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 Higdon 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 130-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. H.C. 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 218 facilities, including 25 acute care hospitals, 187 behavioral health facilities, and six ambulatory surgery centers in 36 states, the District of Columbia, Puerto Rico, and the 11.3. 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 25,000 beds and generated more than 6.3 million patient days from nearly 611,000 admissions in 2011, 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 population. Residential services consist of a Residential Treatment Center (RTC) which is licensed for 79 patients, both male and female by the Department of Mental Health and 32 clients licensed by DHR. Quali?cations and Experience of the Vendor 0 Over 80 years experience in providing holistic care. a 21 years experience in provision of intensive residential treatment. a 11 years experience with our current intensive residential program model that facilitates family involvement, personal growth, and transitional living skills. 0 Stable, tenured program and tenured executive leadership. 0111' CEO has been at Hill Crest since 1995. a Two child/adolescent paychiatrists who are devoted to this population and provide excellent medical care. Both have been dedicated to Hill Crest since 1999. - Continued accreditation by JCAHO: 1980 Current (Hospital) 1988 Current (Behavioral) Presently have the 3 year maximum accreditation by JCAHO, 2012 - 2015. Licenses include the State Department of Human Resources and the State Department of Mental Health. Hill Crest currently provides intensive residential services for 40 adolescent males and females 000080 l'l on cur campus in our main building. We also have a 14 bed intensive group home for older adolescent males in Bessemer, Alabama. We have a separate 18 bed intensive group home for adolescent boys and girls located on our main campus. Hill Crest also has the capacity to provide additional services in a separate 14 bed single-room unit for either males or females. The focus of this unit would be directed by the need determined by DHR. The main Hill Crest Behavioral Health Services campus, along with the child?s living space includes a school, gym, game rooms, and a large ropes course (Adventure-Based Counseling). Each level of service offered is 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 Hill Crest?s mission is to provide state of the art comprehensive mental health services in a safe, secure, and therapeutic environment. We strive to assist the client in developing the skills necessary to move to the least restrictive level of care as quickly as the client is capable. Ggals 1. Assist individuals with mental illness/behavioral issues to lead a more productive and autonomous lifestyle, and to promote mental health through service, advocacy, and education; 2. Assure that clients receive services that are individualized, rehabilitative in nature, and strength based; 3. Initiate new best practices in Mental Health Services for our clients; 4. Continuously monitor the effectiveness of treatment modules through in-house monitoring, performance improvement systems, and post discharge statistics. Management Structure Hill Crest has a Governing Board of Directors to which the Chief Executive Officer directly reports. The Chief Executive delineates direct responsibility for the Residential Treatment Services to the RTC Program Director. 0 The Governing Board of Directors is responsible for the overall operations of the Residential Treatment Center, for the appointment of fully qualified medical staff, and for the ongoing monitoring of the quality of care rendered at Hill Crest. The Governing Board is responsible for any activities necessary for licensures, approvals, and accreditations at Hill Crest. - The Chief Executive Of?cer is responsible for attaining operating goals established by the Governing Board of Directors and Corporate Management pertaining to the quality of services performed by physicians; efficient utilization of material, facilities and human resources; and pro?tability. - The Unit Chief for the Intensive RISE Program will be the physician reSponsible for providing medical direction and also providing general care to clients in conjunction with other physician staff. The Unit Chief reports directly to the Chief Executive Of?cer and the Medical Director of the facility. I The Social Services Director, a LCSW,with many years of experience, provides clinical 18 000081 and human resource management to residential services and has responsibility for the social workers/therapists and ancillary services (recreation and adventure base counseling, etc.). 0 The Director of Nursing is ultimately responsible for the nursing care delivered to the clients. He/She works in conjunction with the Director of Staff Development to ensure timely staff training 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 technicians. The Residential Nurse Manager reports to the Director of Nursing, Program Director, and Unit Chief. Organizational Pro?le Hill Crest employs approximately 400 employees. Approximately 180 employees are directly assigned to Residential Services. Hill Crest will not allow an employee to be assigned to another program during the same shift on the same day when working in the Rehab Intervention Service Enrichment (RISE) Program. The business designation is listed as a corporation. Organizational pro?les are listed in this section. The complete list of the Governing Board is as follows: Organization Information: Hill Crest Behavioral Health Services 6869 5th Avenue South Birmingham, AL 35212 Steve McCabe, Chief Executive Of?cer (205) 838-2065 Board of Directors: Mr. Bob Sanders, Chairperson, was the Administrator of Hill Crest Hospital from 1964 until his retirement in 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, 1995. Mr. McCabe?s responsibilities include the overall day to day operations of the hospital and all affiliated programs. Mr. McCabe is a full-time salaried employee of UHS and has no direct ownership of the facility. Dr. Shakil 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. Sheliah Sanders is the Director of Nursing for Hill Crest Behavioral Health Services. Mrs. Sanders is a mil-time salaried employee of Hill Crest and has no direct ownership of the facility. 19 000082 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 The State Department of Human Resources during the past three years, numerous years prior, and presently. The contract numbers over the past 3 years and presently include: Contract 3063, 3064, 3411, #3310, and #3322 (Phoenix Unit). The Contractual relationship has encompassed moderate level residential care, intensive level residential care, and acute care hospitalization services. Children have been cared for in the least restrictive setting and the length of stay for the children has been decreased over the years. Family 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 presently, the contract numbers are: C60210086, C70210086, C80210086, C90210086, C90210123, and C30210086. This wntractual relationship includes Community Residential Care Services and Inpatient Hospitalization. Currently, there is one employee of Hill Crest who is an employee of State DHR, Ms. Katrina Freeman. Ms. Freeman, also employed as social worker for State DHR, is a part-time therapist who works in the Bessemer Boys Group Home providing individual and intensive group therapy to Group Home clients. Ms. Freeman has not been involved in the submission of this RFP. Hill Crest has identified Alabama Clinical Schools (ACS) as a potential subcontractor for this proposal. Proposed subcontractor ACS has worked with the Alabama Department of Human Resources for over ten years, providing intensive residential services to sexually reactive male clients and specialized foster care services for sexually reactive youth. The current license number for foster care is 139947, which was renewed in 2012 and expires in 2014. The current ACS contract for Youth Exhibiting Predatory Sexual Behaviors Services is 3314. ACS currently has one employee working on a PRN basis who is currently employed by the Department of Human Resources, Ms. Briget Crenshaw. Ms. Crenshaw is a Job Services Specialist. Ms. Crenshaw has not been involved in the submission of this RFP. 4.2.5.1.3 Contract Performance Hill Crest and ACS have had no terminations for default in the past ?ve years and no contract terminations for convenience, non-al location of funds for any other reason 4.2.5.1.4 Project Staff! Resumes] Job Descriptions Numerous skills and levels of education are necessary to provide an Intensive level of Residential Services for children. Job descriptions detailing the level of education, experience, 000083 and skills for all key personnel of the Rehabilitation Intervention Service Enrichment aff program are included. Also mcluded is a listing of all Professional Licenses held by our st and all employees names. (See Attachment A. 4.2.5.1.4) Hill 0rest ensures that all sta?? are properly qualified, trained, and have the necessary education and licensure to treat our clients. Hill Crest?s staff meets or exceeds the staff quali?cations listed in the Minimum St_a_ngards for Residential Child Care Facilities; the same is true for the staff of prOposed sub-contractor ACS. Both facilities are in compliance with all laws pertaining to nan- (Title IV of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, and Americans with Disabilities Act of 1990). Suf?cient staff are presently in position to perform the services required in this RFP. There are approximately 180 personnel on the payroll in the Intensive Residential Program. There are currently other employees who are trained to work on the Residential program if required and who currently work in Acute Services for Hill Crest. Hill Crest/AC8 has the available resources (personnel) to care for the clients and meet their physical and emotional nwds. We conduct New Employee Orientations throughout the year. We have a hill time Human Resources Department that works to establish a consistent hiring process. Processes are in place that allow overtime, and PRN staff are available to fill positions that may be vacant. New staff members are hired as positions become open. Hill Crest will ensure that any subcontractors meet the requirements outlined in this RPP. Staf?ng! Staffing Patterns Hill Crest?s Residential Services has professional and non-professional staff available to provide for the clinical needs of all clients. Adequate staffing numbers are scheduled 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. Staff ratio will be a minimum of 1:3, and safety rounds will be conducted/documented a minimum of every 15 minutes. Physicians, nurses, and House Supervisors are available 24 hours a day, 7 days.a week. A hospital physician on-call schedule/coverage is established Nurses are available every shi? to plan, implement, and evaluate nursing care. Nursmg Supervrsors are available 24 hours a day, 7 days a week to provide supplemental clinical support. Resrdenttal Servrces has umt managers and administrative personnel on call 24 hours a day: 7 days a week. Trained Mental Health Technicians (MI-ITS) are assigned according to acuity in order to meet the needs of all residents. ratios based on historical average daily census within a given trended risk factors, programmatics, the supper! services unit, historical general acuity, and With pnonty acuity The administration has established population, diagnostic groupings, available, size and con?guration 0 measures: 4. Diet and Nutrition 5. Hygiene and Need for Assistance 6. Activities Privileges 1. Therapeutic Interactions 2. Medications and frequency 3. Physical and Medical Problems 000084 2 7. Risk 8. Teaching Planning 9. Other areas Staf?ng ts assessed throughout the year for changing trends and programmatic changes that may necessrtate a change in the variable staf?ng budgets, An evaluation is conducted annually (at a minimum) With . administration, program managers, nursing supervisors, and information available from like facilities. Hill Crest is surveyed by the State Department of Human Resources, State Department of Mental Health, and Joint Commission; staf?ng is a portion of each survey and there have been no recommendations made about staf?ng ratios. An analysis produced at least quarterly of core staf?ng evaluates the areas listed above. Recommendations are made after evaluation of trends, submitted for approval to administration, and incorporated into the plan for patient care services. Unit Managers may use their discretion to determine if supplemental staf?ng is required to address an immediate need. The plan for Patient Care Semces is reviewed by the Medical Staff and the Board of Directors for approval. Hill Crest presently has the suf?cient staff to perform the services required in this RFP and will ensure that any proposed subcontractor complies with the staf?ng ratio identi?ed in this RFP. Dai Shift Shift Staf?n is conducted by nursing managers and/or supervisors and includes feedback from program managers. Factors taken into account are data from previous shift, precautions, constant observation or 1:1 assignments, seclusion or restraint, medical care. transportation required, and the number of residents. Additional staf?ng, based on acuity, is approved by the nurse manager, nurse supervisor, administrator, or facility administrator on-call. Quarterly Analysis A quarterly analysis regarding sta?ing effectiveness is conducted in compliance with the Joint Commission, which gives accreditation to our Residential Treatment Program. We compare staf?ng on two human resource indicators staff turnover and staff injury, and four clinical indicators patient injury, patient satisfaction, staff injury, and staff turnover. The Premium/Clinical Director and Nurse Manager are primarily scheduled for 8?5 Monday through Friday. The Program/Clinical Director and Nurse Manager schedules vary, and tune will be spent on evening, night, or weekend shifts. A nurse supervrsor is also scheduled 7 days 'a week for evening and night shi?s in the facility to provrde clinical support and assure staf?ng IS appropriate. Hill Crest and any subcontractor will meet or exceed the staf?ng ratio identi?ed by the of Human Resources. Programmatic staffing includes managers, nurses, social workem/mempists, mental health technicians, and auxiliary staff (recreation, patrent/t?amrly educator, adventure based, school teachers, etc). the staf?ng pattern would be adjusted accordingly. - es, . If census 18 lowered due to discharg adjusted as needed based on the prewously noted Sta?ing patterns are variable and are irtfonmtion. 