rare circumstances and in
accordance with the co nnty department?s procedures, bill the county departtnentfor certain ancillary
services. The parties understand and acknowledge that the vendor will directly bill Medicaid and
receive payments for all Medicaid eligible children directly from Medicaid. Payments for non-
Medlcaid eligible children will be made by the Department of Human Resources at the same rate paid
for Medicaid eligible children. The vendor will be responsible for any charge backs on Medicaid
eligible children and non-Medicaid eligible children.

Page 5 of 6

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Hill Crest

Behavioral Health Services
Birmingham, AL



has been Accredited by

 

The Joint Commission
Which has surveyed this organization and found it to meet the requirements for the

. Hospital Accreditation Program

April 7, 2012

Accreditation is customarily valid for up to 36 months.

  

Organization 2919
i . min, A P.MPP,
Prelidenl

Chair. Board of 
The Joint Commission is an independent. not-for?pro?t, national body that oversees the safety and quality of health care and

other services provided in accredited organizations. Information about accredited organizations may be provided directly to
The Joint Commission at 1-800?994-6610. Information regarding accreditation and the accreditation performance of individual

   

organizations can be obtained through The Joint Commission's web site at 
. 'uup'u twill .
~u 7i" 
- AMA i1; writ??
I i 5 . I 1'1: 
(4H If at
It?: . ii? I: ?36?

 

Thie reproduction of the original certi?cate hee been issued for In nouletoryfpeyer agency veri?cation of

by The Joint Commission. Pin-e consult Quality Check on The Joint canndeelon'e ?belle to the
omenlzetlon'e current mu- md for listing of the omerdution?e Ioeetione at are.



000666

 

 

Hill Crest

Behavioral Health Services
Birmingham, AL

has been Accredited by

   


1r
.. 

   

Which has surveyed this organization and found it to meet the requirements for the

. Behavioral Health Care Accreditation Program

April .6, 2012

Accreditation is customarily valid for up to 36 months.

Organization ID 2919 @872?

Isabelv. Hoverman, MD. MACP Pm?mapm'nm? 06/26/12 Merit Chitin, A . .

Chelr. Board of I Pro-i dent

The Joint Commission is an independent, nonfat-pro?t, national body that oversees the safety and quality of health care and
other services provided in accredited organizations. Information about accredited organizations may be provided directly to
The joint Commission at 1400-99L6610. Information regarding accreditation and the accreditation performance of individual
organizations can be obtained through 'I?hejoint Coma?erioo'a web site It 

 

?1111'Kf? . 
1+ 51.15 4?
- Thle reproduction or the original leendlulon eeril?eete hee been leeued for In maul-towing" agency veri?cation of

I by The Joint Cemmleelon. Plum eoneult cheek on The Jolnt Cernmleelen?e web-he to con?rm the
. omenlze?on'e current mule end for Mm of the ergenln?en'e of care.

000667

 

 

 

 

 

Wd?mm

CHILD CARE FACILITY

FACTS ID: 123780

This is to certify that HILLCREST BEHAVIORAL HEALTH

(Licensee)

 

is hereby granted this LICENSE to conduct and maintain

HIGDON HILL GROUP HOME
(Name of Child Care Facility)

as a CHILD CARE INSTITUTION for 4%
(Type of Child Care Facility) (Number of children)

 

ages 11-1 EARS 0L
(Age range of children)

1003th at 6869 FIFTH AVEE Eli] SO ?jlj? BIRMI GHAM

(Street Address) (Cit?)

in JEFFERSON State of Alabama
(County)

This LICENSE shall be in force for a period of two years from the QOTQ day of

MARCH, 2243;, to the 30TH day of MAKER, subject, however, to be revoked on
the failure of the above-named Child Care Facility to comply with the provisions of Title
38, Chapter 7, Code of Alabama I975,'or the standards and regulations prescribed by the
Department of Human Resources of the State of Alabarna in accordance with the

provisions of said law. 1

IN WITNESS WHEREOF, I have hereunto set my hand this 4TH day of ?up, 2013.

BY WNW

Commissio'her
State of Alabama Department of Human Resources

 

 

 

 

 

NOTE: This LICENSE must be posted in a conspicuous. place on the premises 5

 


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4.2.5 TECHNICAL PROPOSAL

4.2.5.1 VENDOR QUALIFYING INFORMATION
Vendor Pro?le and Experience

History

Hill Crest Behavioral Health Services (Hill Crest) was founded in 1925 by Dr. Becton as Hill Crest
Sanitarium. The 25-bed facility was located in the Hing Mansion purchased from Birmingham?s
Sheriff Higdon. A state of the art 60-bed hospital was built in 1930 and served the needs
of the southeastern United States until the new and current lBO-bed facility was constructed in 1972.
Hill Crest Foundation was formed at that time to help fund the construction. The hospital was
purchased by HSA from the foundation in 1984 and sold to Ramsay Health Care in 1989. Ramsay
Health Care was purchased by Solutions in July 2003. EC Partnership, D.B.A. Hill
Crest Behavioral Health Services (Hill Crest), is now part of Universal Health Services (UHS)
Behavioral Division which purchased Solutions in November 2010.

UHS offers an extensive continuum of behavioral health programs. UHS owns and operates 225
locally-managed facilities including 25 acute care hospitals, 195 behavioral health facilities, and three
surgery centers in 37 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, and
employs more than 65,000 people. UHS is the largest facilities-based behavioral health provider in
the country. UHS hospitals are licensed for more than 27,000 beds and generated more than 6.5
million patient days from nearly 631,000 admissions in 2013, a re?ection of the high-quality patient

care provided at its facilities.

Hill Crest currently operates acute care services for children, adolescents, and adults. Residential
Treatment Services are currently provided for the adolescent pepulation. Residential services consist
of a Residential Treatment Center (RTC) which is licensed for 79 patients, for both males and
females, by the Department of Mental Health and 32 clients licensed by DHR.

Quali?cations and Experience of the Vendor
- Over 85 years of experience in care;
i 25 years of experience in provision of intensive residential treatment;
0 15 years of experience with our current program model that facilitates family
involvement and growth;
6 Stable, tenured program and executive leadership;
Two child/adolescent who are devoted to this population and provide
exceptional medical care;
Accreditation by the Joint Commission throughout the years of providing service;
I- Presently have the 3-year maximum accreditation by JCAHO, 2012 2015;
Licenses include the State Department of Hmnan Resource and the State Department
of Mental Health.

Hill Crest currently provides intensive residential services for adolescent males and females on our
campus in 2 buildings, and a l4-bed unit for males in Bessemer, Alabama. Hi1] Crest also has the
capacity to provide additional services in a separate 14 bed single-room unit for either males or

000669

 

 

females. The focus of this unit would be directed by the need determined by DHR. One building on
the main campus is known as ?The Main Facility," and another facility on campus is the ?Higdon
Hill Facility.? There are 4 separate units in Intensive Residential Services for Children with the
capability of adding the above referenced 5th, a 14 single occupancy unit. The main Hill Crest
Behavioral Health Services campus, along with the client?s living space includes a school, gym, game
rooms, and a large ropes course (Adventure-Based Counseling).

Each level of service offered will be provided in a separate wing or be located in a separate building.
Programs Operated in the past include a Partial Hospitalization Program for Adults, Adolescents and
Children, and an Intensive Outpatient Program for Chemical Dependency for Adults and
Adolescents.

Mission Statement

l-lill Crest Behavioral Health Services will provide the highest quality, comprehensive mental
healthcare to children, adolescents, and adults through our innovative programs, highly-trained
professional staff, and our commitment to deliver exceptional outcomes.

We will ensure our valued employees exhibit compassionate and caring attitudes, display high levels
of integrity each day, demonstrate full compliance to all regulations and respect each individual's

rights and privacy.

Hill Crest will provide a welcoming and safe environment for patients and their families.
Hill Crest will ensure that our staff continuously improves through consistent training and is fully
prepared to meet the dynamic clinical/administrative challenges of the mental healthcare

environment.

Goals
To develop and re?ne internal and external mechanisms that are designed to ensure

the provision of high quality and behavioral healthcare;

To continue to develop and re?ne the programmatic approach to treatment;
To provide prompt and adequate medical attention for physical illness, to include the
apprOpriate assessment and management of pain;

To create a culture that provides a sense of security, competence, and cooperation
among employees;

To ensure professional growth and development of our employees;

To establish and maintain a continuum of services that will meet needs of our
community;

To develop and expand educational programs to meet the needs of the community;

To continue enhancing the positive image of Hill Crest Behavioral Health Services as
a state-of-the-art private hospital in its programs, clinical leadership,
physical plant, and spectrum of services;

To provide each patient with the highest quality of care in order to both
relieve presenting and enhance coping skills;

J. To meet standards of all regulatOry agencies.

as we 9 no a



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Management Structure

Hill Crest has a Goveming Board of Directors to which the Chief Executive Officer (CBO) directly
reports. The CEO delineates direct reSponsibility for the Residential Treatment Services to the
Residential Treatment Center Program Director, Director of Nursing (DON), and Social Services
Director.

- The Governing Board of Directors is responsible for the overall operations of the
Residential Treatment Center, the appointment of fully quali?ed medical staff, and the
ongoing monitoring of the quality of care rendered at Hill Crest. The Governing Board
is responsible for any activities necessary for any lieensures, approvals, or
accreditations at Hill Crest;

The CEO is the person responsible for attaining operating goals established by the
Governing Board of Directors and Corporate Management pertaining to the quality of
services performed by physicians to clients; ef?cient utilization of material, facilities,
and human resources; pro?tability; and penetration in the community for healthcare
facilities;

The Unit Chief for the Intensive Residential Treatment Center is the physician
responsible for providing medical direction and also provides general care
to clients in conjunction with other physician staff. The Unit Chief reports directly to
the 

0 The Social Services Director, an LCSW with over 25 years of experience, provides
clinical and human resource management to residential services and has responsibility
for the social workers and ancillary services (recreation and adventure base
counseling, etc).

I The DON and Staff DeveIOpment Directors are ultimately responsible for the nursing
care delivered to the children and for staff development services.

I The Residential Nurse Manager is responsible for the nursing care delivered to
residential clients and is responsible for clinical and human resource management of
the nurses and mental health workers. The Residential Nurse Manager reports to the
DON, RTC Program Managers, and Unit Chief;

I The Program Manager is responsible for the development and implementation of
clinical services for each client. The Program Manager ensures that clients Master
Treatment Plans are individualized and fosters therapeutic progression to a less
restrictive environment.

Organizational Profile

Hill Crest employs approximately 425 people. Approximately 195 employees are directly assigned
to Residential Services. Hill Crest will not allow an employee to be assigned to another program
during the same shi? on the same day. The business designation is listed as a corporation.
Organizational pro?les are listed in this section. (Attachment 4.25.1.1) The complete list of the

Governing Board is as follows:

Organization Information:
Hill Crest Behavioral Health Services

. 6869 5th Avenue South

 

000671

 

 

 

Birmingham, AL 35212
Steve McCahe, Chief Executive Of?cer
(205) 8384065

Board of Directors:

Mr. Bob Sanders, Chairperson, was the Administrator of Hill Crest Hospital from 1964 to 1984.
He was asked to join the board in 1998 and has no ownership of Hill Crest Behavioral Health
Services.

Mr. Steve McCabe, has been the CEO/?Board Secretary of Hill Crest Behavioral Health Services
since December 17, 995. Mr. McCabe? responsibilities include the overall day-to-day operations of
the hospital and all af?liated programs. Mr. McCabe is a ?ill-titne salaried employee of UHS and has
no direct ownership of the facility.

Dr. Shaldl Khan is the Medical Director for Hill Crest Behavioral Health Services. Dr. Khan is a
child/adolescent with direct responsibility for the clinical integrity of all programs within
the Hill Crest organization. Dr. Khan devotes the majority of his time to the direct care of clients
within the Hill Crest organization. Dr. Khan does not have direct ownership of Hill Crest Behavioral
Health Services.

Dr. Jon Williamson is the Vice President of the Medical Staff. Dr. Williamson does not have direct
ownership of Hill Crest Behavioral Health Services.

Ms. Bridgette Bishop, RN is the Director ofNursing fur Hill Crest Behavioral Health Services. Ms.
Bishop is a fullrtime salaried employee of Hill Crest and has no direct ownership of the facility.

Mr. Matt Hutcheson is the COO of Hill Crest Behavioral Health Services. Mr. Hutch-Ion is a full-
time salaried employee of Hill Crest and has no direct ownership of the facility.

Senator James T. Waggoner is an Alabama State Senator and has been on the Board since 1998.
Involvement with the facility is limited to consultation as a board member at the quarterly meeting.
Senator Waggoner has no direct ownership of Hill Crest Behavioral Health Services.

Mr. John is a Divisional President for UHS. He was asked to join the board in 2008.
Mr. Hollinsworth has no direct ownership of Hill Crest Behavioral Health Services.

4.2.5.1.2 Past and Present Contractual Relationships with the Department

Hill Crest has maintained a contract and relationship with DHR for the past three years, and plus
years prior and presently. The contract numbers over the past 3 years and presently include: Contract
#3326, #3322, and #3310. The contractual relationship has encompassed moderate level residential
care, intensive level residential care, and acute care hospitalizatioo services. Clients have
been cared For in the least restrictive environment, and the length of stay has decreased over the
years. Family/guardian reuni?cation is a focus in the treatment process and in the services provided.

The Department of Youth Services (DYS) and Hill Crest have maintained a contractual relationship
during the past three years, numerous prior years, and presently. During the past three years and

at.

000672

 

 

presently, the contract numbers are: and
. This contractual relationship includes Community Residential Care Services and
Inpatient Hospitalization.

4.2.5.13 Contract Performance

Hill Crest has experienced no terminations for default in the past ?ve years nor had a contract
terminated for conVenience, non-allocation of ?mds, or any other reason before completion of all
obligations identi?ed under the initial contract provisions.

4.2.5.1.4 Project SM?/Resumes/Job Descriptions

Numerous skills and levels of education are necessary to provide Intensive Residential Services for
Children. Job descriptions detailing the level of education, experience, training, and skills for all key
personnel of the Intensive Residential Services for Children Program are included. Also included is a
listing of all Professional Licenses held by the staff. (Attachment A. 

Hill Crest assures that all staff are properly quali?ed, trained, and have the necessary
education/licensure to treat the clients. Hill Crest?s staff meets or exceeds the staff quali?cation
listed in the Minimum Sm dards for Chi Id ?re Facilities. Hill Crest is in compliance with all laws
pertaining to non-discrimination (Title IV of the Civil Rights Act of 1964, and Section 504 of the
Rehabilitation Act of 1973, and the Americans with Disability Act of 1990).

 

Suf?cient staff is presently in position to perfonn the services required in this RFP. There are
generally 195 personnel on the payroll in the Intensive Residential Program. Additionally, if

. required, several other facility employees are trained and competent to work on the Residential Units
for Hill Crest. Hill Crest has the available resources (personnel) to care for the clients, meet their
physical/emotional needs, and perform required tasks. Hill Crest coordinates New
Employee Orientations (NEO) throughout the year. A full-time Human Resources Department works
to establish a consistent hiring and training process. Processes are presently established to allow
overtime and PRN staff to assist in ?lling positions that may become vacant. New stuff is hired as
positions become available, and training opportunities are provided to prepare staff to work as soon
as possible. Such training assesses/develops competency both within a classroom environment and
on a speci?c unit while accompanied by an employee mentor.

Stai??nngtailing Patterns:
Hill Crest?s httensive Residential Services Unit has both professional and non-professional staff

available to provide for the clinical needs of all clients. Staff is rotated and awake to be available for
their clients 7 days a week. 24 hours a day. Staff ratios will re?ect the special needs of the
population, the scope and intensity of care required, and the number of clients.

Physicians are available 7 days a week, 24 hours a day. A hospital physician on-eall schedule is
established and distributed Nurses are available 7 days a week, 24 hours a day to provide
clinical support. The Intensive Residential Services for Children has Program Managers and
administrative personnel on call 7 days a week, 24 hours a day. Trained Mental Health Technicians

are assigned according to acuity needs of all clients.