000085 23. -E Staff to child ratio will alwa . ya have a suf?crent number of quali?ed staff to rovide ciuld and emotional needs at all times and to perform required tasks. libs ratio Eliza? to residents will not be les - Resources. han the minlmum ratio set by the State Department of Human Staf?ng is provided in a number of ways: 1. Core staff: ?ill-time/part-time nursing and MIIT positions 5. Use of overtime 2. Managers and/or Nurse Supervisor 6. Teacher 3. Some] Worker/Therapist 7. Supervisor on call 4. lexr-pool PRN staff pool 8. Activity Therapist 4.2.5.1.5 Staff Performance Evaluations and Training Hill Crest?s Staff Development Department provides a competency based education and training program that enables staff members both to maintain and improve the knowledge and skills required to perform their jobs. The Sta?? Development Program is based on identi?ed learning are designed to enhance clinical practice by expanding clinical knowledge, skills, and es. The orientation process includes both classroom and ?on the job? 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 Nursing is 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 staff. 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 will be a 4-5 day process for the clinical staff (mental health techs, social workers and nurses), with an additional 2 days for nurses. An employee will remain in orientation on the speci?c program/unit hired for 3 to 5, eight hour shi?s. 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, 11ml orientation, and cross-training to other units in the facility 13 96 hours for mental health workers, 128 hours for nurses, and 40 hours for other non-clinical employees. Hill Crest pmwde staff speci?cally dedicated to the Rehabilitation Intervention Servrce Enrichment (RISE) Program and will assure that any subcontractor does as well. - i) receive an orientation ees rmanent full-time, permanent part tune, ?exr poo . ml? A gempetency test is expected to be successfully completed 30 days of eel: pexit. During the orientation, the employee receives basrc infonnatton regarding the 633$ Completion of a program?s competency module and a post orientation test validate gompctency and provide veri?cation of cross training. 000086 23 All new employees will receive an age?speci?c training module. A post-test must be success?illy completed (score of at least 90%) during the orientation process and during annual in-service. The tests are reviewed by the Staff Development Department staff and forwarded to Director of Staff Development for post competency test review. Any employee who does not satisfactorily I any 0f the competency tests will meet with the Human Reso urces Director 0 ali?PTOprlate for supplemental training. 35181196 as Any previous Hill Crest employee who has been separated from Hill Crest for 18 months or less is not required?to attend New Employee Orientation. lie/she will instead participate in the next annual tn-serv1ce program. These are scheduled for day and evening convenience. All e?gees are adequately trained in their job position and will receive program cross-training as . A new employee?s education, experience, test completion, in-house educational programming and post-testing shall prove whether the employee is competent. Current employees are to attend in-servwe 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 refresher course annually to maintain their skills in physical crisis intervention. Hill Crest also requires each clinical employee to demonstrate competencies 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 to the Minimum Standards for Residential Child Carp Facilities (Minimum Standards). Departmental Orientation is mandatory for all new employees. Tepics reviewed include policies and procedures, departmental organizational structure, work schedule, safety plans, de-escalatron skills etc. This orientation will be in the assigned work area and should be completed Within 30 days. entation upon hire as evidenced by the completion of the intained in the employee?s Staff Development education ation, as evidenced by the sign-tn sheet and All employees will complete Initial. Ori Initial Orientation Checklist which ts ma . 11 em 10 can complete new employee orient fill: erfiploye: glaciation data base maintained by the Director of Staff Development. Each clinical employee completes the Departmental Competency Checklist which is adapted to each . . - - - form is stored in the Staff Development ?les. specific Job description. The complete-t: valuation. Hill Crest?s and employee training ides similar training and personnel . . 313$ or exceeds the recommended training in the Minimum Standards. 000087 SH of Competengy Plan ocurnentatton and reporting of competency plan activities will be as follows: . . . . uman Resources maintain all applications, references, and performance evaluations. Staff DWBIopment maintains records on all employee orientation, training, specialty ill-services, and continuing education classes seminars. Annual performance evaluations are conducted by the Umt Manager; any areas requiring improvement are discussed; and goals are established with the employee. On-going observation the mana continued improvement. rs enables constant feedback to the employee for The nurses are given a medication administration test durin the orientation riod score of 90% will be required. If a score of 90% is not obtaifed; the nurse willpge given an opportunity to retake the test. The Staff Development Department provides innovative lanCI'Vlce' 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 offered 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. Ali Nonviolent Crisis Intervention 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 themselves or someone else. The general scope of education for New Employee Orientation is listed below: Scope of Education for New Employees -M.inimum of 30 Hours within ?rst 180 days of hire A. General Facility Orientation I) Customer Service 2) Hill Crest Philosoghg . 1 we rinc1 es 0 . 3; :i'?gtChildcar: 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) ll) Emergency Preparedness 12) Disasters (Internal and External) l3) Hazardous Materials (MSDS) 14) Waste Management 15) Personal Protective Equipment 16) Body Mechanics: Safe Lifting Techniques in Work Areas 000088 .15 17) Reporting Incidents and Accidents 18) Patient Rights and Patient Beliefs l9) Neglect and Abuse 20) Communication throughout the Life Span Employee Health 22) Infection Control 23) Problem Solving Skills 24) Interactions with Consumer and Family/Guardians 25) Grievance Procedure/Reporting B. Clinical Orientation 1) Age Specific Characteristics and Needs Through 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 Flaming: 9) Progress Notes 10) Patient Rounds 1 1) C.I.W.A. Protocol 12) Precautions 13) Infection Control: A Clinical Perspective 14) Vital Signs 15) Urine Collection 16) Patient Care: Hygiene Codes 18) Levels of Observation 19) Time Out: Documentation 20) Therapeutic Holds: Documentation 21) Patient Searches 22) Child 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 Th Value of Partnerships . . 238?; Ho; Children Enter the Foster Care System/Family Implications among Agency Personnel 30) Overview of the KC. Consent Decree 31) Understanding and Valuing Cultural Differences . 32) Identifying the and Needs of Families and Children 33) Most Common Diagnoses hi tric Medications/Classi?cations . . Ilat:ptrilctive of Families and Consumers Regard to Resrdennal Treatment :1 6 000089 36) Recovery 37) Most Common Diagnosis 38) Medications and Classi?cations C. Nursing Orientation l) Milieu Management 2) Nursing Process 3) Patient Classification 4) Reporting Process 5) Assessment Tools 6) Admission Process 7) Medication Management: Medication Education Medication Administration Records Scheduled Medications One Time Order Taking off Physician Orders ?As Needed" Medication Read Back Verbal Orders Medication Policies/Medication Errors AED Look-Alike/Sound-Alike Medication Abbreviations 8) ER Cart\Medical Emergency 9) Lab Procedures 10) Pharmacy Procedures: Adverse Drug Reaction After Hours 1 l) Consult Procedures 12) EKG Procedure 13) Venipuncture and 1V 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 Employee In-Service is mandatory for all employees. The purpose of the Annual-in- service is to assist in maintaining and strengthening competency, knowledge, and skills. Scheduled Annual in-Service is approximately 15 hours of training. The followmg areas are presently covered in Annual Orientation but may be amended dependent upon the training needs of the employees, standards from the various agencies, etc. CLINICAL ANE UAL IN-SERVICE CHECKLIST {Minimum of 15 hours) Performance Improvement Risk Management/HIPAA/ Method Oriented Safety Thinking Abuse Neglect Bioten'orism 000090 Q1 Human Resources/Corp. Compliance Infection Control! Bloodbome Pathogens/Lice/MRSA Fire Safety Material Safety Data Sheets (MSDS) TB Skin Test (Chest X-Ray) Team Work/Cultural Diversity/Interaction with Consumer and Family Age Speci?c Drug Interactions CPR - Behavioral Management First Aid -DHR Issues Child Safety Issues Crisis intervention/Engaging Families The Impact of the Media on Children Effects of Multiple Placements Cultural Sensitivity and Responsive Services Signi?cance of Birth Families Substance Abuse Gang Activity Universal Precautions and Infection PreventiOri RNILPN Only -Pain Management/Medications (Pharmacy, Herbs) -Blood Sugar/Advantage/Lasette /Accu-Check -Growth Sheet ~Critical Test Results/Readbaek phone/verbal orders -A?er Hours Pharmacy/Prohibited Abbreviations Ongoing Staff evaluation is performed and training is conducted t?imoughout the year. At anytime, a manager may mandate continuing education for a speci?c employee. or whole department. The manager will contact the Director of Staff Development to discuss the timeframe and need for the continuing education. The Staff Development Department Will then provide an accredited facilitator to teach the class. Trainers also periodically observe staff on the unit and teach/train at that time. Trainings may also occur based on Performance Improvement or Risk Management data. These additional training needs may be recommended by a committee to Administration, or Administration may mandate extra traimngs based on written information and/or observations. Annual Performance Evaluations conducted by the employee?s manager may also lead to supplemental training in a particular area. the conclusion of every educational training session. The Director of Staff DeveIOpment, a copy is provided to the in the Education ?les along with the Sign-in sheets. All facilitators are evaluated at evaluations are summarized by the. facilitator, and the original is maintained Hill Crest staff. These classes educational classes are offered to the community an . . (201112313: very diverse list of topics to serve the community and to help prowde quality care. Ema] "Performance Review?. with each employee is held after the ?rst three (3) months 0 :2 000091 employment and annually thereafter, 4.2.5.1.6 Background Checks In tionnection with a job offer from Hill Crest or proposed subcontractor, we require a signed au onzatton form 'us to perform a background investigation. All employees, regardless of then level the organization, are required to submit to a mandatory background check, and all Job offers are contingent upon an acceptable background result. 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 must be received and approvgd prior to the employee?s orientation process. The results from the State of Alabama Department of Human Resources Child Abuse/Neglect Registry Clearance must be rgeiveg and before the employee has one-to-one 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 the different agencies, as required. The background check will include employment veri?cation, personal references, ?ngerprint reports obtained from the Alabama Bureau of Investigation (A31) and Federal Bureau of Investigation (FBI). A report from the Office of the Inspector General (DIG) on all managers and licensed 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; these are reviewed and a determination 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 below, the Human Resources Director will attempt to gain more detail information from the reporting agency. If the information carmot be obtained or there is still a questionable report, the Human Resources Director will meet with the CEO. The CEO makes the ?nal decision to terminate the employee or refuse employment to the applicant. a An employee cannot participate in the orientation process until the Alabama Statewide and National Background reports have been received and approved by the Human Resources Director. The report would contain 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 o?ice 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 unsuitable for employment: 1. Murder, manslaughter, or criminally negligent homicide 2. A sex crime . . 3. A crime that involves the physical or mental injury or malteatrnent of a child, the 000092 Stat >195?? 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 from the State of Alabama report on Child abuse/neglect . Felonies: a. Abuse or neglect against a child (also other felony against a child) . 