ID

000673


 

Hili Crest's administrative team uses ratios based on historical average daily census within a given
. population, diagnostic grouping, trended risk factors, support services available, size and
con?guration of the unit, historical general acuity, and priority acuity measures. Such acuity
measures include but are not limited to Therapeutic Interventions, Medications and Frequency,
Physical and Medical Problems, Diet and Nutrition needs, Hygiene and Need for Assistance, Risk,
Activities and Privileges, Teaching and Flaming and other areas (including seclusion/restraint).

General core staffing is assessed quarterly and throughout the year for emerging trends and

pro grammatic changes that may necessitate a modi?cation in the variable staf?ng budget. An
evaluation is completed at least on a quarterly basis with input from and review by administration,
program managers, and nursing supervisors. Information from available like facilities is
incorporated. An analysis, at least quarterly, of core staf?ng takes into account the areas listed
above. After an evaluation of trends, recommendations are submitted for approval to administration,
and incorporated into the plan for client care services. The Fragrant Managers may use their
discretion to determine if supplemental staff is required to address an imnwdiate need. The plan for
Client Care Services is reviewed by the Medical Staff and Governing Board for approval.

Hill Crest is surveyed by DHR, Department of Mental Health, and Joint Commission. and staf?ng is
a portion of each survey; there have been no recommendations made about program staf?ng.

Hill Crest presently has suf?cient staff to perform the services required in this RFP.

Shift by shift staf?ng is conducted daily by Assistant Program Director, therapists, and Youth Care
Workers feedback from all services is always considered. Factors evaluated include data
. item previous shifts, precautions issues, constant observation or 1 :1 assignments, seclusion or
restraint incidents, medical care, transponation requirements, and the number of clients.
Supplemental staf?ng based on acuity is approved by the Assistant Program Director, Director of

Nursing, or Nurse Administrator on call.

A quarterly analysis regarding staf?ng effectiveness is conducted in compliance with the oint
Commission. Hill Crest compares staf?ng on various indicators: staff turnover, staff injury, client
injury, and client satisfaction. Data is collected on these indicators to determine what, if any,
contribution staf?ng effectiveness has made to the variation. Corrective strategies are then provided

immediately to address the ?ndings as required.

The Assistant Program Director and therapists are primarily scheduled from 3 am. 5 pm, Monday
through Friday. A Nurse Supervisor is also scheduled 7 days a week for evening and night shifts.

Programmatic staf?ng includes managers, nurses, social YCWs, and auxiliary
staff (recreation, clientlfamily educators, school teachers, etc). A staf?ng pattern for a census of 18

would generally be as follows:

7-3 shift: 1- RN 1- Program Director 4- YCWs
2? Therapists 8- School Teachers 2- Auxiliary Staff
1- Program Director 2- Therapists l-Auxiliary Staff

. 3?11 shi?: 

ll.

000674


 

 

4- YCWs

1 shift: 1 RN 4- YCWs 1- Facility wide Nurse Supervisor

I Adjunctive Staff: Day, Evenings, and Weekends
Staf?ng patterns are variable and adjusted as needed

Staff to client ratio will always have a suf?cient number of quali?ed staiT to provide for each client?s
physical and emotional needs at all times and to perform required tasks. The ratio of staff to client
will not be less than the minimum ratio established by DHR.

Staf?ng is provided in a number of ways: core staff (full/part-time positions) set above industry
standards, managers or nurse supervisors, ?exi?pool/PRN staff, utilization of overtime, multiple
supervisors/administrators on call.

4.2.5 .1.5 Sra?Performanee Evaluations and Training

Hill Crest?s Staff Development Department provides a competency based educational and training
program that enables staff members to both maintain and improve the required levels of knowledge
and skills required to perform their jobs. The Staff Development Program is based on identi?ed
learning needs that are designed to enhance clinical practice by expanding clinical knowledge skills
and attitude.

The orientation process includes both classroom and on-the-joh training. These trainings are
conducted by quali?ed individuals according to the established curriculum and outline. Competency
assessments and validations are completed during the classroom and unit orientation. The Director of
Staff Development and Director of Nursing are involved in the clinical training portion. Other
designated nurses, social workers/therapists, and MHTs are also involved in the training. The Risk
Manager, Director of Nursing, and Human Resources Director facilitate the trainings. The trainings
are organized/structured by the Staff Development Department. The orientation period for new
employees is usually up to 30 days, depending on his/her individual needs and the complexity of the
job and role. There is an organized employee orientation for all new employees.

The classroom segment of the new employee orientation entails a 4-5 day process for the clinical
staff (mental health workers, social workers, and nurses), with an additional 2 days for nurses.?
Generally, an employee will remain in orientation on the speci?c home program/unit for 30 days. If
requested by the employee or deemed necessary by the management, the orientation period will be
extended. The approximate amount of time spent in general orientation, unit orientation, and cross-
training to other units in the facility is 96 hours for mental health workers, 128 hours for nurses, and

40 hours for non?clinical employees.

All new employees (pennanent hill-time, permanent part-time, ?exi pool) receive an orientation to
each program. the orientation, the employee receives basic information regarding all
programs. Completion of a home department program?s competency module will validate
competency and provide veri?cation of training.

All new employees receive an age-speci?c training module. A post-test must be successfully
completed {score of at least 90%) during the orientation process and during annual rn-serwce. Any

I2.

000675

 

 

 

employee who does not satisfactorily pass any of the competency tests will meet with the Director of
. Staff Development or designee as appropriate for supplemental training.

Any previous Hill Crest employee who has been separated from Hill Crest for lit-months or less is
not required to attend New Employee Orientation. Helshe will instead participate in the next annual
tit?service program. All employees are adequately named in their job position and will receive
program cross-training as needed.

 

A new employee?s education, experience, test completion, lit-house educational programing, and
postntestmg shall prove whether the employee is competent. Current employees are to attend annual
updates and reviews as required.

During the orientation process, staff will participate in a class to develop skills in managing the
patient in crisis. This is a focus area for our staff. Staff will attend a Nonviolent Crisis Intervention
class in the new employee orientation and a re?esher course annually to maintain their skills in
physical crisis intervention. Hill Crest also requires each clinical employee to demonstrate
competency in Nonviolent Crisis Intervention techniques every six months.

For clinical staff, assessment is based on appropriate performance of skills as related to the needs of

the assigned population. This includes needs relative to age or special needs. The clinical staff's

education and training refers to the minimum educational requirements that all employees of Hill

Crest must meet as set forth in the job speci?cations. All new employees must complete New

Employee Orientation, Departmental Orientation, and any additional orientation that is speci?c to the

position. Hill Crest provides all training recommended in the Minimum Standards for 
. Child Care Facilities.

Departmental Orientation is mandatory for all new employees. Topics reviewed include
policiesfprocedures, departmental organizational structure, work schedule, safety plans, Nonviolent
Crisis Intervention, skills, etc. This orientation will be in the assigned work area and

should be completed within 2-3 weeks.

All employees will complete Initial Orientation upon hire as evidenced by the completion of the
initial Orientation Checklist which is maintained in the employee?s Stall? Development education ?le.
All employees complete new employee orientation, as evidenced by the sign-in sheet and the
employee education database maintained by the Director of Staff Development. Every employee
completes a Departmental Orientation which is documented. Employees complete the Departmental
Competency Checklist which is adapted to each speci?c job description. The completed form is
stored in the Staff Development ?les.

Eemi-tipg of Competency Elan

Documentation and reporting of competency plan activities will be as follows:

Human Resources maintains all applications, references, and performance evaluations. Staff
Development maintains records on all employee orientation, training, specialty and
continuing education classesfsemlnars. Annual performance evaluations are conducted by the Unit
. Manager/designee. Any areas requiring improvement are discussed, and goals are established with

I73.

000676


 

 

the employee. On-going observation by the managers enables constant feedback to the employee for
continued iinprovement.

Nurses are given a medication administration test during the orientation period. A passing score of
90% is required before orientation is completed. The Staff Development Department provides
educational [rt-services and training classes throughout the year. These Iii-Service classes and
trainings are based on identi?ed needs or feedback from sta?' and/or managers and standards
requirements from other agencies. The Staff DeveIOpment Department provides innovative Iii-service
and individualized sessions to improve patient care. These classes center on therapeutic
communication and extended behavior management that goes beyond the initial training employees
receive during orientation. These classes are ?exible, allowing employee participation and
discussion, and are o?ered throughout the year. The intensive training provides information to assist
the employees to better recognize the early warning signs of a potential crisis. The employees re-
familiarize themselves with proxemics and kinesics and ways to avoid confrontations that could
result in power struggles. All Nonviolent Crisis Intervention (N VCI) Instructors are certi?ed to train
staff members to deal with physically acting-out clients. The employees understand that this
technique is used only as a last resort if the client is potentially harmful to himself/herself or someone

else.

l-Iill Crest understands that motivation cannot be taught, but the goal of the Staff Development
Department is to instill these characteristics to staff members. Instilling these goals will improve
staff members? knowledge, allowing them to deal effectively and safely with the challenges of an
evolving community.

The general scope of education for New Employee Orientation is listed below:

SCOPE OF EDUCATION FOR NEW EMPLOYEES
-Minimum of 50 Hours within ?rst 180 days of hire (igcludg individpgl assiggmems of 20 
adolescent behavioral education for clinical sta?t

A. General Facility Orientation
1) Customer Service
2) Hill Crest Philosophy
4) Overview of the Childcare Institutions, Group Homes, and Child Placement Agencies
5) Department Overviews
6) Cultural Diversity
7) Performance Improvement
8) Environment of Care (Safety)
9) Patient Safety Plan
10) Fire Safety (Life Safety)
11) Emergency Preparedness
12) Disasters (Internal and External)
13) Hazardous Materials (MSDS)
15) Personal Protective Equipment
16) Body Mechanics: Safe Lifting Techniques in Work Areas
17) Reporting Incidents and Accidents

M.

000677

 

18) Patient Rights and Patient Beliefs

19) Neglect and Abuse .

20) Comrmmication throughout the Life Span

21) Employee Health

22) Infection Control

23) Problem Solving Skills .

24) Interactions with Consumer and Family/Guardians
25) Perspective of Families and Consumers with Regard to Residential Treatment
26) Recovery

27) Most Common Diagnosis

28) Medications and Classi?cations

29) Grievance Procedure/Reporting

. Clinical Orientation

1) Age Speci?c Characteristics and Needs thmugh the Life Span: A Clinical Perspective
2) Behavior Management Strategies

3) Therapeutic Communication

4) Patient Assessment

5) Food-Drug Interaction

6) Medication Side Effects 

7) Master Treatment Plan and Treatment Plan Meetings
8) Patient Family Education and Discharge Planning:
9) Progress Notes

10) Patient Rounds

11) C.I.W.A. Protocol

12) Precautions

13) Infection Control: A Clinical Perspective

14) Vital Signs

15) Urine Collection

16) Patient Care: Hygiene

l7) Codes

18) Levels of Observation

19) Time Out: Documentation

20) Therapeutic Holds: Documentation

21) Patient Searches

22) Human Development

23) The Process of Grief and Loss

24) The Dynamics of Attachment and Separation

25) Value of Families

26) Individualized Service Plan

27) Behavior as an Expression of Underlying Needs
28) The Value of Partnerships

29) How Children enter the Foster Care System/Family Implications among Agency Personnel

30) Overview of the RC. Consent Decree
31) Understanding and Valuing Cultural Differences
32) Identifying the and Needs of Families and Children

?5

000678

 

 

33) Most Common Diagnosis
. 34) Medications/Classi?cations
35) Problem Solving Skills
36) Interactions with Consumer and randy/Guardians
37) Perspective of Families and Consumers with Regard to Residential Treatment
38) Recovery
39) Most Common Diagnosis
40) Medications and Classi?cations

C. Nursing Orientation
l) Milieu Management
2) Nursing Process
3) Patient Classi?cation
4) Reporting Process: Shi? Report Guidelines
5) Assessment Tool
6) Admission Process
7) Medication Management:
Medication Education
Medication Administration Medications!
Medication Policies/Medication Errors/AED/Abbreviations
Look-Alike! Sound?Alike Medications
One Time Orders Taking off Physician Orders
?As Needed? Medication Read back verbal or phone orders
8) ER Cart\Medieal Emergency
9) Lab Procedures
10) Pharmacy Procedures
Adverse Drug Reaction/After Hours
1 I) Consult Procedures
12) EKG Procedure
13) Venipuncture and IV Maintenance
14) Pattern Blood Sugars and Skin Puncture
15) Discharge Procedure
16) Nursing Policies and Procedures (Overview)
17) Nebulizers

 

D. Supervisors, Safety, Performance Improvement, and Education Staff also receive General
Management and Management of Information orientation and training.

Annual Emplo?e is mandatory for all employees. The purpose of the Annual lit-Service
is to assist in maintaining and strengthening competency, knowledge and skills.

 

ANNUAL is a minimum om hours (includes individual assignments of 20 hours
adolescent behavioral education for clinical staff)

In-scrvice classes are abbreviated orientation classes, with the exception of unit speci?c training and
. extensive nurse training.

iLo.

000679

 

 

Ongoing Staff evaluation is performed and training is conducted throughout the year as needed.

During any time of employment at Hill Crest, an employee or manager may determin continuing
education for a speci?c employee or the whole department is required. The manager will contact the
Director of Sta?' Development to discuss the timeframe and need for the continuing education. The
Staff DeveIOpment Department will then provide an accredited facilitator to teach the class. Trainers
also periodically observe on the unit and teach/train as observations occur. Trainings may also occur
based on Perfonnanee Improvement or Risk Management data. These additional training needs may
be recommended by a committee to Administration, or Administration may at any time mandate extra
trainings based on written infonnation and/or observations. Annual Performance Evaluations
conducted by the employee?s manager/designer. may also lead to supplemental training in a particular
area.

All facilitators are evaluated at the conclusion of every educational training session. The evaluations
are summarized by the Director of Staff Development, a copy is provided to the facilitator, and the
original is maintained in the Education ?les along with the sign-in sheets.

Continuing educational classes are offered to the community and Hill Crest staff. These classes
coosist of a very diverse list of topics which serve the community and help provide quality care. A
formal ?Performance Review? with each employee is held after the ?rst three (3) months of
employment and annually thereafter.

4.2.5.1.6 Background Checks

In connection with a job offer ??om Hill Crest, an employee is required to sign an authorization form
permitting Hill Crest to perform a background investigation. All employees, regardless of their level
within the organization, are required to submit to a mandatory background check, and all job offers
are contingent upon an acceptable background check.

Hill Crest requests an Alabama Statewide Criminal Background Report and a National Background
Report from a national background ?rm prior to the employee?s orientation process. The results of
the National Background Check mpg; be received ad approved prior to the employee?s orientation
process. The results from the State of Alabama background must be received and approved before the
employee has any contact with the clients. The employee is aware that all the background reports
must be acceptable for continuation of employment.

The remaining background information is requested from different agencies as required. The
background check includes employment veri?cation, personal references, Alabama registry on Child
Abuse and Neglect, ?ngerprints reports obtained for Alabama Bureau of Investigation (A81) and
Federal Bureau of Investigation (FBI) background clearance. A report ?'om the Of?ce of the
Inspector General (010) on all staff is also included. In addition to the background reports, the
Human Resources staff will verify all licenses and academic degrees from the original sources. The
reports are received at different times and reviewed, and a determination is made within 24 hours

after the receipt of each report.

If a report is received and cannot be approved within the guidelines and procedure listed above, the
Human Resources Director will attempt to gain more detailed information from the reporting agency.

I'l.

000680



 

If the information cannot be obtained or there is still a problematic report, the Human Resources

DirectOr
whether

will meet with the CEO or CEO's dcsignee. The CEO/designer: makes the ?nal decision
Or not to terminate the employee or refuse ernployment to the applicant.

- An employee cannot participate in the orientation process until the Alabama
Statewide and the National Background reports have been received and approved by
the Human Resources Director. The report contains information about any prior
criminal histOry as a result of a public record(s) search from any federal, state, or
other agency which might contain such records.

- Information regarding conviction will not necessarily bar an applicant from
employment but will be reviewed in light of all the surrounding circumstances
including age at the time of the offense, seriousness and nature of the violation,
rehabilitation, relationship of the offense to employment, and federal statutory
requirements. The report will be reviewed by the Human Resources Director and the
CEO, if necessary.

Convictions for any of the following crimes shall make an individual ineligible for employment:

1
2

3.

qoxu-ta

gar?

. Murder, manslaughter, or criminally negligent homicide

. A sex crime

A crime that involves the physical or mental injury or maltreatment of a child, the
elderly, or an individual with disabilities

. A crime committed against a child

. A crime involving the sale or distribution of a controlled substance

. Robbery

. Conviction for a violation or attempted violation of an offense committed outside the

State of Alabama for a sex crime or any other crime if the offense would be a crime in
Alabama Local court records

. Unfavorable report born the State of Alabama report on Child abuse/neglect

Felonies include:

a. Abuse or neglect against a child (also other felony against a child)

b. Any assault or abuse against a domestic partner or former domestic
partner.

c. Any crime that has violence or threat of violence against any person

d. Promoting prostitution in the ?rst or second degree

e. Arson in the ?rst or second degree

f. Serious intentional, reckless or negligent physical injury, danger or death
of any person such as but not limited to murder, homicide, manslaughter,
assault with a weapon, criminal negligence.

g. Stalking or aggravated stalking

h. Any solicitation, attempt or conspiracy to commit any of the above crimes

Other Felonies within the last 5 years:

i. Physical assault against someone other than a child, domestic partner/
former partner in which a weapon or deadly instrument was used.

j. Battery (report item another state where battery is a felony)

k. Drug-related offense, including felony DUI.

is

000681

 

 

 

. All background information obtained shall be utilized to assist in veri ?cation of the employment
application. Retrieval and usage of this inforrnation complies with all Equal Opportunity Conunission

Americans with Disabilities Act and the Fair Credit Reporting Act. Hill Crest is an Equal
Opportunity
Employer, and does not discriminate as to race, color, gender, national or religious origin, age,
disabilities, or any other characteristic protected by law. The request for Date of Birth is for
permissible purpose and not for purposes proscribed by the laws prohibiting age discrimination. The
Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with
respect to individuals who are least 40 years of age. It is unlawful for an employer to refuse to hire,
discharge, or otherwise discriminate with respect to compensation, terms, conditions, or privileges of
employment because of an individual?s age.

The answers to the questions on the application and related paperwork and any attachments to it
should be true and con-act. Any misstatements of fact(s) or omissions andfor any allegation of child
abuseineglect from the Alabama State Cerrtral Agency may Form the foundation for rejection of an
application or for a dismissal after employment.

The authorization shall remain on ?le and shall serve as ongoing authorization for Hill Crest to
procure background investigations and reports from any of the mentioned agencies at any time during
the employment period.

If thge is an allegation, verbal or written, against a staff member, the Human Resource Director
. andr'or the Risk Manager will conduct a hall investigation. The investigation will include an interview
with the accused staff, the patient, and other who may have information pertaining to
the allegation. The accused staff will be placed on administrative leave while the investigation is on-
going. The accused sta?? will not be allowed to return to work until a favorable decision has been
made. The Risk Manager will contact the various agencies and Corporate UHS Risk Management as

required by policies and procedures.

Whoever receives the reported allegation shall ensure that the Risk Manager is noti?ed immediately.
The Hill Crest Social Services Staff will immediately notify the child?s DHR Social Worker or on?
call DHR personnel. The Hill Crest Social Services will make contact with the client?s
familyfguardian if applicable. The appropriate documentation will be made in the client?s medical
record, and documentation reperting requirements will be followed per licensing standards.

It is the policy of Hill Crest Behavioral Health Services in accordance with State and Federal Law to
report suspected cases of abuse or neglect involving children to the appropriate protective service
agency. All employees are expected to report any suspected client abuse or neglect to their inuncdiate
Supervisor or the hospital CEO. The policies and procedures 'for ?Identifying and Reporting
Suspected Patient Abuse and Neglect by Employee" and ?Identifying and Reported Suspected Abuse
and Neglect to the Protective Services" are reviewed with each new employee during orientation and
reviewed again annually. Reporting requirements are set for the State Department for Mental Health
and State Department of Human Resources. These reporting requirements shall be followed at all

times.

. 

000682


 

A criminal background check is documented and maintained in each eniployee?s personnel ?le.
Documentation of individual criminal background check and criminal background policy/procedure
is included. (See Attachments .6)

4.2.5.2 VENDOR FINANCIAL STABILITY

To document Hillcrest Behavioral Health Services? ?nancial responsibility and stability, we have
provided an audited ?nancial statement for year 2012 and letters from the auditor(s) that performed
the 2011 and 2010 ?nancial audits (Price Waterhouse Cooper). H.C. Partnership, D.B.A. Hi1] Crest
Behavioral Health Services, is part of Premier Behavioral Health Services, a division of Universal
Health Services. (See Attachments 4.2.5.2)

4.2.5.3 METHOD OF PROVIDING SERVICES
Service Delivery Approach

Hill Crest has its intensive Residential Care Services on two campus locations. Four buildings are
located on the main Hill Crest campus while the other site is located in Bessemer, AL. The main
campus houses the largest number of clients. The Higdon Hill Group Home, located on the Hill Crest
campus, with a separate distinct address, provides Intensive Services for 18 clients (8 males and 10
females). Thirty-two beds are licensed by DHR, and the Department of Mental Health licenses 79

beds.

The Higdon Hill Group Home at Hill Crest Behavioral Health is currently sta??ed with an adequate
number of personnel to accomplish its mission. The Higdon Hill Group Home provides an array of
Intensive Residential Treatm services that assist clients to acquire prompt and permanent transfers
to family, guardian, foster home, or alternative lower level of care. hitensive Residential Services are
currently in place and are presently providing all core services and program requirements directed by
DHR. Hill Crest is certi?ed in Medicare/Medicaid programs and is in compliance with Title VI and
VII Seclusion Restraint requirements of 42 CFR, Part 483, staf?ng/medical requirements, and has an
approved utilization review plan.

The Higdon Hill Group Home is a speci?c unit within the Residential Services provided at Hill Crest.
Overall Residential Services currently has 5 units that serve 79 clients. All services and staff are in
place to serve 104 clients. Hill Crest has a licensed capacity of 79 clients and has adequate space and
staff to provide residential services as de?ned in this RFP. Hill Crest is requesting 18 bags (g male
and 10 female} in conjunction with this RFP, #2014-100-03 Intensive Residential Services for
Children. The male and female clients reside in separate wings of the I-ligdon Hill Group Home.

The targeted population of the Higdon Hill Group Home is adolescent males/females (age 13-18)
who have a Diagnostic Statistical Manual, diagnosed mental illness or have been identi?ed by a
mental health professional as having serious emotional and/or behavioral problems and are in need of
treatment in a highly-structured, therapeutic environment. These identi?ed problems must pose a
severe level of impairment to overall functioning in multiple areas. These clients have been
unwilling or unable to commit to a healthier lifestyle and require intensive support and/or
interventions to facilitate new, more appropriate methods of coping and behaving.

.10

000683

 

 

 

 

 

These clients may be delinquent, chronic runaways, display manipulative behaviors, have dif?culty

. maintaining self-control, display poor self-esteem, and have dif?culty accepting authority. Clients
with signi?cant substance abuse needs, which require intensive treatment, are also eligible. This
population may exhibit signi?cant disruptive behaviors such as persistent or unpredictable aggression
and moderate to severe harm to themselves or others.

 

These clients may have not responded successfully to less intensive interventions and therapy, or they
may have been denied admission or been discharged ?'om various placements because of their
emotional and behavioral problems. There is a need for constant adult supervision and intense
treatment which could include the use of medications. Clients that receive 
medication will be monitored and maintained on the lowest dosage of medication, and Hill Crest will
comply with the Federal Drug protocol in regards to the appropriate use and monitoring
of medications.

Several different therapeutic interventions are utilized at the Higdon Hill Group Homet including but
not limited to behavioral modi?cation, individual therapy, intensive group therapy, family therapy,
development of age appropriate social skills, physical ?tness, substance abuse prevention, pre?
vocational therapy, adventure-based counseling, special education (if required), and Trauma-Focused
Cogiitivc Behavior Therapy (TF-CBT) techniques. The treatment focus of the Higdon Hill Group
Home addresses several different areas: breaking denial, correcting impaired dunking,
understanding/modifying the Assault Cycle, condoned care planning/transition assistance,
development/practice of relapse prevention plans, addressing client?s history of abuse (if applicable),
and establishing a discharge plan and monitoring procedures with the client, caregiver, court, or other
. placement agencies. The treatment process is facilitated by Licensed Practicing Counselors
who have several years of experience working with adolescents.

Overview of TF-CBT:

Ultimate goal is to assist the client to process the trauma in a healthy manner;

i Assist client to create a trauma narrative, which provides an opportunity to discuss the
identi?ed issue(s) multiple times while the therapist assists the client to correct faulty
thoughts about the trauma;

. for both the client and family/guardian;

- Assist client and familyfguardian to cope with a range of emotions related to the
trauma;

Teaching stress management skills to the client;

I Encouraging client to share the trauma verbally, in the form of a written narrative, or
in some other developmentally appropriate way;

- Facilitating dialogue with the client and family/guardian about the trauma;
Modifying client?s inaccurate or unhelpful thoughts about the trauma;

Assisting in the development of skills for optimizing the client's emotional and

behavioral adjustment.
8 Components 
l) education;
. . Therapist starts with basics: Speci?c to client; a

000684



 

 

0 Discussion of common effects of problematic thought processes and reasons
the client may not want to talk abOut the identified issue(s);

I Assessment of the client?s knowledge of healthy behaviors;

0 Educate client on appropriate behaviors;

2) Stress Management:
a Controlled breathing techniques, progressive muscle relaxation, and/or
negative thought stopping.

3) Effective Expression:
I Establishing the foundation for future sessions in which the client will be asked
to describe/discuss the feelings related to the trauma;
- Assist the client to learn to label and identify different emotions and their level
of intensity;
0 Explain the difference between and relationship of thoughts and feelings;
0 Exploration of appropriate expression of emotions;

4) Cognitive Coping:
- Educate client on thoughts, feelings, and behaviors affecting one another;
It Educate client on how to identify and restructure inaccurate or unhealthy
thoughts;

5) Creating Trauma Nairative:
I Assist client to break apart unpleasant associations between thoughts, feelings,
and behaviors;
I Educate client on how to control intrusive thoughts, reduce avoidance
behaviors, and prepare for reminders of trauma;
Have client tell the story of the trauma, write it down;
Identify the worst moment, memory, and/or part of the trauma;
Assist client to add thoughts and feelings to story;
Target faulty thought patterns;
Utilize cognitive processing techniques to assist the client;
Praise client for his/her effort and encourage client to provide a positive,
optimistic conclusion to the narrative;
- Prepare client/family that the client?s may get worse before they get
better;

6) Cognitive Processing:
0 Therapist challenges client?s unhelpful and inaccurate thoughts about the

trauma;
- Focused examination of the client's thoughts, not simply telling the client that

their thoughts are wrong;
- Utilization of role play or some other form of expression that facilitates a
dialogue between the client and therapist;

3.3

000685

 

 

 

 

7) Behavioral Management:
I Educate parent/guardian on managing negative behaviors; disruptive,
aggressive, and disrespectful behaviors are common reactions to trauma;
in Emphasize that the trauma is causing the most degree of stress;
Teach parent/guardian to utilize praise in a consistent and appropriate manner;
- Educate on how to ignore behavior that is undesirable but not unsafe;

8) Parent-Client Sessions:
0 Goal is for the client and parent/guardian to communicate openly;

The Higdon Hill Group Home is located on the Hill Crest campus in an independent building. The
?home" is separated into two distinct wings for the males and females. The Higdon Hill Group
Home Program may be completed in 5-6 months, but the average length of stay is 8 months. The
therapists assigned for individual counseling are credentialed at the LPC or LCSW level. The key
theoretical basis for the treatment approach at the Higdon Hill Group Home is the guided workbook
A (initiative Behavioral Therapy workbook f9; thlden by Gary O?Reilly. Trauma
Based Cognitive Behavioral skills are taught through groups/activities and in individual/family .
counseling sessions. The Higdon Hill Group Hornet utilizes a points and phase system, and progress
is closely tied to progress made in the qunitive Behavioral Thempy book and individualized Master
Treatment Plan (MTP).

The goal of the treatment program is to teach each client the segnitive drinking/behavioral actions
and skills that reduce problematic/impulsive thought processes that may result in inappropriate
behaviors. The unit staff assists the client to evaluate different/speci?c situations which facilitate
adverse behaviors. Once these situations have been identi?ed, the staff assists each child to decipher

those attributes that conuibutelperpetuate adverse behaviors:

I ldentifydif?cult situations/triggers

'Start with speci?c situations and then progress towards the abstract;
. Cope with risky situations

?Prevent, interpret, Confront, Avoid, or Escape

Five basic skills taught in the Coarulive Behavioral Therapy workbook:

Self-Expression: Staff members will assist each client to identify speci?c
individualized means of expression utilized in an appropriate manner;

0 Thinking Errors: Staff members will help the client to understand thinking errors and
when automatic thinking goes wrong causing a bad impact on both feelings and
behaviors;

- Communication Skills: The client will learn how to appropriately express droughts,
feelings, and behaviors while gaining a greater understanding how these items are
directly related;

I Cope with situations: The client will learn skills to assist in coping with those high
risk situations that he/she is unable to avoid;

Escape situations: The client will be taught skills to assist him to learn appropriate and
more ef?cient/effective means to escape any high risk situation that is presented.

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For all of our intensive residential services, an initial and ongoing assessment for 
social, educational, and medical history is obtained. Our assessment, initially and
ongoing, uses several standardized assessment tools plus other assessments conducted in accordance
with Joint Commission requirements and professional standards of care for the discipline involved.
These assessments taken together yield a comprehensive picture of the client?s mental, behavioral,
and emotional functioning at school, home (or other living environment), and community.
Assessment information is updated 

Standardized Assessments:

History and Physical Examination
Mental Status Examination

Diagnosis (DSM-V)

Routine medical exam and lab work (and EPSDT)

Other Assessments, conducted per professional standards of care:

Assessment

Nursing Assessment (includes hearing and vision screen, and updates on
immunization)

I Leisure/Recreation Assessment

I Educational Assessment

When required, additional assessments are conducted It intake or later:

- Evaluation

. Evaluation (with assessment of risk)

I Substance Abuse Evaluation more than routine part of the nursing and 
assessments)

The results of these assessments, initially within 10 days and then on a basis, are 
into a Master Treatment Plan (MTP) and the client?s IEP (if he/she is designated for special education
services). The MTP details a discharge plan, the objectives of the client, and interventions
(strategies) planned by the staff that can realistically help achieve that plan Contained
within this MTP is the client?s behavioral management plan. The identi?es both the behavioral
and medical plan for the client. The initial and treatment plans are mailed to the BER
worker. Academic updates are included in the treatment plan updates. These 

reports give a current DSM diagnosis.

Intensive Residential Treatment at Hill Crest is an active tr-eatment program in a therapeutic milieu:

- Structured groups and activities 7 days a week and throughout the day;

a Comprehensive array of treatment modalities such as art, music, social skills,
recreation therapy, sports teams, and substance abuse treatment, EMDR, etc., that far
surpasses minimum requirements;

a Points/phase system that encourages growth, responsibility, and leadership. Rules are
clear and simple;

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0 Both cognitive and behavioral components comprise the therapeutic milieu and phase
system;
Therapeutic milieu is extended to outings, visits, and passes;

- Treatment focuses on identifying and enhancing client and is individualized
according to client needs;

I All aspects of the client?s day are coordinated with the ISP and Master Treatment
Plan. Master Treatment Plans are adjusted as required;

- Teamwork is enhanced through designation of staff ?team leaders" and competitioo
between the resident teams for special prizes;

Full academic day that meets all State of Alabama educational requirements.