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 (or former partner), in which a weapon or deadly instrument was used. j. Battery (report from another state where battery is a felony) k. Drug-related offense: including a felony DUI. All background information obtained shall be utilized to assist in veri?cation of the employment application. Retrieval and usage of this information complieswith all laws, rulesaand regulations'of the Equal Opportunity Commission, Americans with Disabilities Act, and the Fair Credit Reporting Act. Hill Crest is an Equal Opportunity Employer and does not discriminate based on race, 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 prescribed 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. hments to it should swers to the uestions on the application, related paperwork, and any attac . 1:16:11; and correct}. Any misstatements of fact(s) or and/or any allegation of child abuse/neglect from the Alabama State Central Agency may form the basis for rejection of an application or for a dismissal a?er employment. thorization for Hill Crest to t' it shall remain on ?le and shall serve as ongomg au. . . Suitirtethsaii?ggund investigations and reports from any of the mentioned agencies at any time during the employment period. If there is gg allggatiog of abuse or neglect, verbal or written, against a staff member, the Human .30 000093 fzsonges Director andlor the Risk Manager will conduct a full investigation. The investigation will u. an interview with the accused staff, the patient, other patients who may have information pertaining to the allegation, and any other staff who may have information pertaining to the alleged incident. The accused staff will be placed on administrative leave while the investigation is on- gomg. The accused staff 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. The Supervrsor/Manager or CEO who receives the reported allegation shall ensure that the Risk Manager rs noti?ed immediately. The Hill Crest Social Worker/1' herapist will immediately notily the child?s DHR Social Worker or on?call DHR personnel. The Hill Crest Social Worker/Therapist will make contact with the child?s family/guardian, if applicable. The appropriate documentation Will be made in the child?s medical record; and documentation reporting requirements will be followed per licensing standards. It is the policy of Hill Crest, 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 patient abuse or neglect to their immediate 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. Documentation of a criminal background check is maintained in each employee?s personnel ?le. Documentation of individual criminal background check and a criminal background policy/procedure is included. (See Attachment A 4.2.5.1.6) 4.2.5.2 VENDOR FINANCIAL STABILITY To document Hill Crest?s ?nancial responsibility, the audited ?nancial statement for year 2010 and letters from auditor(s) who performed the 2009 and 2008 ?nancial audits (corporation wide) have been provided. (See Attachment A 4.2.5.2) 4.2.5.3 METHOD OF PROVIDING SERVICES Service Delivery Approach . Hill Crest is located in Jefferson County. Alabama. It currently operates acute servrces for children, adolescents, and adults while also providing residential services to adolescents. Its acute unit is attached to the facility. It also operates residential treatment for adolescents. Resrdentral Servrces consists of a residential treatment unit which is licensed for 79 patients by the Dcpartmentof Mental Health and 32 clients licensed by Its proposed subcontractor, ACS, rs also located tn lefferson County. It is an 80 bed facility providing residential treatment to sexually reactive males. IItll Crest requests 40 beds in conjunction with RFP 2012-100-07 or a Rehab Intervention Sen/ice Enrichment Program. Both Hill Crest and Alabama Clinical are already fully pperatronal and Will be as well on 10/1511 2. Hill Crest will serve female children in a RISE unit: and Its WIN . serve male children in a RISE unit. Hill Crest will house the RISE children 1an 8'8pr umt 0? Its campus. Its proposed subcontractor will house the children in a separate and distinct wrng. clearly 000094 3! . identi?ed and closed off from other wings providing different levels of service. The two 1 will be the same at both locations Beth facilities are certi?ed to participate in Medicare/Medicaid programs, are in compliance wun Title. VI VII, seclusron and restraint requirements of 42 CFR1 Part 483, staf?ng and medical record requnements and have an approved utilization review plan. Both facilities also follow Medicaid Chapter 33 Hos ital Under 21 1 ti . . . DMH, and DHR. gu a ons. oth facilities are licensed by JCAHO, The goal for provision of services to RISE clients is to provide a highly structured and safe envrronment that facilitates behavioral stabilization, positive relationship building, and new learning experiences so children can be reunited with their families or moved to a less restrictive community setting. RISE services will be available to all children of Alabama. The children placed in the RISE program will have a DSM-IVR diagnosis within the range of 290-3 1 6 or have otherwise been identi?ed by a mental health professional as having serious emotional/mental illness and behavioral problems for which treatment from other programs was not successful due to the severity of their behaviors. Alternatively, these children might have been receiving mental and behavioral health care out of state. The RISE children will have problems that pose a severe level of impairment to overall functioning in multiple areas. They may have otherwise been denied admission to or have been discharged from various intensive placements because of their emotional, behavioral, and mental illnesses. Signi?th disrespect toward adults and peers, destruction of property, poor selfesteem, and dif?culty accepting authority are some of the features that eligible children might possess or display. The RISE Program will aim to serve teens that require a highly structured and therapy-rich environment. The RISE Program will be equipped to serve a wide range of diagnoses while addressing severe mood and behavioral issues. Treatment goals/objectives will be individualized, undergirded by values of mutual respect, patience, compassion, and persistence. Children housed at either facility who become actively homicidal, suicidal, or whose is not controlled with medication can be referred to and serviced through Hill Crest?s attached acute adolescent unit, with State DHR approval. Hill Crest also offers less intensive adolescent residential programs than the RISE Program, as well as group homes. Because of this3 clients Will be able to transition through and receive services appropriate to their current Situations, whether more intensive treatment is needed and they make use of Hill Crest?s acute unit, or they step down to progressively less restrictive intensive service(s) as the child shows improvement. resent with a rim problem of sexual aggression or sexual reactivity RISE. Adolgscetgfg who are actively suicidal and/or or show of uncontrolled will not be immediately eligible for the program. dWhen such children are referred to the Rise Program, we in obtaining hospitalization an upgln resolution of the emergency, refer the client back to the RISE program for possr placement, or to another appropriate residential treatment center. ta?in awake staff available 7 days a week, 24 both facilities Will be adequate With rotating an . . :ours agdiy and with training that meets or exceeds Minimum Standards for Resrdential Child ng; 32 000095 . identi?ed and closed off from other wings providing different levels of service. The two programs will be the same at both locations. facilities are certi?ed to participate in Medicare/Medicaid programs, are in compliance with Title VI VII, seclusron and restraint requirements of 42 CFR, Part 483, staf?ng and medical record requirements and have an approved utilization review plan. Both facilities also follow Medicaid Chapter 33 Hospital (Under 21) regulations. Both facilities are licensed by JCAHO, DMH, and DHR. The goal for provision of services to RISE clients is to provide a highly structured and safe environment that facilitates behavioral stabilization, positive relationship building, and new learning experiences so children can be reunited with their families or moved to a less restrictive community setting. RISE services will be available to all children of Alabama. The children placed in the RISE program will have a DSM-IVR diagnosis within the range of 290-3 1 6 or have otherwise been identi?ed by a mental health professional as having serious emotional/mental illness and behavioral problems for which treatment from other programs was not successful due to the severity of their behaviors. Alternatively, these children might have been receiving mental and behavioral health care out of state. The RISE children will have problems that pose a severe level of impairment to overall functioning in multiple areas. They may have otherwise been denied admission to or have been discharged from various intensive placements because of their emotional, behavioral, and mental illnesses. Signi?cant disrespect toward adults and peers, destruction of property, poor self-esteem, and dif?culty accepting authority are some of the features that eligible children might possess or display. The RISE Program will aim to serve teens that require a highly structured and therapy-rich environment. The RISE Program will be equipped to serve a wide range of diagnoses while addressing severe mood and behavioral issues. Treatment goals/objectives will be individualized. undergirded by values of mutual respect, patience, compassion, and persistence. Children housed at either facility who become actively homicidal, suicidal, or whose is not controlled with medication can be referred to and serviced through Hill Crest?s attached acute adolescent unit, with State DHR approval. Hill Crest also offers less intensive adolescent residential programs than the RISE Program, as well as group homes. Because of this: chents Will be able to transition through and receive services appropriate to their current Situations, whether more intensive treatment is needed and they make use of Hill Crest?s acute unit, or they step down to progressively less restrictive intensive service(s) as the child shows improvement. cut with a rim problem of sexual aggression or sexual reactivity Adolgscerig who are actively suicidal and/or homicidal or show of uncontrolled will not be immediately eligible for the program. When such children are referred to the Rise Program, we will as51st in obtaining hospitalization and, ups? resolution of the emergency, refer the client back to the RISE program for [30851 placement, or to another appropriate residential treatment center. Staf?ng at both facilities will be adequate with rotating and awake staff available 7 days a week, 24 hours a day and with training that meets or exceeds Minimgm Standards for Residential Child (Egg 3 2 000095 . Facilities, ?Staffa?re also offered trainings not included in the Wsuch as training in medications and diagnoses of mentally/behaviorally disturbed children and adolescents. All staff training will be documented in the personnel ?les. The additional training will be documented in educational ?les. To be eligible for RISE, a child must possess the mental and physical functional capacity to part1c1pate in the RISE services. In assessing the appropriateness and chances for success at Hill Crest of candidates who show an IQ in the borderline to mild MR range, we will look at the speci?cs of IQ subtests, school reports, and other related information. Often a child who has tested MR is not truly MR, and care?il review of case information will demonstrate this fact. All RISE placements will ?rst be submitted for approval to DHR, Family Services, and the Division of Resource Management. A Certi?cate of Need will be obtained prior to placement. Services provided will be authorized through a client's Individual Service Plan (ISP). Upon RISE admission, then quarterly and at discharge, assessments will be obtained of the global mental, behavioral, and emotional functioning of all RISE clients in their various environments. A standardized assessment tool, such as the CAF AS, CAN, or the Kennedy Axis V, will be used to obtain this global functioning level. The results of these assessments will be shared with DH social workers for the ISP process, and for development of goals and speci?c strategies to address preparations for the child to discharge into a less restrictive living environment. These results will also be shared with State DHR Division of Family Services and Division of Resource Management. . Other assessments will also be administered during hospital admission and as needed throughout the client?s stay in the RISE unit. These assessments are discussed in further detail below. In RISE treatment, a visible daily schedule will be provided to clients. This will help provide consistency and a foundation which the clients may build upon. The schedule will assist the clients with organizing their own day. Providing these routines and structure for the client not only provides them with a model of how to manage a stable environment and how to perform routine tasks, but it also helps them develop critical time management life skills that are essential to success. The schedule will include time for daily chores, homework, community/daily living activities, structured recreation, social skills training, group/individual therapy, and educational opportunities. The schedule for RISE children will re?ect structured activities and treatment, daily and on weekends. The schedule for the weekend and holidays is the same except that the classroom academics are not emphasized. Hill Crest and its proposed subcontractor will ?rlly participate in ISPs with the family, DHR, and other providers if any are