Clinical therapy is under the supervision of the therapists in consultation with the Unit Chief
(physician). The Social Services Director assign an individual therapist/case manager to each client
based on matching the needs of the client and expenise/experi once of the staff. Each therapist is
licensed at the Master?s degree level (as a minimum) and brings to work a passion to help clients and
families make positive changes. ln-his/her therapist, each client ?nds a strong advocate, mentor, and
counselor. The therapist has the chore of ensuring that treatment is individualized and is also the
primary contact for family and agencies involved. To meet the needs of this population, we have
staff with specialized credentials in abuse recovery, substance abuse, EMDR, sexual issues, marriage
and family counseling, and medical issues. In addition, the direct care staff, Youth Care Workers

(Y CW3), receive supplemental training speci?c to this population of clients, recognizing
behavioral triggers, thinking errors, victim empathy, trauma based cognitive therapy techniques, and
observational issues relating to this speci?c population, etc.

The treannent team meets to formally update the treatment plan, assessment information,
and discharge plan. The meeting includes but is not limited to the client, MD, client?s individual
therapist, a nurse, a mental health technician, and other auxiliary staff. The teacher forwards a report
on academic progress and school behavior and will attend if needed regarding a speci?c school issue.
The family, DHR worker, and other involved agency staff (such as 1P0, FIND therapist, etc.) are

invited and strongly encouraged to participate.
Family therapy has three distinct aspects:

0 Family counseling conducted by the client?s therapist; two times a month or mere.
depending on the family?s availability. if the family cannot travel to Hill Crest, we
make frequent use of ?speakerphone? conferences with the client in the therapist
of?ce;

. Family Impact, Saturday, every other week. This is a multi-family support and
education group. The client, siblings, and extended family may attend. The education
portion uses videos, role plays, worksheets, and guided discussions from Parenting for
Prevention and other resets-cos. The support portion usually involves our therapist and
veteran (even aftercare) family members helping newcomers ?nd strength and hope.

Family Impact is facilitated by a Licensed Marriage/Family Therapist

Our Family impact (family support and education) Program meets every other Saturdayfollows a very detailed curriculum (from Hazelden) of eight lessons; it usually takes, however,

about 3 months for us to work through the material. Sometimes family members request more time
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000688

 

or emphasis on a certain tepic, and we comply. The curriculum uses video, role play, sessiOns,
and guided discussions to teach the material. We frequently supplement it with child deveIOpme-nt
and other parenting information. The client attends Impact with the family (siblings included). It has
been our experience that Family Impact, combined with the Parenting for Prevention approach,
encourages positive change. The approach seeks to develop and build on slcill, as opposed to
revisiting old failures. It teaches a behavior management system that works and is effectiVe. Parents
must utilize this system when the client is on a home pass with family. For adults who have been
uninvolved, overwhelmed, or ineffective as parents, the format provides them a simple way to start
parenting. The client?s rules, expectations, and consequences are the same while here or on a home
pass. The parent acts in the staff role. Their written feedback (a sort of scorecard) at the conclusion
of the home pass gives them a voice in determining the client?s level (in our point and phase system)
and the conditions for the next pass. This process strengthens the relationship between Hill Crest and
the client?s parent guardian which in turn increases the opportunity for success once a client
discharges.

The employees that play important roles in the client?s care are Physicians (both and
medical), Social Workers/Therapists, Management, Nurses, Nurse Practitioners,
Recreation leaders, School staff, Mental Health Technicians, and Patient/Family Educators. Staff is
on duty 24 hours a day, 7 days a week, and is awake and available for the clients. Staff is rotated by
shifts. Medication management by an on-site Board Certi?ed Childedolescent is
conducted. Nurse(s) are on duty 7 days a week, 24 hours a day. In the (rare) event of a
seclusion/restraint. a licensed professional makes a face- to-faee evaluation within one hour of the
seclusion/restraint. A physician orders seclusion or restraint when necessary (client is harmful to self
and/or others). An on-call is available during evenings and weekends. The 
leads the treatment team and sees the client 1 to 2 times a month or more often if required.

The nurses also play a vital role, focusing on health and medication teaching, completing
physician orders for care, and assessing resident status and needs shift by shift. The nurses provide
our clinical services continuity and leadership. The Mental Health Technicians ensure the
consistency and integrity of our points and phase system which is the primary behavior management
tool. Allowances, outings, special events, and various individualized prizes motivate the client to
comply with program rules both at Hill Crest and while on passes.

Additional roles of the Mental Health Technicians, who are directly with the clients more than any
other staff, include mentoring, modeling assertiveness and leadership, and teaching daily living skills.
These staff members are primarily assigned as team leaders to a ?team? of clients on the unit and
often deve10p a very strong relationship with than.

Within the facility, life skills are addressed through a wide variety of groups and activities. The
clients normally attend two groups and two activities a day. All the clients participate in each of the

following groups Once or twice weekly:

Adventure Based Counseling
Creative Expression (arts and crafts)
Recreation Therapy 

Music Therapy
Pastoral Care (optional)- Non Denominational

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000689

 

 

 

Life skills group: These groups are supervised and facilitated by the staff which rotates different
topics from the approved list. Each client learns various important skills required for successful
socialization and independent living.

0 Meal Preparation (healthy food selection, how to prepare meals, and how to prepare
the table);

I Personal Hygiene (feminine hygiene issues, grooming, good dental care, available

personal products);

Housekeeping covers clothing, room cleaning, and clean-up after meals;

Time Management (good planning, organizing, and budgeting of time);

Laundry/Sewing/clothing maintenance;

(participating in shopping, how to comparison shop, and following a

get);

Money Management (saving, budgeting, checking, and savings accounts);

0 Use of public transportation;
Medication management (identi?cation, the use, bene?ts/risks, and side effects of



medication);

- Stress Management and Healthy Lifestyle (positive ways to help improve your life and
reduce stress);

0 Behavior Education addresses ways to handle negative behaviors and the ongoing
adaptation to life.

The clients also participate daily in team CTMs (Come Together Meeting), to discuss con?icts and
set goals, and in News Group (current events). These groups are primarily led by the clients with
MHTs serving as facilitators. As they progress through the program, there is the opportunity for
competitive sports (community leagues) and leadership/community service. Outings in the

community (movies, ball games, concerts, special events) once or tvnce weekly are used to recognize
and reward progress. Clients are also exposed to a variety of co-od activities.

An extra and extremely effective intervention (service) we offer at Hill Crest is the ?staff visiting
resource.? When residents lack involvement from family, we frequently designate a staff member to
serve in this role. Staff members who assume this role are same gender as the client and must make a
commitment to visit with the client weekly. It is necessary that the staff he a Hill Crest employee in
good standing, and both the Assistant Group Home Director and staff' immediate Supervisor must
approve. Usually staff is recruited for this task based on interests that meet the need of the client.

Staff is compensated, exactly as for any other job duty.

A staff visiting resource provides a lonely client a friend and mentor. The client must demonstrate a
positive effort in the program to receive outings with the resource, and Hill Crest provides funds to
the staff for that purpose. if the client is not progressing, the staff resource will visit with the client
on the campus. The Visiting Resources are not permitted to take clients to their homes. The speci?c
details of the outing are approved ahead of time by the Director of Social Services. The resource
serves to motivate and encourage the client.

Hill Crest will also use staff visiting resources to address speci?c treatment issues. For example, a 15
year old male expressed a tremendous desire to utilize his artistic skills as an appropriate means to
express his anger. The client feared that if he did not learn how to channel his anger at his family

no

000690

 

 

members into something positive, he would be placed in a more restrictive environment after
discharging horn Hill Crest, incarcerated. The inability to re-focus his anger prevented his
discharge although he had largely completed all his core treatment objectives. Over a two month
period, a skilled staff (artist) visited him weekly, and together they initiated an illustration program.
While drawing, the client discussed several of his issues that led to his admission to Hill Crest.
Progress by the client was fast and sustained. He discharged 

In other situations, we select the visiting resource based on a skill or interest that the client wants to
develop, such as cooking, music, or a speci?c sport. Becoming more knowledgeable and pro?cient
in that speci?c area forti?es the client to better manage the stressors of regular school and a
community level placement. In all situations, the staff visiting resource coordinates efforts closely
with the client?s therapist and the Program Manager.

Points and Phase System

Hill Crest operates a phase system. The client may progress or regress only one phase per week.
Advancement is based on caming hourly points and completing assigned projects. From 7 am to 11
pm, the clients may earn ?ve points per hour by being ?on task" (doing what is expected) that hour.
They earn up to twenty points (10 for morning, 10 for evening) for completing personal hygiene and
room cleanliness. On outings and passes, the clients remain on this point system. Clients are
requested to complete daily journals in order to facilitate discussion about appropriate expression of
feelings, to safety communicate any issues related to their individual therapy treatment, and to safely

address the trauma that facilitated their admission.
The hourly and hygiene/housekeeping points combine to total a potential score of 100.
Each phase advancement means increased freedom and privileges:

Orientation to Phase 1: - Complete 72 hours without a Major rule violation
- Read Handbook
- Complete autobiogaphy

Phase 1 to 2: - Complete Phase 1 objectives
- Make 80% of points (4) weeks
(Promotion to Phase 2 is relatively easy)

Phase 2 to 3: . Complete Phase 2 objectives
- Make 90% of points for (8) weeks
- Maintain average overall in school

Phase 3 to 4: - Complete Phase 3 objectives
- Make 95% of points for (4) consecutive weeks
. 95% is required to keep or regain 4
Maintain average overall in school

New Phases are assigned weekly.
Graduation: Objectives (Treatment Plan) completed and Phase 3 held for 8 weeks, or Phase 4

attained and held for 4 weeks.
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000691

 

 

Each client assists in the development of an individualized Master Treatment Plan.
. Precautions and Awareness_Status

Precautions and awareness are MD orders which limit a client?s movement. They are for the
following situations:

Assault

Elopement

Suicide gestures

Self-Mutilation (cutting, piercing, banning self)
Sexual Acting Out

Safety

Seizure



When on precautions, the client is limited to the unit, school, and family therapy areas. Meals are
eaten on the unit. On Awareness, the client is limited to activities within the locked perimeter of the
building. We have secure outdoor areas for the child to get outside even while on precautions.
Seizure precautions are handled on a case-by-case basis with speci?c Physician orders.

The MD must order the discontinuance of precautions and awareness. The treatment team and MD
review Precautions and Awareness status weekly or more frequently as needed.

The purpose of precautions and awareness is to focus the client and staff on any issue that threatens
safety. Staff members are assigned special duties, approved by the Program Manager, to complete
for those on precautions and awareness, i levels of observation or documentation requirements.

Activities

Physical Education by Recreation Leaders or other designated staff consists of physical activities,
recreation center, gym, Game Room, Basketball Court, Ball Field, Track, or the ropes course. The
Ropes Course entails various climbing, balancing and group interaction skills on Low and High
Elements. The Ropes Course is monitored by a Certi?ed Therapeutic Recreation Specialist (CTRS).
At Hill Crest, the gymnasium provides an area for basketball, volleyball, kickball, weight workouts,
walking, general exercises, aerobics, and dancing for the clients. Hill Crest also provides access to a
new ball ?eld and walking track on the Hill Crest campus.

Fun} Socialization

A variety of events or outings are planned for the clients at the Higdon Hill Group Home. A few of
these events/outings include Birthday celebrations and Holiday partiesfeelcbrations such as a
Valentine?s Dance, 4lh of July picnic, Halloween decorating, dressing up and going through the
facility trick-or-treating, Veteran?s Day presentation and show by the clients, and Christians
decorations and gifts. Outings away from the facility may include museums, dining out, amusement
parks, parks and recreation for hiking, walking, playing so?ball or football, attending sporting events,
concerts, or plays, etc. Another very important celebration is a client?s graduation from the program

and/or school.

. cher Services
Jot

000692

 

 

 

Individual art, music, or sports lessons
Academic tutoring

Library and computer room

Team competitions and prizes

?Travel teams? for sports

Medical Needs/Emergencv Maggi Needs

The majority of the medical needs of our clients are met within our facility by Physicians, Nurse
Practitioners, and Nurses. We have speci?c plans and responses to medical issues and emergencies.
In addition to the staff nurses and nurse practitioner, we have ongoing relationships established with
licensed practicing physicians for medical (physical) and emergencies and critical
incident response. Each client is admitted by an attending physician. Hill Crest provides for
physician coverage at all times. A on-call schedule is provided to assure physician coverage
for residents on week nights, weekends and holidays. An cit-call schedule is sent out by the
Department by the 25?? ofthe previous month. Nurses are available on-site for
emergencies 24 hours, 7 days a week. A nurse practitioner and two medical doctors are employed by
Hill Crest Behavioral Health Services to manage routine medical (physical) health problems.

Contractual agreements are established with St. Vincent?s East and Children's Hospital to provide
any necessary emergency care, inpatient care, or outpatient clinical services. Portable radiology and
EEG services are provided through a contractual agreement with Mobile-X. A pharmacy is on-sitc,
and contracts with outside pharmacy vendors are also in place. Dental and optical services are
provided through outside vendors per agreement. EPSDT screenings are provided by a contracted
service for our clients. We have an on-site contractual dietician to assess the nutritional needs of our
children. Any client for whom the physician determines a need for medical consultation will be
referred to an appropriate practitioner. All residential staff are trained in ?rst aid, CPR, and non-
violent crisis intervention in the new employee orientation and annual in-service. We also have a
streng Infection Prevention Program. All of these keep clients healthy.

Hill Crest Behavioral Health Services has developed a Rapid Response Team (RRT) to address any
medical conditions that our clients may exhibit. When the RT has been activated, speci?c RNs
which have receive specialized response training, will respond to the designated area, provide
immediate ?rst aid (if applicable) and assess if the medical condition is an emergency that would

reqmre more specialized treatment.

It is the policy of Hill Crest Behavioral Health Services that all employees utilize a uniform code
system for emergencies. Whenever a code is announced, staff members respond appropriately due to
extensive training in proper management of the situation whether it is behavioral problems, medical
problems, elopement, weather issues, etc. Various codes utilized:

Code Red - To be utilized in the event of a ?re situation or ?re drill;

Code Blue - Medical emergency; ?rst aid box needed, in area;

Code Black - Bomb threat has been received;

Code Purple - Staff assistance is needed; behavioral management assistance;

Code Yellow Natural Disaster;
Code Rapid Response- Any medical problem of a serious nature such as fainting,

30

000693

 

shock, seizure, deep cuts, etc. Location of event would be announced;
0 Code Gray Pending - Threatening weather conditions exist, i.e. tornado watch or
inclement weather is approaching;
Code Gray Active - Tornado warning has been announced;
Code Flight - To be utilized in case of an elopement;
Code Orange- Hazardous Waste Spill;
Code Silver - To be utilized When an individual has a weapon and is threatening to use
it to harm an individual;
a Code Adam- Child abduction

Staff responds to an emergency or critical incident from the Residential 'l?reatment Center when a
code is announced. All Staff has been trained to respond to an emergency call. A minimum number
of staff should be le? in each area to keep those areas safe and secure during this emergency time
period. More than adequate number of staff is available in seconds to respond to an or
critical incident. All clinical staff and school staff are trained in non-violent crisis intervention.

Upon admission, the parentiguardian is responsible for signing for medical care to be rendered. In
the event an ernergency occurs, the nurse or social worker will attempt to contact the parent/guardian.
The emergency will be assessed by the nurse practitioner, or medical doctors. Any
client whom a physician determines is in need of emergency medical treannent outside the facility
will be transported to an appropriate medical facility. A client with an acute medical cinergency will
be given basic emergency resuscitation if deemed necessary and basic treatrnent; helshe will then be
transported for advanced medical care.

Hill Crest Behavioral Health Services staff are trained and certi?ed providers of basic cardiac life
support. A Code Blue will be called. and all available nursing personnel will respond while
maintaining suf?cient staff on units for safe care. Emergency bags with oxygen and a de?brillator
will be available. A nurse will take?responsibility to run the emergency situation; he/she will make

an assessment and have paramedics called if appropriate.

Upon arrival of the paramedics. the Residential staff will turn over the medical treatment to the
advanced trained personnel. If the paramedics are not needed, the nurse or designee will call for the
ambulance or, when appropriate, the patient may be transported by hospital van by staff for further
medical care. The Fire Department Paramedics (91 I) will be utilized as deemed necessary by the
Program Director/Nurse Supervisor/or client?s physician. Otherwise, client's physician will be
noti?ed. The nurse will advise the emergency room nurse of the type of emergency, client?s name,
nature of hospitalization, brief history, and emergency treatment given. Nursing personnel will
accompany client to the hospital, and the nurse or attending physician will notify the familyfguardian.
The nurse will document the incident and notify the Director of Nursing. The nurse manager will
critique the code for appropriateness and any areas needed for improvement.

Hill Crest has made provisions and established procedures for routine medical services, emergency
medical andtor hospitalization of the clients. it is policy to provide staff with knowledge of the
availability of emergency equipment and medications in order to respond quickly to any emergency
situation. Emergency equipment and medications are located in various designated areas. A daily
emergency equipment check is conducted by a nurse. Restoclcing the emergency can supply is the

responsibility of the Hill Crest Ntuse Managers or facility nurse supervisor who may be there at the
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000694

 

time. Pharmacy will check and restock on a routine basis and after emergency use. A pharmacy is
located within the facility.

Hill Crest Behavioral Health Services conducts Mock Code Blues (medical emergency) once a
quarter/per shi?. The Sta?? Development Director and Director of Nursing (DON) are responsible for
monitoring the procedure. The fol-lowing areas are assessed:

Staff response time;

Appropriateness of equipment brought to scene of code;
MD response;

Number of quali?ed staff responding;

Functioning of equipment;

Organization/Structure of the Code Blue

Identi?ed problems, recommendations, and actions taken will be noted on the Code Blue Critique
Form. It is the responsibility of the DON to assure all identi?ed problems have an appropriate
corrective action. Mock Code Blues will be reviewed by the Safety Committee. All emergencies or
critical incidents are reviewed and investigated. The Risk Manager has this responsibility in
conjunction with the DON and assures any identi?ed problems are met with appropriate action.
These reports go to the Safety Committee, Performance Improvement Committee, Medical Sta??, and

the Board of Directors.

Other services provided include but are not limited to Pro-Vocational Therapy, Independent Living
Skills, transportation, weekly allowances, and a private school, Higdon Hill School, which is
registered with the State Departxnent of Education. Pro-Vocational Therapy and Independent Living
Skills are currently addressed in both youps and 1:1 environments. Direct care staff assists the
clients on personal hygiene, room care, and laundry; giving instructions as required.

The opportunity for independent living is one of the goals for many of our clients. The Treatment
and ISP teams have the responsibility to assure the client, as soon as capable, is assisted with
independent living. Vocational training, GED, assistance in applying for a job, providing
employment opportunities, transportation, money management, and relationship building/dating skills
are some of the areas involved in independent living component. The treatment plan and ISP will
reflect the goals/objectives for independent living.

The program provides transportation as Speci?ed in the ISP and as needed to meet the needs of the
client in treatment. Hill Crest Behavioral Health Services has vans on campus and has numerous
licensed drivers. Staff must go through training and a test to become a driver. We sometimes
provide ?mding for transportation for family members to ensure involvement in treatment. In
addition, Hill Crest has the capability to transport for local medical, dental, and vision care.

Hill Crest pays weekly allowances in the range of $5.00 to $20.00 per week to our clients. Client
funds are not utilized as a form of restitution if a client commits an act of vandalism. Facility funds
are utilized for many of our outings (movies, plays, ball games, restaurants, concerts, etc). Greater
than $50.00 per month is provided for special needs and occasions such as haircuts, hygiene products,

Christmas gifts, etc.



000695

 

 

 

Hill Crest has its own private school, Higdon Hill School, which the clients attend. The school is on-

. site and provides for a full school day during the academic year and also provides summer school.
We have eight certi?ed teachers (special education teachers included), a a teacher?s
assistant and a school secretary. Instruction is in a small setting and is individualized. School
behavior is linked to the program points and phase system. Special education services are provided
by certi?ed special education teachers. Homework assistance is provided to any client who is
identi?ed a needing supplemental academic assistance. IEPs are completed as required for each
client. School staff communicates with the treatment team regularly to provide an update on the IEP
process. Tutoring, which is consistent with the ISP is provided by the teaching staffer a designated
RTC staff. Tutoring is provided for a minimum of 2 hours per week as consistent with the ISP.
Tutoring is monitored for achievement outcomes by the client?s teacher.

Services are delivered in abundance at Hill Crest Behavioral Health Services. In the Intensive
Residential Services level of care, extensive arrays of services are required for the client and will be
proVided by Hill Crest Behavioral Health Services. All services provided shall be authorized on an
ISP. If a service authorization document is not provided within ten days from date of placement, Hill
Crest will notify the State Department of Human Resources.

Flexibility and creativity are required in working with this population, along with consistency and
structure. These services have been developed to meet our client's needs and in response to their
feedback. In order to continually evaluate the services provided, clients are provided opportunities to
complete program critiques throughout the treatment process.

Hill Crest attests that we will meet or exceed all requirements and core services identi?ed in The
. State Department of Human Resource?s #20] 4-100? 1m siv Resi 'ces Children.

STATE DHR PROGRAM REQUIREMENTS FOR. #2014-100-03 INTENSIVE
RESIDENTIAL SERVICES FOR CHILDREN

Hill Crest Behavioral Health Services attests that we will meet all of the program requirements for
#2014?100-03 Intensive Residential Services for Children. This is a brief overview of how these

requirements are presently being met.
A. Be Licensed by DHR, DMH, JCAHO, COA, and I or CARF

We have JCAHO accreditation, Alabama Department of Mental Health Licensure, and Alabama
Department of Human Resource licensure.

B. Certi?cation of Need
Certi?cate of need is required for DHR placement. It is obtained prior to placement.

C. Screen Referrals for Appropriate Diagnosis

Each referral is screened by the Director of Social Services, in consultation with the Unit Chief
(physician), to ensure that this is in the acceptable diagnosis range (290-316). All clients meeting
criteria will be considered for treatment. If a client is rejected, it will be reported to the referring
county and to SDHR-Division of Resource Management, Of?ce on Contracts on a weekly basis.

. D. Assess Using a Standardized Assessment Tool

 

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Assessment, initially and ongoing, uses several standardized assessment tools plus other assessments
conducted in accordance with Commission requirements and the professional standard of
care for the discipline involved. These assessments, taken together, yield a full picture of the client's
mental, behavioral, and emotional functioning at school, home (or other living environment), and
community. Assessment information is updated 

Standardized Assessments:

Physical;

Mental Status Examination;

Diagnosis;



Routine medical exam and lab work (and 

Risk assessment for re?offending completed at admission and discharge;

Other Assessments conducted per professional standards of care:

Assessment;
Nursing Assessment (includes hearing/vision screens and updates on immunizations);

Leisure/Recreation Assessment;
Educational;

Where needed, additional assessments are conducted at intake or later:

- Evaluation;
- Evaluation (with assessment of risk);
Substance Abuse Evaluation more than routine part of the nursing and 

assessrhents).

The results of these assessments, initially and then on a basis, are into a Master
Treatment Plan and the client?s IEP (if he/she is designated for special education services). The
Master Treatment Plan details a discharge plan, the objectives of the client, and interventions
(strategies) planned by the staff that can realistically help achieve the plan The initial and
treatment plans are submitted to the DHR worker for the ISP process. Academic updates
are included in the treatment plan updates. These reports give a current DSM

diagnosis.
E. Process and IEP

Hill Crest ?ully participates in lSPs. Commonly. we ask for and host and IEP meetings and
updates. We request at intake, every 6 months, and when signi?cant changes in case plans are
indicated. We go to great to involve the family/guardian in ISPs and other treatment
activities. We o?en help with meals and transportation to facilitate family involvement. if it helps
the client, we get creative and proactive. We work to ensure that family members feel comfortable
and not intimidated here. Our best allies in this process are the family members who continue to
attend amily Impact? even when their child has discharged.

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We incorporate the into the child's Master Treatment Plan. The initial treatment plan is
developed within 10 days of admission and reviewed at least We document a discharge
plan at intake and update it The treatment plan includes goals that are quantitative and
address the reduction, duration, frequency, and intensity of and what interventions are
utilized to meet each goal. As discharge approaches. we incorporate other providers, who will be part
of the client?s and family?s support network, into the discharge planning process. We insist on pre-
placement visits, school meetings, and whatever else is required to make a successful transition to a
lower, less intensive level of care.

IBPs are updated yearly and may be changed at any time due to minimum academic progress,
tremendous progress, or to meet appropriate academic benchmarks. Family and DHR are invited to
these meetings. It is then the responsibility of the client's therapist to document into the treatment
plan pertinent school planning information, and this information is relayed to the DHR worker for
inclusion in the All services provided shall be authorized on an 15?. Also, the will address
any planning issues, especially discharge plan concerns, such as school placement, as appropriate.

F. Create a Behavioral Management Plan with Input and Collaboration with Family's ISP
Team

As indicated above, details of the are incorporated into the Master Treatment Plan (a key aspect
of which is a behavioral management plan). Most often, the regular points and phase system of the
program yields an appropriate plan for behavior management. When it does not, we develop and
implement specialized approaches. The Master Treatment Plan update demonstrates the
effectiveness of the behavioral management plan and any changes we have made. The plan is
initiated at intake, completed ?illy within 10 days, and than updatedladjusted at least in a
united (and effective) way we involve the family in the behavior management plan. Through family
therapy sessions, Family Impact Saturdays, and informal interactions with staff, the family is trained
to use, during passes away from the hospital, the approaches that are working for the client at Hill
Crest. We tell the family we are serving in their role when the client is here, and they are in our role
when the client is with them. The family, as a result, has input in determining the client?s status in
our points/phase system and is part of the behavioral management plan.

G. Informed Consent

At times, when treating a client, the use of medications is required. Prior to the
distribution of medications, Hill Crest will obtain informed consent from the DHR
worker, parent, or guardian and educate the client on the proposed utilization of medication. The
risks and bene?ts of the proposed treatments as well as the risks and bene?ts of alternative
treatments, including no treatment will be fully explained. This will include information about the
potential bene?ts of the medication, the possible risks, and the range of doses. Information about
serious adverse effects and how to'contact the physician will be discussed. Staff, parents, guardian,
and/or DHR representatives will be given ample time to ask questions and discuss the treatment

process before consent is requested.
H. Ensure that staff (rotating and awake) will be available '7 days a weekl24 hours a day

Intensive Residential treatment care at Hill Crest is conducted by rotating, awake staff, 7 days a week
and 24 hours a day. Direct care mental health technicians, nurses, medical, and therapy staff are

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present on weekdays, weekends, and holidays. We have a large number of staff. We maintain
approximately 200 residential employees. Many other staff work in other behavioral health units in
the facility, and they are trained to work in the intensive residential program as required. We hire
full?time, part-time, and PRN staff.

I. Offer Staff the training recommended in the Minimum Standagd for gang Carg
Miles

The program already offers extensive training for new hires, training throughout the year, and annual
in-service training. We meet and exceed all the training requirements of the 'mum dard 
Residential Child Care Facilities. We also offer trainings not included in the Minjmw ?tandards for
g?idential Care Fm'litigs by offering an 8-hour course in Non-Violent Crisis intervention for new
employees and a refresher course annually. We train in ergonomics (body mechanics: safe lifting)
techniques. Problem-solving and teamwork are also included. Medication teaching, including side
effects of medication, is offered. Hearing and vision screening, vital sigis, urine collection, ?rst-aid,
and client care hygiene are key aspects of training for the mental health technicians. Staff are trained
in patient rights and in identifying and reporting neglect/abuse. Life skills. restricted items, and
search procedures are also required trainings. The nurses are trained in all the same areas as mental
health technicians; RNs also receive more extensive training in such areas as assessment, medication
management, reporting progress, emergency procedures, pharmacy procedures, consults, EKG,
venipuncture, pattern blood sugar, growth chart, and pain management, to mention a few. New hire
clinical staff and mental health technicians receive classroom training, online training, and training on
the residential program prior to completion of the orientation period. The nurses receive 48 hours of
classroom orientation and at least 40 hours of training on the units. Throughout the year, several
hours of in-service training are conducted. At the end of the year of an employee?s employment, an
annual in-service is conducted. All staff training is documented in the personnel ?les. Training in
Medications and diagnoses will be documented in personnel ?les. All minimum
standards for training for Residential Child Care Facilities will be met or exceeded.

J. Provide Reports

reports, in the form of the comprehensive Master Treatment Plan updates, are mailed to the
county DHR worker. This report includes progress update, current diagnosis, school report,
medication update, and information on family inVolvement. It also details current medical concerns,
any special situations occurring during the month (such as restraints), and any changes in the
discharge plans. Our policy is to mail these out on the ?fth working day of the month. They arrive
before the 15th of each month. They demonstrate month-to-month progress on goals and changes in

assessment information.

K. Length of Stay Form

Hill Crest will complete and submit a Length of Stay over Form each month to the SDHR-
Division of Resources Management, Of?ce of Resource DeveIOpment and Utilization.

L. Ensure that Children are receiving Education Services

Our specialized school setting, Higdon Hill, is located on campus. The teachers and clinical staff
coordinate their efforts closely. Educational services are provided as needed by each child. are
coordinated and implemented as appropriate. School staff work closely with clinical staff to ensure

3L9

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. client progress. Homework assistance is provided by both the school and clinical staff. The State
Department of Education monitors our school and conducts regular surveys to ensure compliance. In
:nyg?clase where a client can attend an off-campus school, program requirements by State DHR shall
lowed.

M. Ensure the Child Receives Routine and Emergency Medical Care

Routine and emergency medical care is provided. There are always 1-2 nurses on duty with the
client. The family Nurse Practitioner or Family Practice MD are here daily and are on call alter
hours. We access specialized medical care as needed. The pharmacy is managed per hospital
standards by registered pharmacists experienced in this environment. Outside conununity vendors
are also available to provide medication services as required. In addition, services such as X-ray, lab
work, physical therapy, and speech therapy are available as required through contracted providers
who come to Hill Crest. We participate in the EPSDT program. We have developed close working
relationships with two dental clinics that see Medicaid consumers. As a result, the dental care that is
almost always long overdue for children in care is obtained. We have deveIOped a working
relationship with two providers for vision care and dental care.

N. Outcome Data must he Submitted in a Format Prescribed by SDI-IR
Outcome data is submitted in the format prescribed by the State DHR.

0. Discharge Surveys

We already obtain a ?Satisfaction Survey? at discharge. Program changes are implemented based on

. information received. Examples of program changes based on the surveys include increasing the
number of co-ed functions, adding extra substance abuse groups (with more social skills
training, and a more vigorous school day. We have created a process where the Health Information
Department assists with sending out the 6~week post-discharge survey. The surveys are placed in the
client?s medical record by the Health information Department. A quarterly summary of survey
results is submitted to SDHR-Division of Resource Management, Of?ce of Resource Development
and Utilization and will include any program changes instituted as a result of the survey.

This process will be expanded to 6 months, 12 months, 18 months, and 24 months. This survey will
be enhanced to evaluate the stability in residence and educational environments. The surveys will be
placed in the client?s medical record by the Health Information Department.

STATE DHR CORE SERVICES FOR INTENSIVE RESIDENTIAL PROGRAMS

Hill Crest Behavioral Health Services attests that we will provide all of the core services listed by.
DHR for Intensive Residential Services for Children. This is a brief overview of how we meet this

presently:
A. Provide ongoing Medical, Social, and Educational Assessments

Initial and on-going assessment as to medical, social, and
educational functioning is obtained and documented. This is discussed in treatment team
meetings. In addition, when required to clarify diagnosis or special problems, 

. eval nation is ordered. We have a full-time in-house 

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B. Provide a Diagnosis

These assessments: Physician evaluation, history Physical, mental status
exams, nursing, educational. and leisure recreational assessments yield a diagnosis
per DSM criteria. The assessments and diagnosis are updated (or more frequently if
required) and reported on the treatment plan update.