involved. We will schedule and coordinate the child?s treatment plan in conjunction with the family?s ISP and the child?s Individual Educational Program (IEP). We will ask for, and host, ISP and IEP meetings and updates. We will request ISPS at intake. every 6 months, and when significant changes in case plans are indicated. We will go to great to involve the family/guardian in and other treatment activities. Help with meals and transportation can be offered when this will improve family involvement. We will be creative and proactive to help the client. We will work to ensure that family members feel comfortable to partrelpate tn family centered activities. Our best allies in this process will be the family members who regulme attend ?Family . Impact," 3 family therapy event involVing the family members of clients. Some famrly members continue to attend even when their child has discharged- 33 000096 We will incorporate the into the child?s . . . aster Treatment Plan. The initial treatm developed 10 days of admission and reviewed at least thereafter. A being/?032! wul be 9116.1?. and client?s family 01? caregivers. The behavroral management plan focuses on the use of and interests and will be strictly positive. One aspect common to each client in the pmgram be_a set of mics centered on safety and effort. When expectations for safety and effort are met. multiple rcinforcers (rewards) will be available. These will be speci?c to the unique mtcfeSlS 0f each client and will serve to develop and hobbies. These reinforcers will be available one week of admission. The child?s response or progression in relation to the behavmr management plan Will be monitored, providing a basis for evaluation of the behavior plan. We will document at intake a discharge plan and update it 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 will insist on pro-placement visits, school meetings, and whatever else is required to make a successful transition to a less intensive level of care. IEPs are updated yearly and may change at any time due to academic progress or to meet appropriate academic benchmarks. amily members and DHR representatives will be invited to these meetings. It will then be the responsibility of the child?s therapist to document in the treatment plan pertinent school planning infonnatioo, and this information will be relayed to the DHR worker for inclusion in the ISP. Also, the IEP will address any planning issues, especially discharge planning concerns, such . as school placement, as appropriate. Our staff will work closely with local school systems to assure a smooth transition to the community. reports, to arrive on the 15?h of each month, will be sent to the referring county DHR, Division of Resource Management, and Division of Family Services. The report will include a description of services provided during that month and description of the child?s response or progress related to the goals outlined in the previous month?s treatment plan. Academic updates will be included in the treatment plan updates. Quarterly summaries of functioning levels and progress or response as measured by the Kennedy Axis will be developed and sent to the DHR worker. This will also be provided to the DHR worker upon discharge. The RISE clients will be provided ongoing medical, social, and educational assessments. Diagnoses will be determined on the basis of this information. This assessment will utilize several standardized assessment tools, plus other assessments conducted in accordance with JCAHO requirements and professional standards of care for the discipline involved. These assessments, taken together, will yield a comprehensive picture of the client?s mental, behavioral, and emotional ?mctioning in their living environment, school, and community. These assessments will consist of but are not limited to: Standardized Assessments: . - History and Physical Examination Routine medical exam and lab work (and EPSDT) . Axis I through diagnosis, per DSM-IVR Mental Status Examination Basic Achievement Skills Inventory 3% 000097 Other Assessments, conducted in ace . ordance with professional standards of care: Assessment Lersure/.Recreation Assessment Educational Assessment Assessment (Includes hearing and vision screen, and updates on immunization) Where reguired, 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 assessments) The results of these assessments will be used to develop the Master Treatment Plan. The Master Treatment Plan will re?ect the objectives of the client and the interventions (strategies) planned by the staff as well as his/her educational (if designated for special education services), behavioral, and medical plan. It will contain measureable goals that children will achieve while in treatment. The plan Will be implemented, and the child?s response/progress to the behavioral management plan will be monitored. Individualized treatment goals will be designed to help children develop communication and relationship skills, strengthen personal identity, and foster pro-social attitudes and behaviors with the treatment team, family, others in the facility and in the community. Hill Crest and any subcontractor will provide all of the core services listed by DHR for Rehabilitation Intervention Service Enrichment programs. Brie?y, this is an overview of how these requirements will be met: I The staf?ng ratio for the RISE Program will be 1:3 with single room occupancy. As the client progresses through the program, the treatment team, including the Social Worker, DHR worker, family, physician, RN, and school representative may discuss moving the client into a semi?private room; Room checks/rounds will be completed and documented a minimum of every 15 minutes; At a minimum: Two individual therapy sessions, one family session, and three group therapy sessions per week as designated in the - Based on the individual needs of the client, treatment will be individualized with cognitive and behavioral elements. Through individual and group therapy, clients will be taught new skills and thinking patterns. These will include skills to enhance communication and relationship building. Acquisition of skills sets such as anger management, social skills, mindfulness, self-soothing, problem solving, and trauma recovery will be common goals in the RISE program; Treatment will include use of workbooks, which will keep clients working on skill acquisition and new cognitive learning in between therapy sessions. The treatment day will be rigorously full and challenging. Coupled with the behavior management plan, it will provide for almost immediate success and access to a range ofreinforcers cash, special outings, point store, etc Grtiup therapy will be utilized both for process work and to introduce and practice skill acquisition. For instance, through daily intensive and debrie?ng groups, the client Will have an opportunity to learn and practice social skills such as assertiveness, leadership, and the vital skill of goal setting and evaluation; The milieu will be therapeutic, focusing on validation and encouragement. Elements of the RISE program will be interlaced throughout the environment so that newly learned or acquired skills can be reinforced. Within the RISE program, all aspects 0f the client 8 day 35 000098 ?g?gtlo pffer reinforcement and practice of RISE program elements. All RISE staff pro rain ralilning in the cognitive and behaVioral elements that form the core of the RISE cns?re a as we as in adolescent development, diagnoses, and medications to conSistent and supportive milieu for the client. This will give opportunities for clients to learn through staff modeling and shaping behaviors. Through the therapeutic milieu as well as through formal educational elements of the RISE program, the client will learn skills required to live success?illy on their own (see below, section G, for more information). Even the money provided to RISE clients through allowances and other monies) will be used as an opportunity for skill building. Savings accounts Will be encouraged as will saving and spending plans, developed in conjunction with RISE staff members (for further information, see section I below). Together, this a??ords RISE clients a comprehensive treatment environment; RISE clients will be provided regular opportunities for success through educational, physical, cultural, and social avenues. Progress in school for these children has typically been difficult due to family chaos, emotional/behavioral programs, and frequent moves. In the RISE program, all of our students will be assumed to need some special accommodations, with extra tutoring and homework assistance as needed. With this approach, we hope to see these students succeed academically, perhaps increasing their achievement scores by as much as 1.5 grade levels (for additional information see section I below). Through the RISE program, clients will be exposed to a range of recreational and vocational activities (see section below) they might not ever had the chance to experience. The exposure to such varied activities increases the chance for individual clients to develop hobbies and interests that strengthen personal identity and foster relationship building and pro-social attitudes; 0 Relationships with caregivers will potentially improve as clients move through the RISE program. This is not only because of the skills being provided directly to clients, but also due to the weekly opportunities for families to be involved and learn and practice new relationship and communication skills themselves (see sections below); - RISE clients will bene?t ?'om ongoing assessment of the program. We are accustomed to assessing treatment programs on a regular basis (see section 4.2.53.3) and enthusrastically embrace the opportunities to make changes to improve the program based on the multiple methods of program assessment already in place, in addition to those to be added as indicated (see section below); ntain ialized school settings located on campus. The teachers and clinical staff clgely. Homework assistance. will be provided by school sta?? and chancel. staff. lEPs will be conducted as appropriate and in a timely manner. There Will he chose (?10ml 1118:1101} between the school and clinical staff. The State Department of Education monitor; 00 an conducts regular surveys to assure compliance. In the event that a client can atten an campus school, program requirements by State DHR shall be followed. "ml for a kc develo mental task for all clients, but it is ever more vi 18 emotional/behavioral problems, and ??equent mlofve: 'kfore ucationa aiure. DHR custody clients in facilities are at high ns . (?5115131in Eigf?aggog'?rzin assesses for learning styles and incorporates tlus informatkilon into tge The ulEP The educational component of the RISE Program will incorporate bot core an educational classes that will provide an age and academically appropriate education. A client?s progress in school clients in treatment. Due to family chaos, 3b 000099 i Intcludedfas well Will be a structured study hall time for both homework assistance and focused .u ortng or problematic academic subjects. We aim for clients to demonstrate academic improvements that are double their length of stay. That is, for a 9 month stay, we hope to see ac revetment scores increase by 1.5 grade levels during that time frame. The ma] onty of the routine medical needs of the clients are met within facilities by medical staff which Includes Nurse Practitioners, and/or Nurses. Speci?c plans and responses to medical issues'and emergencies are in place. In addition to the staff nurses and nurse practitioner- there are ongoing relationships established with licensed practicing physicians for medical (physical) and emergencies and critical incident response. Each RISE client will be admitted by an attending phys1cian. There will be physician coverage at all times. A on-call schedule is provrded to assure physician coverage for residents on week nights, weekends, and holidays. Nurses are available on-site for emergencies 24 hours. seven days a week. A nurse practitioner and two medical doctors are employed 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 semces are provided through a contractual agreement with Mobile X, and EEG services are provided through a local neurology service at Hill Crest. Pharmacy services are available at both Hill Crest and ACS through contracted Pharmacy entities. Dental and optical services are provided through outside vendOrs per agreement. EPSDT screenings for the clients will be conducted. An on-site contractual dietician is provided to assess the nutritional needs of the clients. 