C. Provide Transportation to Appointments in ISP

The program provides local transportation as speci?ed in the ISP and as needed to meet the needs of
the clients in treatment. We have vans onsite and have numerous licensed drivers. We sometimes
provide transportation to family members to ensure involvement in treatment. We transport for local
medical, dental, and vision care.

D. Provide Treatment Planning with a Treatment Team

The treatment team meets to update the treatment plan, assessment information, and
discharge plan. The meeting includes the child, physician, the child?s individual therapist, a nurse,
and a mental health Worker. The teacher forwards a report on academic progress and school behavior
or attends the treatment team as necessary to discuss a speci?c school issue if identi?ed. The family,
DHR worker, and other involved agency staff (such as JPO, FIND therapist, etc.) are invited. In
addition, Hill Crest Behavioral Health Services also completes a bi-weekly treatment plan summary
as an abbreviated Master Treatment Plan update.

E. Provide an Active Treatment Program in a Therapeutic Milieu

intensive Residential Treatment at Hill Crest is an active treatment program in a therapeutic milieu:

. Structured groups and activities 7 days a week, and throughout the day;
Comprehensive array of treatment modalities (such as art, music, substance abuse
treatment, EMDR, etc.) that far surpass minimum requirements;

I Points/phase system that encourages growth, responsibility, and leadership. Rules are
clear and simple;

0 Both cognitive and behavioral components make-up the therapeutic milieu and level
system;

a Therapeutic milieu is extended to outings, visits, and passes;

a Treatment focuses on identifying and enhancing resident and is
individualized according the client?s needs;

a All aspects of the child?s day are coordinated with the and Master Treatment Plan
and are adjusted as needed;

- Teamwork is enhanced through designation of staff "team leaders" and competitions
between the resident teams for special prizes.

F. Provide Services/Medication Management

Medication management by an on-site Board Certi?ed Child/Adolescent is conducted.
Nurses are on duty 7 days a week, 24 hours a day. Hill Crest complies with the 01-111 
Medicatiom?tvlouitoring Policy. In the (rare) event of a seclusionfrestraint, a designated licensed

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professional makes a face-to-face evaluation of the client within 1 hour of the seclusion/restraint.
The order shall be received from a physician. An order is made only if the client is at risk to harm
self or others. An ?on call? is available during evenings and weekends. The 
leads the treatment team and sees the client I to 2 times a month, more often if needed.

G. Provide Clinical Therapy Services, including Family Therapy and any Behavioral
Programming

Clinical therapy is under the supervision of the Program Manager in consultation with the Unit Chief
(physician). The Program Manager assigns an individual therapist/case manager to each client based
on matching the needs of the client and the expertise/experimce of the staff. Each therapist is
licensed at the Master?s degree level and brings to work a passion to help clients and families make
positive changes. Individual therapy is conducted once a week at a minimum. In their therapist, each
client ?nds a strong advocate, mentor, and counselor. The therapist has the chore ofcnsuring that
treatment is individualized and is also the primary contact for family and agencies involved. To meet
the needs of this population, we have therapists with specialized credentials in working with youth
who engage in sexually inappropriate behaviors.

The treatment team meets formally update the treatment plan, assessment information,
and discharge plan. The meeting includes but is not limited to the client, the MD, the client?s
individual therapist, a nurse, a mental health worker, and other auxiliary sta?'. The teacher forwards
a report on academic progress and school behavior and will attend, if needed, regarding a speci?c
school issue. The family, DHR worker, and other involved agency staff (such as P0, FIND

. therapist, etc.) are invited and strongly encouraged to participate.

Our Family Impact (family support and education) Program meets every other Saturdayfollows a very detailed curriculum (?om Hazelden) of eight lessens. It usually takes,
however, about 3 months for us to work through the material. Sometimes family members request
more time or emphasis on a certain topic, and we comply. The curriculum uses video, role play,
sessions, and guided discussions to teach the material. We ?'cquently supplement it with client
development and other parenting information. The client attends Impact with the family (siblings
included). It has been our experience that Family Impact, combined with the Parenting for Prevention
approach, encourages positive change. The approach seeks to develop and build on skills as opposed
to revisiting old failures. It teaches a behavior management system that is proven to be effective.
Parents must utilize this system when the client is on a home pass with family. For adults who have
been uninvolved, overwhelmed, or ine??ective as parents, the format provides them a simple way to
start parenting. The client?s rules, expectations, and consequences are the same while here or on a
home pass. The parent acts in the staff role. Their written feedback (a sort of scorecard) at the
conclusion of the home pass gives them a voice in determining the client?s level in our point and
phase system and the conditions for the next pass. This process strengthens the relationship between
Hill Crest and the client's parent 1' guardian which in turn increases the opportunity for success once a

client discharges.
Family Therapy has Three Distinct Aspects:

Family counseling conducted by the child?s therapist two times a month, or more if

. needed, depending on the family?s availability. If the family cannot come to Hill
Crest, we make frequent use of ?speakerphone" conferences, with the child in the

3?t

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therapist?s of?ce;

. Family Imp act, every other Saturday. This is a multi-family support and education
group. The resident, siblings, and extended family may attend. The education portion
uses videos, role plays, worksheets, and guided discussions from Parenting for
Prevgtion. The support portion usually involves our therapists and veteran (even
after care) family members helping newcomers ?nd and hope;

- Family Impact is facilitated by a Licensed Marriage and Family Therapist.

There is a wide array of group therapies oriented around the skill set of Egrentm' for Erevenp?gn. We
also utilize non-talk approaches (art, music, etc.) with all clients. Such approaches are also used 1:1
with a client who is not progressing well in group therapy or needs extra attention to develop a talent
or express long pent-up feelings.

The employees that play important roles in the client?s care are Physicians (both and
medical), Social Workers/Therapists, Management, Nurses, Nurse Practitioners,
Recreation leaders, School staff, Mental Health Technicians, and Patient/Family Educators. Staff are
on duty 24 hours a day, 7 days a week, and are awake and available for the clients. Staff are rotated
by shi?s. Medication management by an on-site Board Eligible Child/Adolescent is
conducted. Nurses are on duty 7 days a week, 24 hours a day. In the rare event of a
seclusion/restraint, a licensed professional makes a face? to-face evaluation within one hour of the
seclusion/restraint. A physician orders seclusion or restraint when necessary (client is harmful to self
and/0r others). An ?on call" is available during evenings and weekends. The 
leads the treatment team and sees the client 1 to 2 times a month or more often if required.

The nurses play an important role, focusing on 1:1 health and medication teaching, completing
physician orders for care, and assessing resident status and needs shift by shift. The nurses provide
our clinical services continuity and leadership. The Mental Health Technicians ensure the
consistency and integrity of our points and phase system, the primary behavior management tool.
Allowances, outings, special events, and various individualized prizes motivate the client to comply
with program rules, both at Hill Crest and while on passes.

Additional vital roles of the Mental Health Technicians, who are directly with the clients more than
any other staff, are mentoring, modeling assertiveness and leadership, and teaching daily living skills.
These staff members are primarily assigned as team leaders to a ?team" of clients on the unit and
often deve10p a very strong relationship with them.

Within the facility, life skills are addressed through a wide variety of groups and activities. The
clients normally attend two groups and two activities a day. All the clients participate in each of the
following groups once or twice weekly:

Adventure Based Counseling

Creative Expression (arts and era?s)

Recreation Therapy .
Music Therapy

Pastoral Care (optional)



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Life skills group: These groups are supervised and facilitated by the staff which rotates different
topics from the approved list. Each client learns various important skills required for successful
socialization and independent living.

I Meal Preparation (healthy food selection, how to prepare meals, and how to prepare

the table);

Personal Hygiene;

Housekeeping, room cleaning, and clean-up after meals;

Time Managememt (good planning, organizing, and budgeting of time);

Laundry/ Sewing/ clothing maintenance (laundry skills, small mending jobs, and

selection of clothing);

I Shopping (participating in shopping, how to comparison shop, and following a
budget);

Money Management (saving, budgeting, checking and savings accounts);
Use of public transportation;

9 Medication management (identi?cation, the use, bene?tslrisks, and side effects of
medication);

Stress Management and Healthy Lifestyle (positive ways to help iniprove your life and
reduce stress);

9 Behavior Education addressu ways to handle negative behaviors and the ongoing
adaptation to life.

. In addition, clients are assigned to speci?c topic therapy groups depending on their individual needs.
These meet two to three times a week, and topics include but are not limited to:

Feeling Expression

Abuse Survival/Recovery

Anger Management

Establishing Positive Behavior

Coping Tools

Substance Abuse Recovery

Mood Maintenance 

Con?ict ResolutiOn

Other- as identi?ed by therapist or client

I 9 . I I I

The clients also participate daily in team CTMs (Come Together Meeting) to discuss con?icts and set
goals, and in News Group (current events). As they progress through the program, clients have the
opportunity to participate in competitive sports (community leagues) and leadership/community
service. Outings in the community (movies, ball games, concerts, special events, once or twice
weekly are used to recognize and reWard progress. Clients are also exposed to a variety of co-ed
activities.

An extra and extremely effective intervention (service), we offer at Hill Crest is the ?staff visiting
resource.? When clients lack involvement from family, we frequently designate a staff to serve in
this role. Staff members who assume this role are same gender as the client and must make a
oonunihnent to visit with the client weekly. It is necessary that the staff be a Hill Crest employee in

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good standing, and both the Program Manager and staff's immediate Supervisor must approve.
Usually, staff are recruited for this task due to interests that meet the need of the child. Staff are

compensated just as for any other job duty.

A sta?? visiting resource provides a lonely client a ?iend and mentor. The client must demonstrate a
positive effort in the program to receive outings with the resource, and Hill Crest provides funds to
the staff for that purpose. if the client is not progressing, the staff resource will visit with the client
on the campus. The Visiting Resources are not permitted to take clients to their homes. The speci?c
details of the outing are approved ahead of time by the Program Manager. The resource serves to
motivate and encourage the client.

H. Provide Routine Medical Care

Routine medical care is available on-site. Either a family practice physician or nurse practitioner is
here daily. A pharmacy is on site, and most xn-ray and lab procedures are conducted here.
Specialized care is obtained offsite when required. We have a strong Infection Prevention Program
(hospital standards), and clients participate in the EPSDT Program. Both measures help keep clients
healthy. Dental and vision care is obtained at nearby clinics.

1. Provide Educational Programs

Clients attend Higdon Hill School on site for a full school day during the academic year (August
through June). Instruction is in a small setting and is individualized. School behavior is linked to the
program points and phase system. Special Education services are provided by certi?ed special

. education teachers. A. client may attend a public school if in the best interest of the child. This
would be a treatment teamIISP decision. GED preparation is also available if high school graduation

is no longer in the plan.

J. Provide Vocational and Recreational Therapies

The clients participate in to 2 recreational activities a day. We focus on ?tness, sportsmanship, and
developing new, positive interests such as the examples of art, guitar, hiking, croquet, golf, and
poetry. This is an extremely strong aspect of care here, led by an enthusiastic staff that perseveres in

reaching dif?cult clients.

Vocational Therapy and Independent Living Skills are currently addressed in both groups and 
and as a part of the school curriculum. Twice a day, direct care staff grades the clients on hygiene
and room care, giving instruction and assistance as needed. Doing one's personal laundry is a part of
this. Such daily living training is part of pquaI'ing to step-down in care, as well as addressing
independent living as appropriate to the client?s age.

Vocational Therapy is vital at Hill Crest. Each ?team? of clients participates in I to 2 weekly
groups, which are led by a Master?s level Counselor. These sessions focus on ?Establishin Positive
Behaviors? and have addressed cooking, leadership, etiquette, community 
vocational exploration/interest, personal appearance, and perfoaning arts. We will also continue a
10 year tradition of focusing on vocational exploration via ?eld trips, speakers, and discussions in
the 4 week break between summer'school and fall semester. As in previous years, clients will take
. ?eld trips to such places as factories, University campuses, museums, and military bases. Hill Crest

4?2,

000705

 

 

 

will make every effort to assist the client to loam a valuable trade in conjunction with the Mater
Treatment Plan and ISP.

K. Provide Independent Living Skills

{as the client progresses the opportunity for independent living skills are taught. Some of the areas
involved in the independent living component are assistance in applying for a job, employment
opportunity, transportation, money management, and relationship building/dating skills.

L. Provide a Minimum of 35410-51000 per week allowance

We currently pay weekly allowances in the range of $5.00 to $20.00 per week. Our current practice
is to use facility funds for our many outings (movies, plays, ball games, restaurants, concerts, etc).
Allowances are not used to recoup for damages or restitution.

M. Provide up to $50.00 per Month for Special Needs and Occasions

Hill Crest currently exceeds the $50.00 per month amount for personal and special needs and
occasions. We give the client much discretion to make personal preferences known, and we meet
their needs. We are visited here by a barber once or twice a month. Over-the-counter medications,
when needed, are ordered by the physician, obtained by the pharmacy, and diSpensed as directed by
the nurses. Stringent physician and nursing control of the medication process is vital to the health of
our population. The clients and family are not required to spend their own ?inds for personal care,
special needs, over-the-counter medication, or special occasions.

N. Provide Supportive Services to the Family as Agreed in the 

Parent/Family supportive services are extremely strong at Hill Crest and are a point of pride for the
program. We recognize that both time and money are well spent when family ?mctioning and
relationships are improved. We often feed and transport parents to facilitate family involvement in
treatment. Our Family Impact Program and Behavioral Treatment Model help parents and families
overcome anxieties about care and discipline of their child. The Family Impact Services provide
support, encouragement, and education to the families. Family Impact is held every other Saturday
(4 hours). The average attendance is approximately 35 people.

0. State Reparting

Hill Crest attests that it will provide all required incident reports to the Of?ce of Licensing on a child
in DHR custody. The incidents will be reported to that Of?ce of Licensure within 24 hours after
occurrence or the ?rst work day following the occurrence, whichever if sooner. This includes reports
that are made to DMH from an approved licensed DMH facility. A written explanation will be
provided to the Department within ?ve days.

P. Mandatory Reporting
Hill Crest attests that all of its employees will abide by mandatory reporting guidelines

Q. Relationships



000706

 

 

 

Hill Crest encourages the client's relationship with family, peers. and other significant persons,
including but not limited to the supervision of family visitations as agreed in the plan.
Hill Crest assumes reaponsibility for including the family?s participation in treatment planning,
providing a space for quality visitation at the facility, ensuring that the structure of the treatment
program and MTP does not limit family contact unless speci?cally identi?ed in the ISP, and agreeing
to comply with all policies developed by DHR regarding family contact and visitation. 

R. Provide a Minimum of 2 hours per Week of Tutoring

Tutoring is available by quali?ed staff when directed by the ISP (or IEP for special education). We
have several staff that are regular school personnel and work at I-Iil] Crest on a part-time basis. We
can provide specialized assistance in a wide variety of academic areas as the need arises. The school

teachers are also available for tutoring.
We understand and acknowledge the following:

- All services provided above and beyond ?Core Services for Intensive
Residential Programs" must be authorized by the ISP and on a DHR-1878 to authorize
payment of such services;

- All services billed as Medicaid Rehabilitation services must be in compliance with
Chapter 33 of the Medicaid Provider Manual;

- The contractor in rare circumstances and in accordance with the County Department?s
procedures bill the County Department for certain ancillary services;

a The contractor will directly bill Medicaid and receive payments for all Medicaid
eligible children directly from Medicaid. Payments for non~Medicaid eligible children
will be made to the Department of Human Resources at the same rate paid for
Medicaid eligible children. The contractor will be responsible for any charge backs on
Medicaid eligible and non-Medicaid eligible children.

4.2.5.3.2 Start-Up Plan

Hill Crest is currently prepared to provide all services and adequate staff to serve the clients
identi?ed in this RFP. Hill Crest agrees to meet or exceed all of the Program Requirements and Core
Services identi?ed in the RF for Intensive Residential Services for Children when awarded the

contract.

Supplemental tasks not speci?cally outlined in RFP Section 3: Scope of Work are:

0 Adventure Based Course- The Ropes Course entails various climbing, balancing,
and group interaction skill: to help facilitate problem solving;

0 Staff Visiting Resource- The Staff Visiting Resource is a staff person who provides a
lonely client a friend or mentor. This intervention may be utilized when the client?s
family/guardian lack involvement, or to address very speci?c treatment issues such as
fear of independence;

I Family Impact Weekend? Family Impact Weekends are educational and supportive
groups for the client and the client?s family/guardian;

44

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Assistance with observation of a client discharged to a medical facility from Hill
Crest- When a client is discharged from the facility and requires admission to a
medical facility, Hill Crest will provide DHR some assistance with staying/sitting
with a client until a ?hopeful re-admission back to Hill Crest is achieved;

. Rapid Response Team- The Rapid Response Team is comprised of Speci?cally
trained nurses that address any emergency medical complications that may arise
within the facility.

4.2.5.3.3 Referral, Admission, and Exclusion Policy

The RTC Unit accepts clients ages 13- 18 years of age who present with a combination of 
behavioral, and family problems. These client?s needs cannot be met in their own home, traditional
foster home, therapeutic foster care home, basic or moderate residential care. For some, treatment
goals cannot be met in a less ctive setting. Treatment in less structured settings has failed to
help them succeed. The client may have been discharged ?rom various placements because of
emotional and/?or behavioral problems. Constant adult supervision and intensive treatment, which
could include use of medications, are required. These clients are at high risk for
hospitalization or being institutionalized. It is required that they have a case plan which wilt
encourage and facilitate success. Hill Crest refuses to be just another step on the ?circuit" (placement
to placement to placement) many clients experience. Hill Crest accepts clients with an array of
and behavioral issues, looking closely at their current status and their potential to succeed,
not just their problems and history of treatment failures. These client?s needs cannot be met in a less
restrictive environment. These clients have problems that pose a severe level of impairment to the
client?s overall functioning in multiple areas. There must be a DSM diagnosis, within the range of
290-316, requiring active treatment. There will be a professionally developed and supervised
individualized plan of care. These clients will be given prior approval and certi?ed by an
independent team as meeting medical necessity for this level of care. A Certi?cate of Need must be

completed.

Information requested from the referral source to assist with the assessment of appropriateness of
admission would include testing, summary, discharge summary from
previous placemen?s), pertinent progress notes, medical information, risk assessment, and
recommendation for treatment in an Intensive Residential Program.

This information is reviewed by the Intake Director, Residential Services Program Director, and
physician. Other therapists may be, included in this assessment. If supplemental information is
deemed necessary, it will be requested. Hill Crest wants to ensure that this level of care is the most
appropriate level and is the least restrictive environment possible for the client.

Hill Crest has worked successfully with youth with such diagnoses as Paranoid Schizophrerda,
Schizoaitcctive Disorder, Depression with Features, Reactive Attachment Disorder, and
PTSD. Referrals may include consumers who are delinquents, chronic runaways, display
manipulative behaviors, have dif?culty maintaining self-control, display poor self-esteem, and have
dif?culty accepting authority. Clients with signi?cant substance abuse needs are also eligible for
admission. This population may also have a diagnosis of autism or display autistic behaviors such as
persistent or unpredictable aggression and moderate to serious risk of causing harm to themselves or

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others. Hill Crest has an extensive history of success?il experiences treating most of the Axis 

. diagnoses, and no speci?c disordmr is universally excluded with the exception of Mental Retardation.
When clients present with an IQ in the borderline to mild MR range, speci?cs of IQ subtests, school
reports, and other related information are evaluated. Often, a child who has tested MR is not
accurately diagnosed, and careful review of case information will demonstrate this fact. (Attachment
4.2.5.3.3)

Hill Crest cannot serve clients who' are actively suicidal or homicidal, or those clients who have a
not controlled by medications. History of such, however, is not an exclusionary factor.
Often Hill Crest has assisted workers to obtain hospital level care for such clients with a plan to ?step
down? to Intensive Residential Services upon stabilization. Clients who have displayed major acts of
violence or aggression such as rape, arson, assault with a deadly weapon, murder, and attempted
murder within the past six months would also be deemed ineligible fer the program. O?en,
adjustments to the case plan are requested as a criterion for acceptance.

If it appears that the case plan gives a client no motivation for treatment, the Treatment Team may
request modi?cations through the ISP process. Hill Crest is able to work successfully with most Axis
conditions. The presence of strong nursing care and a Nurse Practitioner enables us to treat most
conditions on site. Medication monitoring is a primary nursing practice. If it is determined that Hill
Crest cannot effectively serve a client, recommendations/referrals are provided to DHR on a 
basis. All admissions are audited for appropriateness and the information is presented to the facility

Board of Directors quarterly.
. 4.2.5.3.4 Children/Youth to be Served and Number of Slots Proposed

The geographic area to be served is the entire state of Alabama. Speci?cs of this population are
addressed in Section 4.2.5.3. 1.

Hill Crest proposes and is requesting 18 beds (8 male and 10 female) in which to provide Intensive
Residential Services for Children at the Higdon Hill Group Home.

4.2.5.3.5 Discharge Policy

Family/guardian reuni?cation and/or progression to a lower level of care is the focus (if possible) at
Hill Crest. Before accepting a client to the wait list, a case plan is agreed upon with the DHR worker
or other referral source. This tentative ease plan is then formalized at a pro?admission (usually, but
not always, on the day of admission) ISP. Treatment at Hill Crest is ?purpose-driven?; the purpose is
assisting the client secure a permanent placement at a lower level of care. For a client that has
endured multiple placements, regardless of cause, the ISP is paramount. Individualized treatment
plans are designed to meet or exceed the demands of the ISP. Hill Crest is extraordinarily ?exible
concerning schedules for visitation, therapies, and passes if required by the ISP. That is, the ISP
assists in the direction of the treatment plan instead of requiring the ISP to ?t the treatment plan.

When there is a disagreement or uncertainty about a case plan or what actions would best serve a

client in care, Hill Crest will request and usually host an ISP meeting. At these meetings, 
i. andlor terms are explained in a manner the client and the family membersr guardian

419

000709

 

 

 

 

understand. The focus of the ISP meetings is based on the and interests of the client rather
than focusing on facility needs or requirements.

The philosophy is to seek and arrange family/guardian involvement as part of the ISP process in
harmony with this best serves the interests of the clients in care. The DHR Worker is closely
involved in the treatment process, and the worker is provided a comprehensive report about
the client in care. In addition, the DHR worker is invited to regularly scheduled treatment team
meetings.

Prior to admission, the client?s family/guardians that are a component of the case plan are identi?ed.
Throughout the treatment process, Hill Crest works creatively to keep these individuals involved in
treatment through visits, passes, therapy sessions, conference calls, IEPI, treatment team meetings,
special events, and most importantly, bi-weekly Family Impact meetings. The approach utilized at
Hill Crest is vastly different from other treatment facilities. The client does not ?cam" family contact
based on behaviors; visits are a core part of the treatment process. The ?Parenting for Prevention?
approach helps families overcome guilt and shame connected to past parenting failures in an ef?cient
manner. This approach frees the family to adopt a ?esh approach and get a new start.

Discharge and aftercare plans are also established, at least tentatively, prior to admission. These
plans are included in treatment plan updates and are modi?ed as appropriate to the case.
Often follow-up care resources are involved in the treatment process while the client is still receiving
services. Intensive focus on social skills development can make aftercare a success. Development of
hobbies, outings with a staff visiting resource, job training, and securing of an ANNA sponsor are
examples of actions utilized to assist clients with the transition to the community. The discharge
planning is extremely strong. Therapy staff members are receptive to supervisor-y consultation in this
area. Staff members are willing to contact state-level of?cials and other advocates when required to
obtain appropriate follow-up services for each client. All of the above will be re?ected in the ISP.

Discharge prior to program completion does occur due to the following reasons:

M?ical- Sometimes a client must be admitted to a medical facility for surgical or other specialized
care. Medicaid standards require a discharge from residential treatment in such cases, but the client?s
bed is held "open" and all attempts are made to readmit the client as soon as possible. O?en the
"chapcrone" for the hospitalized client is provided by Hill Crest.

?evge Violene - Police reports are made and charges are ?lled for willful, overt violent acts that
result in injury. In rare cases, the Magistrate will decide to detain a client, and, consequently a
discharge is required. When law enforcement is involved, the DHR worker is included in the
decision making process. When a client is detained, Hill Crest memes that their medication reglmen

is continue as ordered by a physician.

Proms made and Sign Down Pigment must be ?gured or he Lost- Rarel, the planned aftercare
placement must be utilized prior to the anticipated time'of discharge. Such situations sometimes
occur and are not the ?fault" of the worker or client.

4n

00071 0

 

 

or other Severe Mental Sometimes, the status of a client deteriorates,
and increased structure and care are required. When the physician recommends a transfer from the
residential unit to an Acute Unit, this is explained in detail to the client?s DHR worker. A letter is
written detailing the plans, and all attempts are made to make the transition seamless. The objective
is to stabilize the client to the point that he can return to the residential unit. Extra care and staf?ng
can be provided in the Intensive Residential Program, as needed to ensure safety, until the transfer
can be properly vetted and completed.

 

Each client is provided a risk assessment at both admission and upon discharge in order to evaluate
the need for and progress in treatment. The results of these assessments assist in determining the
focus of treatment and the most appropriate discharge plan.

Requests for re-admissicn are considered on a case-by-case basis. The key criterion that most be
addressed is whether the residential placement at second time will assist the client to secure a
permanent placement in a lower level of care. To answer this question, a treatment team meeting,
which would include the Physician, Social key staff, and outpatient resources
that are familiar with the client, is conducted.

The treatment approach is based on relapse prevention and trauma focused cognitive behavioral
therapy concepts. The Treatment Team seeks to arm the client with ?life skills? (coping
tools) that predict success in the proposed step-down placement. Each client?s individualized
treatment plan demonstrates his/her path through the phase system as they obtain a greater grasp of
relapse preventiomT -CBT concepts and progress towards graduation" and a step down in
treatment. Many activities are offered that provide the clients with opportunities at both leadership
and social skills development. The client is gently guided to do more than they commonly believe
they can. This process allows the client to gain experiences in a safe environment that prepare them
for life outside a treatment facility. Recent examples are training for a 5k race, and graduation from
high school which led to a client believing he could obtain a college degree. One client was able to
provide volunteer work at an animal shelter.

Program adjustments are frequently made based on the experience of the youth post-discharge. A
process of continually surveying the client, client?s family/guardian, and DHR worker's satisfaction
with services is established. Hill Crest will also ensure the six week repeated satisfaction surveys are
distributed. A copy of the satisfaction survey will be maintained in the client?s ?le. Adding
supplemental Social Skills training, extra Substance Abuse groups (with ANNA), a more vigorous
academic program, restructuring of Come Together Meetings (CTM) on each unit, and more co-ed
events are a few examples of program adjustments based on survey feedback. Below is an example
of the program?s process for moving a client though the goals and objectives outlined in an which
includes a provision of ?step-down" to a less restrictive placement.

Example:

0 Assessment and counseling sessions identi?ed a foster home in which a teen, who had
experienced over 30 placements, felt safe and happy. It was in another state;
i Hill Crest received consent from the client and DHR worker to initiate contact with the

family;
4%

00071 1

 

 

0 While the worker initiated the ICPC process, Hill Crest completed new testing that re?ected
more favorably for the client;

Weekly phone conferences were held with the client and out-of-state family. Reports were
sent on the client?s school work and activities; the family was an integral part of treatment;

I Treatment focused on helping the client develop the social and personal skills needed for
success in the future foster home. As a result, the client was enthusiastic and motivated to
confront the trauma of abuse, neglect, multiple moves, and disappointment;

I The client discharged directly from Hill Crest to the out-of-state foster home. Hill Crest
established follow-up care and a school transition plan for the new placement.

4.2.5.3.6 Natural Disaster Evacuation/Pandemic Plans

Hill Crest maintains that a plan for emergencies be in existence and that the plan for emergencies be
exercised in drills a minimum of once every (6) months except for ?re drills which will occur
quarterly for each shift. The plan exists to provide guidance in case of disaster which includes ?re,
tornado, accidents. explosion encompassing a large area, work stoppage, or any other phenomena that
might disrupt the normal routine of treating clients.

The Safety Committee consists of Administrators, Medical Staff Representative, Director of Clinical
Services, Director of Plant Operations, Risk Manager, DON, Program Managers, and Dietary
Representative. The function of the committee is to coordinate the development of the Hospital?s
Disaster Plan; to coordinate the plan in conjunction with the overall Community Disaster Plan; to
supervise and conduct frequent drills; to practice and test for the facility's continued preparedness for
disaster; to review and revise the facility?s Disaster Plan at regular intervals; to assign physicians to
disaster positions in cooperation with the local Medical Society; to conduct training/education
programs for the positions on the management of mass casualties; to supervise programs for the
training of nurses, mental health technicians, social workers/therapists, and other personnel in the
medical aspects of addressing casualties; and to establish standard emergency medical procedures for

the facility.

The Internal Evacuation Plan will be to remove the clients in immediate danger ?rst, close the door,
and place a pillow by the door to signify that the room as been ?cleared" of all clients. If a ?re or
danger is con?ned to one room or zone, clients will be evacuated to an alternate zone on the same
?oor. When evacuating to another ?oor is required, the move will usually be to the lower level at the
opposite side of the building. Clients will be moved to the closest safe route. If the situation
requires a large number of clients to be relocated, clients in immediate danger will be moved ?rst.

In an effort to notify personnel, the operator will immediately inform each unit, stating the incident
and location of the incident over the facility paging system. Furthamore, all visitors will be asked to
leave immediately. A copy of the key personnel list will be maintained at the switchboard, in the
supervisor?s of?ce, and on each unit. The Administrator will establish a list of Community Agencies
to be noti?ed in the event of a disaster or emergency. A copy of the Community Agency list will be
maintained at the switchboard, in the supervisor's of?ce, and in the Risk Manager?s of?ce. Once a
decision to activate the Disaster Plan has been authorized, the operator or designee is to obtain the
lists and immediately notify the individuals/agencies on the list.

The hospital switchboard will serve as the Disaster Communication Center. The nurse?s station is to
utilize facility two-way radios to communicate triage. The Chief Executive Of?cer's of?ce will
4%

00071 2

 

 

serve as a command center during a disaster emergency. All activities within the center during the
disaster shall be under the supervision of the facility Incident Commander.

Control Center activities will include:

I Veri?cation of activation of all phases of the Disaster Plan;

0 Determination of needs for evacuation of clients/persoonel from affected areas;

Initiation of the recall plan based upon information regarding the extent of the disaster;

Coordination of disaster activity communication among control centers, treatment

areas, and hospital departments;

- Communication coordination between the hospital and other community agencies, 
police, ?re department, homeland defense, national guard, etc.;

0 Approval of press releases;

- Arrangement for transportation of clients to other treatment centers (Hill Crest has a
written agreement with two other treatment facilities which are also owned by to
accept patients in a disaster situation. These facilities are located in both Birmingham,
AL and Dothan, AL. Hill Crest has a written contract with a local busing company to
provide transportation for patients, records, and medication to these alternative
treatment locations);

Procurement of supplemental supplies and equipment;
Copy of casualty list from triage will be forwarded to Administration;
Providing periodic release of client status report to local medical facility.

Designated areas for disaster are included in the Disaster Plan for Bill Crest. The plan contains a
policy which includes information concerning traf?c control, communication, medical records,
documentation, identi?cation for casualties, valuables and clothing, mass feeding, medications, and
procedure for facility evacuation if required.