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. Hill Crest has a strong Infection Control Program. All of these keep clients healthy. Hill Crest/AC8 has develOped an Emergency Medical Reaponse Team to address any medical conditions that the clients may exhibit. When the Emergency Team has been activated, speci?c RNs who 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 require more specialized treatment (Le. EMT). Both facilities also employ a uniform code system for emergencies including ?Code Blue? announcements that signal a medical emergency has occurred, and emergency ?rst aid boxes are available. ?code" is announced. Staff has been trained so that everyone available should respond to an emergency call. A minimum number of staff is left in each area to keep thcse areas safe and secure during this emergency time period. More than adequate number of sta?' IS available, in seconds, to respond to an emergency or critical incident. Upon admISSlOIl, the parent/guardians are responsible for signing a release for medical care to be rendered. In the event an emergency occurs, ardian. The emergency will be the nurse or social worker attempt to contact the parents/gu . assessed by the nurse practitioner, registered nurse, or medical doctors. eed of emergency medical treatment outsnde the facuhty Will be determines is in . . whom a facility. A client with an acute medical emergency will be trans rted to an appropriate medical . . git/ergo basic emergency resuscitation, if deemed necessary, and basrc treatment, the client is then transported for advanced medical care. Staff responds when a 000100 ?allied: and certified providers of basic cardiac life support respond to a cardiac personnel will I: am: Victim immediately. A.?Code Blue" will be called, and all available nursing ox spori while maintaining suffiment staff on units for safe care. Emergency cart with . ygen an a de?brillator Will be available. A nurse will take responsibility to run the emergency Situation and will make an assessment, then will have paramedics called if appropriate. Upon arrival of the paramedics, staff turn over life saving procedures to the advanced trained personnel. If the paramedics are not needed, the nurse or designee will call for the ambulance or when appropriate, the client may be transported by staff in a hospital van for further medical care. The Fire Department Paramedics (91 1) will be utilized as deemed necessary by the Program Director, Nurse, Nurse SupeWisor, or client?s physician. Otherwise, client?s physician will be noti?ed. The facility 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 family/guardian. The nurse will document the incident and notify the Program Director Social Services. The nurse manager Will critique the code for and any areas needed for improvement. Both Hill Crest and its subcontractor, ACS, have made provisions and established procedures for routine medical services, emergency medical, and/or 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. Restocking the emergency cart supply is the responsibility of the facility managers, or facility nurse supervisor who may be there at the time. Pharmacy will check and restock on a routine basis and after emergency use. Pharmacy services are available at both facilities. Identi?ed problems, recommendations, and actions taken will be noted on the Code Blue Critique Form. It is the responsibility of the Performance Improvement Coordinator 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 Director of Nursing and assures any identi?ed problems are met with appropriate action. These reports go to the Safety Comrriittee. Outcome data will be submitted in the format prescribed by the State DHR. . We will obtain a. ?Satisfaction Survey? at discharge and six weeks post discharge With the child, family (if available), 0 I I .ded and DHR scrotal worker to assess satisfaction With the seryices, care, and treatment provr . I Program changes will be implemented based on information received. The appropriate facility staff . . - - ?ll be placed in the aSSists With sending out the 6 week post discharge survey The surveys wr . gigginedical record by the Medical Records Department Results of the satisfaction surveys will be discussed quarterly (at a minimum) and submitted to DHR on a quarterly bans. Results of initial, quarterly, and discharge . . .11 local and state DHR of?cials. Other outcome data, as directe distributed to staff and state and local DHR of?cials. Both facilities will provide an active treatment program which is highly structured and will provide a 3?3 000101 . positive enviro nment in Which all clients can have a success-oriented experience. The program is described in more detail below. itself The - . of monatlonas Speci?ed in the ISP and as needed to meg-t the needs sometimes be able men .. have vans made and have numerous licensed drivers. We will We will transport f00 Egg/Ede transmutation to faintly members to ensure involvement in treatment. activiti . . medical, dental, and Viswn appointments. as well as for extra-curricular es, 0 mid socral skills. The RISE Program will provide transportation to this activity. 1221:1136 1n the Program will'receive vocational education 1 hour each school day and . (art, musrc, sports, ?eld trips, etc) 2 hours a day, every day. Clients will be involved in ?311.1qu tn-house and ?eld trips. We will take advantage of the many resources available to Greater area. The RISE Program will also plan ?eld trips that reinforce classroom learning a theater production at Birmingham-Southem College at the conclusion of an academic umt on drama/theater). Clients will also be introduced to positive activities and experiences. As a result, clients will ideally develop new hobbies/interests that support progress in treatment and prepare them to succeed in a step-down placement. The purpose of these activities is to provide the client with positive, successful experiences through physical, cultural, and social accomplishments. The RISE Program will provide independent living services focusing on learning the skills required to live successfully on their own. Topics of discussion will include, but are not limited to, meal planning, laundry, general housekeeping, budgeting, employability skills training, and the exploration . of post-secondary education opportunities. These supplemental Independent Living Services will be carefully coordinated with the treatment team and DHR social worker in accordance with the child?s Independent Living Plan. 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. Transitional or Vocational Education will be a part of every school day. The objective, in addition to school credits, will be a structured, systematic preparation for living independently. While on the unit, clients will be assisted by RISE staff to manage laundry, personal organization, and light housekeeping (their own personal area). Clients will also be . involved in planning outings, activities, and special events. Through daily mtenswe and debriefing groups, the client will learn and practice social skills such as assertiveness, leadership, and the Vltal skill of goal setting and evaluation. Clients will attend on-site schooling .for a full schooluday during the academic year. Behavior . interventions are implemented into the academic setting that promotes appropnatc'behawor while In a structured learning environment. During the summer months, the academic focus [8 on vocational. exploration. instruction is provided in a small setting and IS structured but mdrv1duahzed. Ingtrucuon will be based on initial and ongoing assessments of both academic knowledge/grade level as learning style. The client who gives a good effort in school Will stay on pace to receive or: Atls bor both core classes and electives. Classes and credits thatwdl be offered are in keeping wn a argad High School graduation requirements and GED instructions. Special Education servuilels a? certi?ed special education teachers. School behavior will be used to help evaluate 0 rent 3 pzogression in the Rehabilitation Intervention Service program. . Facilities will provide weekly allowances or ?bonus bucks? in the range of $5.00 to $20.00 per week, 3% 000102 . dependent on the child?s age, the ISP guidelines, and the client?s effort in treatment and maintaining safety. The newly admitted client will have the opportunity to earn $20 a week. Allowances are not used to recoup for damages or restitution. Facilities will provide each RISE client with $50.00 per month for personal and special needs and occasrons. The facility will provide basic hygiene products free to the clients. Combined with the allowance, this makes for a considerable sum, and savings accounts will be encouraged and Further, the client will work with his/her primary therapist to plan spending and savings. The cash will remain in a safe location until spending and savings are planned. The child will be given much discretion to make personal preferences known. The children and their family will not be required to spend their own funds for personal care, special needs, or special occasions. Parent/Family supportive services are extremely important to the success of the RISE children. We recognize that both time and money are well spent when family ?mctioning and relationships are improved. We can often offer to feed and transport parents to facilitate family involvement in treatment. We will offer family sapport groups, traditional (on-site) family therapy, and phone/video conferencing contact for all to foster family participation in the client?s therapy. The treatment day will not limit family contact. Daily supervised visitation will be available as well as visitation outside of these hours, which can be arranged on a case by case basis. DHR policies regarding visitation will be followed. Limits on family contact require ISP authorization and a physician order. We will invite family to attend treatment team meetings and strive to be accessible and available to . support the family as they support their adolescent in treatment. Our Family Impact Program and Behavioral Treatment Model help parents and family 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). Additionally, we will provide traditional family therapy. Twice opposite from Family Impact, the family will meet with the therapist and client. The focus Will be on improvmg communication and using the RISE treatment program acquired skills. ura the stren thenin of relationships with peers, family, and other accgord with ISP afd re?ected in the Master Treatment Plan. Whenever possible, we will involve the client?s family and/or ISP team members to be involved in the development of the behavior management plan that ts contained in the Master Treatment Plan. Through family therapy sessions, Family Impact Saturdays, and informal utteracttons staff, the family will be trained to use (on patient temporary leaves'of absence from the . 1 approaches that are working for the child while he/she is in the RISE program. Wt: wr hcomm?c? to the family that we serve in their role when the cluld is in our facilities and that. 'ey :h en :iid? it our role when the child is with them. The family, as a result, has input in progress in treatment and is part of the behavroral management plan. Additionally the following measures are also provided to further encourage the child?s relationship with family, peers, and signi?cant others: - Siblings and extended family will be invited to participate in Family Impact; and 'call th often come; . . . 1113:3112: aditissieg?ns, as part of the ISP and intake process, we ask DHR to identify a ?40 0001 03 lame! placement remurce for the child. We will make adjustments in schedules and help tuiiLforvisitntionarxl super-Vise all visitations. We can be ?exible in scheduling this to meet family/vim recommneeds. resource will be invited to the continent team meeting in which beupdamd Thisupdatewill include consideration of discharge plan issues; We will not permit facility or program policies to hinder family contact miles identi?ed mtheISP. Wewillutilize tours, ?exibleschedules, mdthempportofothetfamilie?vie Femily hnpoct Group) to overcome anxieties and make families feel connected. ?they Willbepartofthetcam. changes withom mowing blame for previous ?tiled placements; Opportunities to have phone contact with family members for both social and therapeutic gain will be numerous; Vile agree to comply with all policies developed by DHR warding family enamel and ?suction. Tutoring will be available by quali?ed staff when directed by the (or IEP for special education). Some facilitystaffateregularschool personnel andcanoffertutoringservices while being employed chum-WW5. the need arises. The school teachers are also available for tutoring. At least two hours of tutoring per week will be available as required by the ISP. Tutoring will be monitored for the achievement of outcomes in the educational setting. We understand and aclmowledge the following: Discharge for my reasonodterthan successful completion ofthe program requires approval from State DHR Division of Resource Management; All services must be billed in compliance with Chapter 33 of the Medicaid Provider Manuel; mustbeappmved bythe ISP team. A Department pwchese order must be secured by the provider paint to service provision for services authorized in the 131? that are not eligible for Medicaid rcimbmsement; The parties understand and acknowledge that the Contractor may, in rate circumstances and in accordance with the County Department's procedures, bill the County Depot-uncut for certain ancillmy services; The parties and acknowledge that the Contractor will bill Medicaid and receive payments for all Medicaid eligible children directly from Medicaid. Payments for non-Medicaid eligible children will be made by the Department ofHuman Resources at the same rate paid for Medicaid eligible children. The contractor W111 be for any charge-backs on Medicaid eligible children and non-Medicaid eligible children. Mgr-am Requirements mt. ?ll 000104 . treatment programs in Alabama, or need a ?step-down" from the Mental Health Department Unit at UAB (court ordered treatment for evere mental illness . These teens have been denied at lower levels of care (including intensive residential treatment). for Will provrde a highly structured and safe environment to facilitate stabilization of th 00 and behaViors. The focus Will be on developing positive relationships with others so at amin reunification or step-down to a less restrictive level ofcare is possible. The program will comply With Medicare/Medicaid criteria, Title VI and VII, and Part 483 of the CF regulations. The program Will be located in Jefferson" County, AL and will be certified by the JCAHO. The programs will exclude teens that are actively suicidal and/or homicidal or show of uncontrolled When such teens are referred to the RISE Program, we will assist in obtaining hospitalization and, upon resolution of the emergency, refer the client back to the RISE Program or another appropriate Residential Treatment Center. The RISE Program will be equipped to serve a wide range of diagnoses while addressing severe mood and behavioral issues. Treatment will be individualized, based on cognitive and behavioral elements, and always undergirded by values of mutual respect, patience, compassion, and The RISE Program will not serve teens presenting with a primary problem of sexual aggression or sexual reactivity. As the details provided below demonstrate, this will be a comprehensive treatment enviromnent. Services will be closely coordinated with State and County DHR of?cials and authorized by the client's ISP. At admission, the will be created or updated to re?ect placement in the RISE Program and will authorize the provision of services at this level of care. An adeSSlon will not occur without such an ISP. That is, admission to the RISB Program will be planned, authorized by State DHR, and appropriate for the and needs of the client. A client's success will require that DHR workers maintain regular contact With the client and the RISE Program. RISE PROGRAM REQUIREMENTS meet or exceed all of the program I Crest attests that it and any proposed subcontractor W1 . . . . ghiimments for Rehab Intervention Service Enrichment clients. This is a brief overvrew of how these requirements are will be met. ?l7. 