It is the policy of Hill Crest to managefprevent the transmission of all respiratory infections,
including the HINI virus and Infection prevention measures will be implemented at the ?rst
point of contact with a potentially infected individual.

4.2.5.3.7 Assessment of Bene?ts and Impact

There are several opportunities for assessment to determine the bene?ts and impact of the services
provided at Hill Crest. Changes are made based on statistical analysis as well as client
suggestions/recommendations. Data is aggregated, evaluated, and utilized to help direct the treatment
process. Quarterly surveys of both the clients and staff are conducted concerning the behavior
management system. "Is it fair? Is it effective? What changes would you recommend if you were in
charge?" (and more). All participants in Family Impact are also surveyed. In addition, Hill Crest
convenes a Patient Rights Committee meeting at least once a quarter. This committee is comprised
of residential clients, external members of the and four Hill Crest employees. The
Patient Rights Committee provides a forum for clients to identify/discuss any issues, concerns, or
desire for changes in the treatment program. The information obtained from both the surveys and
Patient Rights Committee is utilized to improve the treatment the clients receive.

Through the Perionnanoe Improvement process, Hill Crest analyzes the admission appropriateness,
accuracy of treatment plans, seclusion/restraint data, and critical incidents.
50

000713

 

 

 

 

Area(s) requiring improvement may be added to the performance improvement data to be collected
and evaluated more closely, initiate the formation of a Quality Action Team, Failure Mode Effects
Analysis, or Root Cause Analysis. Indicators will be developed to assess progress and goals. The
Performance Improvement (PI) Committee is scheduled to meet quarterly (as a minimum) throughout
the year, although statistical data is submitted to and evaluated by the Pl Director If
required, the PI Committee will meet more frequently to address any problematic areas. This
committee has a physician as Chairperson, and all departments throughout the facility are involved.
The client's functional improvement from admission to discharge, and attempts to identify factors
that best predict treatment success are also measured.

The PI Director and Pl Committee ensure the continuous assessment andlor modi?cation of services
to meet the needs of the population. Hill Crest also participates in outcome
monitoring which focuses on such issues as length of stay, promptness of step down, and family
involvement. A discharge survey is also completed with the client, family, and DHR worker to
assess satisfaction with services, care, and treatment. DHR is assured that data is not arbitrarily
collected; it is collected to be utilized to improve treatment services at all levels.

4.2.5.33 O?ice Location

Hill Crest Behavioral Health Services
6869 Avenue South

Birmingham, AL 35212

(205) 833-9000

4.2.5.4 VENDOR CERTIFICATIONS

Hill Crest attests that it warrants and represents to DHR that Hill Crest accepts and agrees with all
certi?cations and terms and conditions of the RFP. By submission of a response to the RFP, Hill
Crest certi?es to DHR that it is legally authorized to conduct business within the State of Alabama
and to carry out the services described in the document- RFP #2014?100-03 Intensive Residential

Services for Children.

4.2.5.4.1 Door Policy

Hill Crest attests that neither Hill Crest nor any of its trustees, of?cers, directors, agents, servants, or
employees is a current employee of DHR, and none of the said individuals have been employees of
DHR in violation of the revolving door prohibition contained in the State of Alabama ethics law.

4.2.5.4.2 Debarmem
Hill Crest attests that neither Hill Crest nor any of its trustees, of?cers, directors, agents, servants, or

employees (whether paid or voluntary) are debarred. suspended, or otherwise ineligible for
participation in Federal Assistance programs under Executive Order 12549, ?Debarment and

Suspensicm?.

SI

000714

 

 

 

4.2.5.4.3 Standard Contract

Hill Crest agrees to the use of standard contract document. Hill Crest will comply with all
terms and conditions of that document, including but not limited to compliance with the Title of
the Civil Rights Act of 1964, the Rehabilitation Act of 1973, as amended, the Americans with
Disabilities Act, Alabama Act No. 2000-775 (governing individuals in direct service positions who
have unsupervised access to children), the Health Insurance Portability and Accountability Act of
1996 (HIPAA) as applicable, and all other federal and state laws, mles and regulations applicable to
receiving funds from the Department to carry out the services described in RFP 2014-100-03
Intensive Residential Services for Children. Any contract executed pursuant to the RFP will be
subject to review by the Department?s legal counsel as to its legality of form and compliance with
State contract law, terms, and conditions, and may further be subject to review by the Alabama
Legislative Contract Review Committee, Examiners of Public Accounts, State Finance Director, and

the Of?ce of the Governor.
4.2.5.4.4 Charitable Choice (applies tofaith-based organizations)
Non-Applicable

4.2.54.5 Financial Accounting

Hill Crest agrees that the accounting system will be consistent with General Accepted Governmental
Accounting Principles (GAAP). Hill Crest will maintain suf?cient ?nancial accounting records
documenting all funding sources and applicable expenditure of all ?mds from all sources.

4.2.5.4.6 Vendor Work Product

Hill Crest attests that the proposal submitted in reSponse to this document, RFP #2014?100-03
Intensive Residential Services for Children, is the work product of Hill Crest.

51

000715

 

 

 

Section 5: COST PROPOSAL

The Pom to Establish a Rate of Service has been completed. Hill Crest Behavioral Health
Services has a thorough knowledge of Chapter 33 of the Medicaid Provider Manual. Hill Crest
Behavioral Health Services certify that we have the capacity to bill Medicaid electronically and
receive payments directly from Medicaid for all eligible children. The Department will be billed
directly for services rendered to children who are not eligible for Medicaid.

L90

000716

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000734

?40

 

Hill Crest Behavioral Health Services
Organizational Chart

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000737

 

Residential Treatment Center Organizational Chart

    

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DIRECTORS 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 

 

 

 

 

 

 

 

 

 

CEO
CFO PHYSICIAN
UNIT CHIEF
wild," I i
DON

x" Nursing
Supervisors
Nurse Manager
PROGRAM DIRECTOR Residential Services
Ancillary \?I'herapiaIsISociaJ Aunt. Program Pragram Man-gar Nunos MHW
Smwha ?h?mn Dbuh?q Hmum:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

000738

 

 

State 'ofAlebema Intent-Ive We! Service- tor Children Rm Jon-1004B
. . AFFIDAVIT 

    

 

. Alabama Department of Human Resources
AFFIDAVIT FOR TRADE SECRET CONFIDENTIALITY
DEPARTMENT OF 
)sa. Non-applicable
County of 

 

(A?iant), being ?rst duly sworn under oath, and representing
(hereafter endor?), hereby dcposes and says that:

 

 

1.1 am an attorney licensed to practice in the State of representing
the Vendor referenced in this mafia, and have full authority from the Vendor to submit this af?davit and

accept the responsibilities stated herein.

2. I am aware that the Vendor is submitting a proposal to the Alabama Department of Emma
Resumes fer RFP . Public agencies in Alabama are required by Alabama law to
permit the public to examine that are kept or maintained by the public agencies, other than
i these legitimately meeting the provisions of the Alabama Trade Secrets Act, Alabama Code Section 8-
. 27-1, and that the Department is required to review claims of trade secret con?dentiality.

oftheAlabama Trade SecrelaAct, am
familiar with the case law interpreting it, and understand that all information received in responeeto this
RFP will be available for public examination except for:

trade secrets meeting the requirements ofthe Act; and

information requested by the Department to establish vendor responsibility
unless prior written consent has been: given by the vendor.

4., 
fully completed and submitted to the Department, and the following conditions must be met by the

Vendor:
information to be withheld under a claim of con?dentiality must be clearly
marked and separated item the rest of the mopesal;
the proposal may not contain trade secret matter in the cost orprice; and
the Vendor?s explanation of the validity of this trade secret claim is attached to
this a?davit.
5.1 and the Vendor accept that, should the Department determine that the explanation' ts
. incomplete, inadequate or invalid, the submitted materials will be treated as any other document in the
department? a possession. insofar as its examination as a public record is concerned. 1 and the Vendor are

5L9

000739

 

 




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sure Intensive Residential Services for Children 2014-1004]:


solely responsible for the adequacy and su?icieney of the explanation. Once a proposal is opened, its
contents cannot be returned to the Vendor if the Vendor disagrees with the Department?s detennination
of the issue of trade secret con?dentiality.

6. I, on behslf of the Vader, warrant that the Vendor will be solely responsible for all legal
costs and fees associated with any defense by the Department of the Vendor?s claim for trade secret
protection in the event of an open records request ?om another party which the Vendor chooses to
oppose. The Vendor will either totally assume all responsibility for the opposition of the request, and all
liability and costs of any such defense, thereby defending, protecting, indemnifying and saving harmless
the Department, 9; the Vendor will immediately withdrew its opposition to the open records request and
permit the Department to release the docrnnents for examination. The Department will inform the
Vendor in writing of any open records request that is made, and the Vendor will have ?ve working days
from receipt of the notice to notify the Department in writing whether the Vendor opposes the request or
not. Failure to provide that notice in writing will waive the claim of trade secret con?dentiality, and
allow the Department to treat the documents as a public record

Documents ?rst, in the opinion of the Department, do not meet all the requirements of the above will be
available for public inspection. including any copyrighted materials.

 

 

 

 

 

 

 

 

 

 

 

A?ant?s Signatw'e
Signed and sworn to before me on . (date) by 
(A?ant's name).
Name of Notary Public: for the
Department of!
My Commission Expires:
Plane ml hrs.
Insert Seal

000744



 

Assistance Payments

Budget I Contract Review

Contract 
Date Received 
Date Review Completed 

Scheduled for Finance
Revlew Committee:

Review Completed By 

3331



8(20?2014

 

Jennifer Ray

Amount: $3,552,660.00

8/20/14 9:48 AM

000745

 

Addendum for Hill Crest - Higdon- RTF program
Contract #3331

This Addendum will be in effect from October 1, 20M through September 30, 2015
for:
A. RFP awarded slots per month: 18 slots per month (6570 units)
B. Attrition slots per month: 0 per month (Q units). These placements are to be
used for attrition only. No additional children can be admitted under contract
until all of the attrition slots are vacant and a slot is available in ?Section 
Once an attrition slot is vacated, the slot will no longer exist.

The following conditions apply:

1. The provider will directly bill Medicaid for the children in the RTF program and
directly receive reimbursement from Medicaid for the services provided to the
children.

2. The provider will maintain records on each child in this program and ensure that the
individual records agree with the required Medicaid documentation for billing and
audit purposes.

3. The provider understands that all chargebacks from Medicaid resulting from errors in
billing or audit exceptions will be the responsibility of the provider.

4. The daily rate charged to DHR for children that are not Medicaid eligible shall not
exceed salt; per day and will be inclusive of all services. DHR will be the biller of
last resort and will not be responsible for payment unless the child has been
detennined ineligible for Medicaid. Provider will be expected to carry the costs of
the child while Medicaid eligibility is being determined for a period of 60 days.

5. The provider will provide a report to the State DHR Of?ce of Resource
Management regarding children in care. This report should list the name of each
individual child, social security number, date of birth, county responsible for
placement, admission and discharge dates and the reason for discharge. Attachments
to the report should include a copy of all received from DHR county
of?ces authorizing speci?c services for an individual child above those included in
the daily rate.

6. The Individualized Service Plan authorizes speci?c services for the child; the 1878
authorizes payment of these speci?c services outlined in the 15?. Services authorized
for payment by an 1873 but not outlined in the ISP are not billable to the Medicaid

Program.

7. The provider understands that the daily rate of $279 is a fee for service and there will
be no year-end cost adjustment associated with this program.

000746

 

 

Hme2
Addendum 
Contract No. 3331

8. if a provider intends to issue a notice to the County DHR Of?ce for a child to he
removed from their program, for any reason other than a successful completion of the
program, this action will require State Office approval in writing from the Division of
Resource Management. The contact number is 334?242-1650 and speak with Betsy
King. It is recognized that situations may arise where the child poses an imminent
threat of serious harm to themselves. other persons, or property and immediate action
is necessary. In such situations written notice will be waived to the DHR County
Office but the provider will need to have verbal permission from the Division of
Resource Management at State DHR or by use of the after-hours numbers available
to the provider. If in the event that no representative from the Resource Management
Division can be reached the provider should take the appropriate steps to cnsare the
safety and well-being of the child in question as well as the other children in the
provider's care. Careful cooperation between the Contractor?s staff and the County
Department?s caseworker and supervisor is of the utmost importance in transitioning
a child from one placement to another placement.

9. The Multidimensional Assessment Tool will he used to evaluate children in
intensive programs. The MAT will be completed by DHR or the State DHR designee
but not by the intensive provider. If the MAT shows the child is ready for a less
restrictive placerttent1 the provider will work with the County to schedule an 
within 3t) days of the MAT and in the plan the discharge of the child to a less
restrictive placement within 60 days of the MAT. If the County does not schedule
the within 20 days of the MAT it will be the responsibility of the provider to
report the problem to their Contract Analyst in the Division of Resource
Management. Failure to report to the Division of Resource Management could result
in of a portion of the intensive rate.

000747



 

 

Addendum for Hill Crest . Higdon- RTF program
Contract #3331

This Addendum will be in effect from October 1, 2015 through September 30, 2016
for:
RFP awarded slots per month: 18 slots per month (QSSQ units)

The following conditions apply:

.1. The provider will directly bill Medicaid for the children in the RTF program and
directly receive reimbursement from Medicaid for the services provided to the
children.

2. The provider will maintain records on each child in this program and ensure that the
individual records agree with the required Medicaid documentation for billing and
audit purposes.

3. The provider understands that all charge-backs from Medicaid resulting from errors in
billing or audit exceptions will be the responsibility of the provider.

4- The daily rate charged to DHR for children that are not Medicaid eligible shall not
exceed per day and will be inclusive of all services. DHR will be the biller of
last resort and will not be responsible for payment unless the child has been
determined ineligible for Medicaid. Provider will be expected to carry the costs of
the child while Medicaid eligibility is being determined for a period of 60 days.

5. The provider will provide a report to the State DHR Of?ce of Resource
Management regarding children in care. This report should list the name of each
individual child. social security number. date of birth. county responsible for
placement, admission and discharge dates and the reason for discharge. Attachments
to the report should include. a copy of all 1373's received from DHR county
of?ces authorizing speci?c services for an individual child above those included in
the daily rate.

6. The Individualized Service Plan authorizes speci?c services for the child; the 1878
authorizes payment of these speci?c services outlined in the 151?. Services authorized
for payment by an 1878 but not outlined in the are not billable to the Medicaid
Program.

7. The provider understands that the daily rate of $270 is a fee for service and there will
be no year-end cost adjustment associated with this program.

000748

 

 

Page2
Addendum 
Connacho.333]

B. If a provider intends to issue a notice to the County DHR Of?ce for a child to be
removed from their program, for any reason other than a successful completion of the
program, this action will require State Of?ce approval in writing from the Division of
Resource Management. The contact number is 334-242-1650 and speak with Starr
Stewart or Betsy King. It is recognized that situations may arise where the child
poses an imminent threat of serious harm to themselves. other persons, or property
and immediate action is necessary. In such situations written notice will be waived to
the DHR County Office but the provider will need to have verbal permission from
the Division of Resource Management at State DHR or by use of the after-hours
numbers available to the provider. If in the event that no representative from the
Resource Management Division can be reached the provider should take the
appropriate steps to ensure the safety and well-being of the child in question as well
as the other children in the provider?s care. Careful cooperation between the
Contractor?s staff and the County Department?s caseworker and supervisor is of the
utmost importance in transitioning a child from one placement to another placement.

9. The Multidimensional Assessment Tool (MAT) will be used to evaluate children in
intensive programs. The MAT will be completed by DHR or the State DHR designee
but not by the intensive provider. If the MAT shows the child is ready for a less
restrictive placement, the provider will work with the County to schedule an ISP
within 30 days of the MAT and in the ISP plan the discharge of the child to a less
restrictive placement within 60 days of the MAT. if the County does not schedule
the 181? within 20 days of the MAT it will be the responsibility of the provider to
report the problem to their Contract Analyst in the Division of Resource
Management. Failure to report to the Division of Resource Management could result
in recoupment ofa portion of the intensive rate.

000749