000105 A. Licensedby DHR or Department of Mental Health Current servrces at Hill Crest or ACS are licensed by DHR and/or the Department of Mental Health. The RISE Program meet all licensing requirements identi?ed in this RF P. B. Complete the Certi?cate of Need on Emergency Placements A Certificate of Need (CON) will be completed prior to or at the time of admission to the RISE Program, depending on the case situation. The RISE Program admissions must and will meet CON on one. C. Admission Assessments (Assessments of Client Functioning) Upon hospital admission, then quarterly and at discharge, assessments will be obtained of the global mental, behavioral, and emotional functioning of RISE client in his/her various environments. A standardized assessment tool, such as the CAFAS or the Kennedy Axis V, will be utilized to assess/validate global functioning level. The results of these assessments will be shared with DHR social workers for the ISP process and for development of goals and strategies to speci?cally address preparations for the child to discharge into a less restrictive living environment. These results will also be shared with State DHR Division of Family Services and Division of Resource Management. Other assessments will also be administered during hospital admission as needed throughout the client?s stay in the RISE unit. These assessments are discussed in further detail in Section 4.2.5.3.1. D. Structure and Schedule Proposed daily schedule is attached as Appendix A 4.2.5.11. The schedule for the weekend and holidays is the same except that the classroom academics are eliminated. The RISE Pragram will be highly structured with time for daily chores, homework, community and daily living activities, structured recreation, social skills training, group therapy, individual therapy, and education. E. ISP Master Treatment Plan Coordination Hill Crest and its proposed subcontractor will fully participate in with the faintly, DHR, and other providers if any are involved. We will schedule and coordinate the child?s treatment plan in conjunction with the ISP and the child?s Individual Education Program We will ask for, and host, ISP and meetings and updates. We will request at admisston, every six months, and when significant changes in case plans are indicated. We will go to great to involve the family/guardian in ISPs and other treatment activities. Help With meals and transportation can be offered when this will improve family involvement. We will be creative and proactive to help the client. We will work to ensure that family members (if available) feel comfortable and not intimidated by the treatment process. Hill Crest?s best ally in this process Will be the family members who regularly attend "Family Impact,? a event involvmg the family members of clients who continue to attend even when their child had discharged. We Will incorporate the into the client?s Master Treatment Plan. The initial treatment plan will be developed within 10 days of admission and reviewed at least thereafter. F. Behavioral Management 000106 '45 Exciegaworal Management Plan will be incorporated in the Master Treatment Plan which will strength Ssont input of the client and their family. It will focus on the use of individual will be a fiesta and Will be positive. The aspect common to each client in the program inulti le ru es centered onisafety and effort. When expectations for safety and effort are met, each Elie rem odrcers (rewards) Will be available. These will be speci?c to the unique interests of in relatiogti mil}; serve to further develop and hobbies. The client?s response or progression th beh . behavior management plan will be monitored, providing a basis for evaluation of avror plan. Daily rewards Will also be built into the RISB Program. G. Staff Coverage Staffing ratio on the Rise Program will meet or exceed the staf?ng requirements identi?ed by State DHR in this RFP. H. Staff Training Both Hill Crest and ACS already offer extensive training for new hires, training throughout the year, and annual in?service training which meet and/or exceed all training requirements of Minimum ?La_n_da_r_ds. Training not included in the Minimum for Residential Child Cam Facilities is also offered at both facilities through which employees are trained in, among other courses, Non- Violent Crises Intervention, Verbal De-Escalation, Patient Rights, life skills, ?rst aid, medication, and diagnosis of mentally/behaviorally disturbed children and adolescents. All staff training is documented in the Staff Development ?les. urther, all RISE Program staff will be trained in elements of treatment afforded clients and will include training in adolescent development, Axis I and ll diagnosis, and medications. This will ensure a consistent and supportive milieu for clients. Most importantly, RISE treatment philosophy is based on a belief that real and sustained positive change is possible when clients, family members, and staff work as allies. I. Reports reports, in the form of the comprehensive Master Treatment Plan updates, will be mailed to the county DHR worker, State DHR Division of Resource Management, and Division of Family Services. This report will include progress updates, current diagnosis, school report, medication and information on family involvement (if available). It will also detail current medical ons occurring during the month (such as restraint) and any changes update, al that these reports will arrive at the local and state DHR problems and any Special situati in the discharge plan. It is our go of?ces by the 15?? of each month. J. Ensure that Children are receiving Education Services . opmental task for all clients, but it is even more Vital for clients in Pro ass in school is a key devel trea?lnent. Due to family chaos, emotional/behavioral problems, and frequent moves (usually before and after DHR custody); clients in facilities are at a high risk for educational failure. The Education pro assesses for learning styles and incorporates this information in the client?s IEP. We anticipate that 100% of our students will merit Special Education Service:Ci The educationalth ill Pro ram will inco crate both core and elective ucattona asses a component ofthe RIS rp will be a structured study . . . . ll the an a and academically appropriate education. Included as we . ginorfor bothg homework assistance and formal tutoring for problem academic areas. We aim for clients to demonstrate academic improvements that are double their length of stay. Thatis, for a 9 month stay, we hope to see achievement scores increase by 1.5 grade levels during that time frame. 0001 07 K. Routine and Emergency Medical Care gaming and emergency medical care will be provided. There will always be a nurse available to the requrred. Routine medical care will be provided by a family practitioner, CRNP, or emergent medical needs of the child which cannot be met at the facility will be handled through referrals to the appropriate professionals, depending on the individual?s needs for best care, including referral to local hospitals for emergency medical treatment if required. Prompt return to the RISE Program is anticipated in such a situation. All external providers will be required to bill Medicaid for services rendered. Hill Crest/AC8 will not be for any necessary external medical services provided. We will assure timely medical services. L. Outcome Data Results of initial, quarterly, and discharge assessments will be provided to RISE staff, as well as local and state DHR. Initial, ongoing, and discharge educational assessments will also be forwarded to local and state DHR of?cials. Other outcome data, as directed by DHR, will be obtained and distributed to staff and local/state DHR of?cials. M. Satisfaction Questionnaire (Survey) . We will obtain a ?Satisfaction Survey? at discharge and six weeks post discharge With the client, family (if available), and DHR social worker to assess satisfaction with services, care, and treatment provided. Program changes will be implemented based on information received. Examples of program changes based on the surveys we have received in the past have included increasing the number of co-ed functions, adding supplemental substance abuse groups (with supplemental social skills training, and a more vigorous school day. The appropriate facility staff will assist with sending out the 6 week post-discharge survey. The surveys Will be placed in the . child?s medical record by the Medical Records Department. Results of the Satisfaction Surveys Will be discussed quarterly (at a minimum). The results of the surveys. and any program changes instituted in the face of the results Will be submitted to DHR of?cials. CORE SERVICES OR REHAB INTERVENTION SERVICE ENRICHMENT We attest that we will provide all the services identi?ed below: . 1 Assessment . . gig; 52d on- going assessment as to c. medical, social, and ?ll be discussed in functionin Will be obtained and documented. This wt . giggi?iam meetings. In addition, when required to clarify-diagnose or spam] problims, will evaluation may be ordered. The physician, With input from the Treatment earn, adjust Axis I through diagnosis or treatment objectives as necessary. 000108 ?1 . 8. Professional Staff In the RISE Program, clients will be provided frequent contact with licensed professionals, including a therapist, social workers, and other disciplines as appropriate. will supervise all aspects of care and will see the client to complete face to face sessrons at least twice a monthduty for 24 hours a day (at Hill Crest) and present at ACS during day and evening hours, on call nurses available overnight. tensive group therapy three times a week and Licensed Therapist/Social Worker- Will provide in he contact point for individual therapy two times a week. The therapist/social worker will serve as the family and DHR. Provides/administers testing when indicated by the physician and/or Treatment Team. The staf?ng ratio for the Rise Program will meet or exceed the 1:3 ratio established by State DHR. The Girl?s unit will have single occupancy rooms only. The Boys? Unit, located at ACS, will also be single occupancy upon admission. As the client progresses through the program, the Treatment team, including the DHR worker, may discuss moving the client into a semi-private room when . clinically appropriate. Other areas: Medication- The physicians are committed to appropriate, state-of-the'art, care. medications will be at the lowest level possible to provide for both safety and full participation in a rigorous treatment day. Further, our physicians strive to simplify/reduce medication regimes, to enhance compliance post discharge. Therapy? The client's Primary Social Worker/ Therapist will see him/her for individual counseling, twice weekly, at a minimum. Family therapy will be provided three different ways: 1. Family lmpact- Support group that meets twice a month. Family members, including ong standing and extremely successful siblings, attend with the client. This is a 1 treatment format that utilizes a variety of approaches to improve family communication and support. 2. Traditional Family Therapy Twice (opposite from Family impact), the family will meet with the therapist and client. Focus will be on improving communication. Evening and weekend sessions are available. 3. Phone/video conferencing Sessions? If a family is unable to attend on-site, phone/video conferencing contact will be made weekly, as part of an individual therapy session with the client. a1 worker/therapist, family (if available), DHR Master Treatment Plan within the ?rst 10 days of management plan which is C. Treatment Plans 'ng of the client, soci . The treatment team, consisti worker, and physician will create a comprehensiv Plan will include the client's behavior admission. The Master Treatment nib 000109 based on and interests. The goals established on the Master Treatment Plan will be measurable and capable of being achieved by the client. Though individualized, treatment goals will contain cognitive and behavioral elements with common goals of development of skill sets such as anger management, social skills, mindfulness, self-soothing, problem solving, and trauma recovery. The structure of the Master Treatment Plan will provide a guide to assist the client to develop appropriate communication and relationship skills, strengthen personal identity, and foster pro-social attitudes and behaviors with the treatment team, family (if available), others in the facility, and others within the community. D. Active Treatment Program The RISE Programs will provide an active treatment program which is highly structured and provides a positive environment in which all clients can have a success-oriented experience. The treatment day will be rigorously full and challenging. Coupled with the behavior management plan, it will provide almost immediate success and access to a range of reinforcers cash, ?bonus bucks,? special outings, point store The milieu will be structured and positive. For further information regarding the specifics on the treatment program, please refer to the Service Delivery Approach section. E. Transportation The RISE Program will provide local transportation as speci?ed in the and as needed to meet the needs of the clients in treatment. We have vans onsite and have numerous licensed drivers. We will sometimes be able to provide transportation to family members to ensure involvement in treatment. We will transport for local medical, dental, and vision care. F. Vocational and Recreational Services . All clients in the RISE Program will receive vocational education and recreation (art, muSie, sports, ?eld trips, etc.) daily. Clients will be involved in planning activities and ?eld trips. We will take advantage of the many resources available in the Greater Birmingham area. Hill Crest/AC8 also will plan ?eld trips that reinforce classroom learning (such as a play at Birmingham Southern at the conclusion of an academic unit on drama/theatre). Clients will also be introduced to positive activities and experiences. As a result, ideally, clients will develop new hobbiesfmterests that support progress in treatment and prepare them to succeed in a step-down placement. Team sports are a good example. The purpose of these activntes 18 to provrde the client With posmve successful experiences through physical, cultural, and socral accomplishments. G. Independent Living We will provide indepen successfully on their own. objective, in addition to school credit . Living Services topics of discusswn kee in bud eting, employability skills . . . These supplemental Independent Livmg Services Will be dance with the child?s With the Treatment Team and DHR socral worker in ac cor . . Legerghiagm Living Plan. Some of the areas involved in the independent component are assistance in applying for ajob, employment opportunity, transportation, money magagelment, relationship building/dating skills. Through daily intensrve and debriefing groups, 1entw1 dent living services focusing on learning the skills required to live Transition/Vocational Education will be a part of every school day. The s, is systematic preparation to live independently. Independent include, but are not limited to meal planning, laundry, training, and the exploration of post- in 000110 learn and tactics social - - - . evaluationp skills such as assertiveness, leadership, and the Vital skill of goal setting and H. Education The school program will be structured but individualized. Instruction will be based on initial and ongomg assessments of both academic knowledge/grade level and learning style. The client who gives a good'effort in school will stay on pace for credits for both core classes and electives. Classes/credits that will be o??ered are in keeping with Alabama High School graduation requirements. GED instructions and testing will be offered, but only when graduation options have been-exhausted. GED instructions and testing can be offered. Special Education services will be proVided by certi?ed special education teachers, in accordance with clients? TEPs. School behavior Will be used to help evaluate the client?s progression in the RISE Program. I. Allowance Allowance for the RISE Program will be $5 to $20 weekly or ?bonus bucks?, based on effort in treatment and maintaining safety, as well as dependent on ISP guidelines. Allowances are not used tourecoup for damages or restitution. Newly admitted clients will have to opportunity to earn an a owance. J. $50 a Month The RISE Program will provide $50 a month that the client may spend on hair care, gifts, hobbies, clothing, etc. (The facility will provide basic hygiene products free to the clients). Combined with allowance, it makes for a considerable sum, and savings accounts will be encouraged and facilitated. Further, the client must work with his/her primary therapist to plan spending and savings. The cash will remain in a safe location until spending and savings are planned. Routine outings/?eld trips and activities will not require client funds. We anticipate clients being able to purchase much of their own personal clothing, if desired, out of their own funds (though we always welcome DHR vouchers). K. Supportive Services to the Family The RISE Program?s attitude towards families is warm, open, and inviting. Clients do better when they have family support, and we will do all we can to facilitate family involvement. As discussed above, we will offer family support group, traditional (on-site) family therapy, and phone/video conferencing contact for all to foster participation in the client?s therapy. If the client progresses but family dynamics do not improve, the client's progress can rapidly be lost. We are creative and persistent in encouraging family involvement. We can offer to feed and transport family members to facilitate family involvement in treatment. L. Relationships with Family The RISE Program encourages family visitation. Daily supervised visitation will be available, if indicated in the Mater Treatment Plan/IS P. Visitation outsideof these hours'can be arranged on a case by case basis. The designated space for visitation is a qmet and conducive location. .1138 . treatment day will not limit family contact and participation. policies regarding Visnation Will be followed. Limits on family contact require ISP authorization and a order. We mvrte family to attend Treatment Team meetings and can (at times) With family '18 000111 transportation costs; we st child. rive to be and available to support them as they support their M. Tutoring Tutoring, to 1 or in small groups,- will be provided by a teacher or other quali?ed staff member. On school days, tutoring will be provided during study hall time on the unit. If required, tutoring can be provrded at other points in the day. As discussed above, progress in education will be assessed. Small classes, a variety of approaches tailored to learning styles, regular tutoring, and behavior plans help produce a cairn and productive classroom and positive result. Tutoring will be monitored for achievement of outcomes in the client?s educational settings. We understand and acknowledge the following: - Discharge for any reason other than successful completion of the program requires approval from State DHR Division of Resource Management; 0 All services must be billed in compliance with Chapter 33 of the Medicaid Provider Manual; 0 All services not included in this agreement must be approved by the ISP team. A Department purchase order must be secured by the provider prior to service provision for services authorized in the ISP that are not eligible for Medicaid reimbursement; The parties understand/acknowledge that Hill Crest, in rare circumstances and in accordance with the County Department's procedures, bill the County Department for certain ancillary servrces; 0 The parties understand and acknowledge that Hill Crest will bill Medicaid and receive payments for all Medicaid eligible children directly from Medicaid. Payments for non- Medicaid eligible children will be made by DHR at the same rate paid for Medicaid eligible children. Hill Crest will be responsible for any charge-backs on Medicaid eligible children and non-Medicaid eligible children. 4.2.5.3.2 Start-Up Plan rest and ACS are prepared with all services and adequate staff to provide Rehab Intervention 0 beds and may begin accepting clients October 15, 2012. Hill ed in this RFP. Hill Service Enrichment treatment for 4 Crest and any subcontractor will meet the requirements outlin It not Speci?cally outlined in Section Scope of Work balancing, and group interaction skills; supportive groups for the child and the child?s Supplemental informatio The Repes Course entails various climbing, a Family Impact Weekends are educational an family; he facility and requires admission to a medical facility, we 0 When a child is discharged from . . . provide DHR some assistance with staying/sitting With the child until helshe hepefully returns back to the facility. Our start up plan is to audit all ?Core Services and Program Requirements? as per the scope of this project to assure compliancy. 4.2.5.3.3 Assessment of Bene?ts and Impact . We will make ongoing assessments of the bene?t and impact of RISE semces. ll?l 0001 1 2 Shelf, along With family members (if available), and the DHR worker will be surveyed at 15c rge and again at 6 weeks post discharge about satisfaction with the RISE services We antimpatethat this satisfaction survey will result in positive program adjustments Speci?call the input andideas of clients who successfully complete the program and get a step down in care {and results will also be reviewed and discussed by RISE staff to determine areas of the programs which can be built upon, and weaknesses, which might highlight needs for revisions. Additionally, results of initial, quarterly, and discharge assessment of client's global functioning will be analyzed. (For further information, see section above.) These instruments will provide information regarding how treatment has impacted clients? functioning over a wide range of domains. We would expect that functioning levels would increase across domains with RISE treatment. The global functioning assessments should provide information about whether treatment is globally effective across all domains or is more effective in select domains. With that information, program changes can be made to strengthen and focus treatment on any areas found to not signi?cantly improve. We will attempt to identify factors that best predict treatment success versus failure from such data. We will survey clients and staff on a quarterly basis concerning our behavior management system. We will be asking questions such as, ?Is it fair??; ?Is it effective??; ?What changes would you make if you could wave a magic wand?? We will survey all participants in the Family Impact program. In the past, surveys such as these have solicited very bene?cial feedback that has led to positive program changes. Through our Performance improvement process, an on-going review process at the facilities, we take a hard, analytical look at speci?c and meaningful indicators of whether treatment services are making satisfactory progress towards established goals. Some of these indicators will include a review of admission appropriateness, accuracy of tieatment plans, seclusion/restraint data, and critical incidents. Admission appropriateness, for instance, can be analyzed with a survey of sample charts to determine if the RISE client truly met the established admission criteria. Treatment plan appropriateness can be addressed with another chart audit. Through the Performance Improvement process, we can identify an area inneed of improvement based on quantitative measures, consistent observation, etc. Area(s) requiring improvement may be added to the Performance Improvement data to be collected and evaluated more closely. Indicators will be deveIOped to assess progress and goals. The Performance Improvement Committee generally meets quarterly throughout the year. committee has a as a Chairperson, and all departments throughout the facility are involved in this committee. The herformancte Improvement Committee will ensure continuous assessment of serVices and modification 0 services to better meet the needs of the RISE population. hich focuses on such issues as lso arttci ate in DI-IR 5 outcome monitoring . . [We WlIt?it'astaypproni?ptness of step down, and family involvement. We Will collect data and use it to the bene?ts and impact of our services. We will constantly assess the reasons for any 000113 60 treatment failures in speci?c cases and will make adjustments based on that analysis. 4.2.5.3.4 Of?ce Location Hill Behavioral Health Services Alabama Clinical Schools 6069.5 Avenue South 1221 Alton Drive AL 35212 Birmingham, AL 35210 4.2.5.4 VENDOR CERTIFICATIONS Hill Crest attests that we warrant and represent to the Department of Human Resources that Hill Crest and proposed subcontractor accept and agree with all certi?cations and terms and conditions of this RFP. By submission of a response to the RFP, Hill Crest certi?es to the Department that we are legally authorized to conduct business within the State of Alabama and to carry out the services described in the document 2012-100-07 Rehab Intervention Service Enrichment. 4.2.5.4.1 Revolving Door Policy Hill Crest attests that neither Hill Crest/AC8 nor any of its trustees, of?cers, directors, agents, servants, or employees is a current employee of the Department, and none of the said individuals have been employees of the Department in violation of the revolving door prohibitions contained in the State of Alabama Ethic Laws. 4.2.5.4.2 Debarment Hill Crest attests that neither Hill Crest nor proposed subcontractor, ACS, nor any of its trustees, of?cers, directors, agents, servants, or employees (whether paid or voluntary) are debarred or suspended or otherwise excluded from nor ineligible for participation in Federal Assistance programs under Executive Order 12549, ?Debarment and Suspensions." 4.2.5.4.3 Standard Contract Hill Crest and proposed subcontractor, ACS, agree to the use of the Department?s standard contract document. Hill Crest and ACS will comply with all terms and conditions of that document, including, but not limited to, compliance with Title VI 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, rules and regulations applicable to receiving funds from the Department to carry out the services described in this RFP. 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 laws, terms, and conditions, and may further be subject to revrew by the Alabama Legislative Contract Review Committee, Examiners of Public Accounts, the State Finance Director, and the Of?ce of the Governor. 41.5.4.4 Charitable Choice Non-Applicable 4.2.5.4.5 Financial Accounting Hill Crest and proposed subcontractor, ACS, agree that the accounting system will be consistent Si 000114 with General Accepted Governmental Accounting Principles (GAGAP). Hill Crest and A08 will maintain suf?cient ?nancial accounting records documenting all funding sources and applicable expenditure of all funds from all sources. 4.2.5.4.6 Vendor Work Project Hill Crest and proposed subcontractor, ACS, attest that the proposal submitted in response to this document, 2012-100-07 Rehab Intervention Service Enrichment, is the work product of Hill Crest and ACS. 0001 1 5 99.25%; State of Alabama Li; -, Department of Human Resources Il ~m?f (Z: 5. Gordon Persons Building ?9 so Ripley 5m: ROBERT BENTLEY 304000 Nancy T. Buckner Gamma, Montgomery. Alabama 36130-4000 Commim?oncr (334) 242-1510 bama.gcw October 24, 2012 Mr. Steve McCabe, Executive Director Hill Crest Behavioral Health Services 6869 5'h Avenue South Birmingham, Alabama 35212 RE: Contract #3326 FY4012 Dear Mr. McCabe: Attached please ?nd your capy of the Contract between our agencies from October 15, 2012 to September 30, 2014. Also attached and made part of this Contract is an Addendum B. which will provide terms of reimbursement for ?scal year. 2012 and/ or any attachments. am pleased that we are able to continue to provide this service through this Contract with your agency. If you have any questions, please contact the Of?ce of Resource Management at (334) 242-1650. Sincerely, ?v Nancy T. Buckner Commissioner SW: 18 Attachments PC: Resource Management Finance new! Opportunity Fmrluy" 000053 Contact lull. Pm: Wye on mm Hon MWJIM as?. Mabml 00mm of Man Resource: um. Memory. 0. Hitter-ll Behaviors! Health Services 0889 Avenue. Scum ma City ST W?s PW SM Mm (Na PD. Box) NOJL N0 YES NO '1..me 22mm WLNO .4334?; If?? Give Nam: mum-film a Ham.? 6 Cow-mm Tons: 3114450400000 1m: ?may: Mu: MM ?Foam ?mm. .. mean-m: Bumiw10/15m12 Coma awe/30,2014 Typelencr. MEML meme? mm "Mm.?il NU Mawwormm-umeb W?nhmudlmemm widen a out of India ?0le I In. snolhm Ilia-tor hon a batman?)! Received . .111, (Danae: Keven - CONTRACT BETWEEN THE ALABAMA DEPARTMENT OF HUMAN RESOURCES AND HILL CREST BEHAVIORAL HEALTH SERVICES CONTRACT NUMBER: 3326 (RISE) THIS CONTRACT (hereinafter referred to as the ?Contract") is hereby entered into by and between the Alabama Department of Human Resources (hereinafter referred to as the and Hill Crest Behavioral Health Services (hereinafter referred to as the for the purpose of purchasing the services described 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 sufficient 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 Comma shall become effective on the 15th day of October, 2012, and shall remain in effect through September 30, 2014, unless otherwise terminated earlier in accordance with its terms and conditions. The Contract may be renewed or extended by letter, or other written instrument, duly executed by the parties hereto. B. SERVICES TO BE PROVIDED l. 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. 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 to pan wath funds paid to the CONTRACTOR by the DEPARTMENT under this Contract. The term subcontractor may include, but is not limited to, service providers such as therapeutic foster parents, consultants, dieticians, behavioral aides, and any other professionals utilized by the contractor, The DEPARTMENT shall have the right under this Contract to review and approve, prim to their execution by the pm'ties thereto, all subcontracts and all amendments and extensions thereto, as I 000055 applicable, proposed by the CONTRACTOR for the purpose of carrying out any task or responsibility to be paid for in whole or in art with fu . DEPARTMENT under this Contract. paid to the CONTRACTOR by the The services to be performed by the CONTRACTOR subcontracted, in whole or in part, without the ?111? net'l?hb? terms and conditions of this Contract, and such additional terms and conditigicsm' the DEPARTMENT may require, shall be included in all approved subcontracts A rovallas ti:3 DEPARTMENT of a subcontract shall not relieve the CONTRACTOR of an' refponsib'l' the performance of services required under this Contract. The CONTRACTOR s?hall be: 131;; the DEPARTMENT for the performance, conformance and compliance of its 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. 1. 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 l. 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 $1 inseampo . 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 numb? of eligible units of service provided, as applicable pursuant to Addendum B, during the designated billing period. CONTRACTOR will submit said certi?ed statements to the DEPARTMENT on a 2 000056 l0. ll. basis following the end of each month services are provided under this Contract CONTRACTOR will further submit said certi?ed statements - . . in I - format and instructions as may be required by the tests In accordance w'th such For purposes of this Contract, ?scal year means the twelve-month September. The CONTRACTOR understands and agrees that the 33mg unable to reimburse the CONTRACTOR for any certi?ed statement of expenditures receivci?l 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 OfAlabama' 1n 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, mics and regulations have been fully met and satis?ed. The CONTRACTOR shall keep and maintain, t0 the DEPARTMENTS 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 ?irther 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. 11ie CONTRACTOR shall maintain all records, accounts, ?nancial records, statistical records, and other books and records under this Contract for the current fiscal year plus three additional years or until all pending matters are resolved, whichever is longer. This provrsion shall survive the termination of the Contract. To the extent allowed by applicable Alabama lair. the (30chqu will at all times indemnify and save harmless the DEPARTMENT against any and 81.] liabilities, losses, damages, costs or expenses which the DEPARTMENT may herea?cr Stirs? Incur. or berequned or ordered to pay: (1) by reason of any persons to be served under '5 outract suffering a loss or 3 000057 12. l3. I4. 15. damage either while participating in or receivin . from the CONTRA - hereunder or while on premises owned, CTOR the some? to be leased, or crated . (2) by reason of any person suffering persona] inju by the CONTRACTOR, or death, 0" pro 108 any of?cer, agent, employee or volunteer of the 27%) b; 1:8 $11;an 3:53:02): agent, employee or volunteer of the CONTRACTOR suffering personal in'u petty . eath, loss or damage; provrded, however, that the provisions of this no? giggly 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 ??om 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 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, 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 sewed under this Contract. TERMINATION 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 fulfill 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 termination, as fol lows: 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. 000058 OTHER AGREEMENTS l. The CONTRACTOR represents and warrants to the DEPARTMENT that i funds received from the DEPARTMENT under this Contract there will b: 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 I975), 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 hands received from 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 CONTRACT OR's 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 Alabma 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 213 of the Constitution of Alabama, 1901, 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 Attomey General, when considering settlement of such disputes, to utilize appropriate forms of non-binding alternative dispute resolution including, but not limited to, mediation by and through the Attorney General?s Office of Administrative hearings or, where appropriate, private mediators. The terms and conditions of the Contract may be amended only in writing duly executed by the parties 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 funds 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 Complimce Requirements," which is hereby incorporated into this Contract by reference and made a part iter as if set forth herein .verbatltn, and any. additional forms, disclosures, reports, procedures, timeliness standards and instructions pertaining thereto 88 may be required by the DEPARTMENT. All references to the Contract Compliance Requirements 5 000059 10. 11. i3. document in this Contract shall be deemed to refer to th - document, as amend ed by the DEPARTMENT. Contract Compliance Requirements Th: and represents that the funds rece un er is ontract not be used for the purchase, develo mentor property, including land, real estate and any appurtenance warrants and represents to the DEPARTMENT that said funds shall not be used for the purchase or development of any personal property of any type, whether tangible (such as equipment) or Intangible (such as copyrights and patents), without the prior written consent of the DEPARTMENT. Title to all personal property purchased or developed by the CONTRACTOR said funds under this Contract shall vest upon acquisition, or development with the DEPARTMENT. Said personal property shall be governed by the applicable laws, iegulations 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. ived from the DEPARTMENT The CONTRACTOR shall carry appropriate liability insurance, including but not limimd to liability insurance covering on-premises liability and off-premises liability for clams against the CONTRACTOR by any and all service recipients, employees and other persons. The CONTRACTOR shall also carry 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 Certificates of Insurance prior to transporting clients. No employee, agent, consultant, servant, representative, officer, 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. of the Board of Directors, or other governing body, are expressly gar-mm 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. RTMENT that neither the NTRACTOR warrants and represents to the DEPA . nor any of the trustees, of?cers, directors, agents, servants and employees (whether paid or voluntary) is debarred or suspended or otherwise excluded from or ineligible for participation in federal assistance programs under Executive Order 12549, "Debannent and Suspension." the use or disclosure of information, by any party 811d f9? any The CONg?oiAce?l'S: or mipicms of services under this Contract that is not puma: . the of and directly connected with, the'performance of servrces under this 2363:;th prohibited, except as may be authorized in Minus by in the event such written antherization is given. the CONTRACTOR un em and am that 6 000060 lS. l6. 17. 18. I9. release of information forms, including the the client or the client's authorized represen to whom information regarding the client threatening situations when time does not equired written consent, must also be com leted tative, as applicable. citing each agency or or scmce recipient is to be provided, except in life- perrnit obtaining a written release. The DEPARTMENT may, at its discretion, perform consultation, teehnica and monitoring activities of such nature as to aid the CONTRA required hereunder and to determine compliance herewith. . assistance, training CTOR in carrying out the services Any Wb'iCitY given to the services provided under this Contract shall funding source. the The CONTRACTOR shall conduct DI-IR 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 mics 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 Information 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; 'des Protected Health D. Ensure that an agents, Including a subcontractor, to whom it provt . Information reZeived from, or created or received by the Business Associate on behalf of, the Covered Entity agrees to the some restrictions and conditions that apply to the Business Associate with respect to such information; 5 Make available Protected Health Information in accordance with 45 C.F.R. Section l64.524; (See Addendum D) dment and incorporate any lo Protected Health Information for amen . Protecwd Health information in accordance With 45 C.F.R. Section 164.526; (See Addendum 0) 'fed to Provide an accounting of available Protected Health Information TEQUI- zigzsures in accordance with 45 C.F.R. Section 164.528, (See Addendum Make its internal practices, books, and records relating to the use and disclosure of ived from or created or received by the business Prggici?? Entity available 10 the Secretary for PUFPOSCS of as 000061 20. determining the Covered Entity's compliance with this subpart; and Upon termination of the Contract, for any reason, return 01' destroy all Protected Health Information received ?om, or created or received by the Business Associate on behalf of the Coveted Entity unless unfeasibie or illegal to do so or that the . Business Associate for any other reason 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. J. Extend the protections of this Contract 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 _Bntity if the Covered Entity determines that the Business Associate has violated the material terms of the contract. for the duration of the agreement, that 51 mn this contract, the contracting parties affirm,_ gill violate federal immigration law out" einriitljoiy; 13:: fso?t or subcontract an unau orize ien . $231120: cat?rfg?acting party found to be in violation of this prowsmn shall be deemed Th: bu sell of die agreement and shall be responsible for all damagesresultmg thei'lefrorn.that is shall participate in the E-Verify program and verify ever-1y emplizz'izcm The ?red to be veri?ed according to the applicable federal rules an that the shall provide documentation to the- ?tabu?bc?me iv ed by comm is '5'?st assessment n, to the beginning 0 . er the ??mg?ig?n? Certi?cate of Compliance With the ?gitim protection Act (ACT 2011-535, as amended by Act 201 . a ffective TRACTO agrees that this Contract is not acknowledges, understands an 81m? net Eglftohlzs receivedRall requisite state government 33133233 ENT. The this Contract um um . date of :tilt?iitigd to compensation for work performed prior to the effective CON the Contract or the extension amendment.