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HomeMy WebLinkAboutMINUTES - 05061997 - C89 TO: BOARD OF SUPERVISORS , V, William Walker, M.D. , Health Services Director By: Ginger Marieiro, Contracts Administrator �`�=JF Contra Costa DATE: Apr i l 23, 1997 ((�� }}�� Approval of Intercounty Services Contract #24- ith ACION9bTa SUBJECT: County for Provision of Psychiatric Treatment Services for Adolescents SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Chair, Board of Supervisors, to execute on behalf of the County, Intercounty Services Contract #24-889 with Alameda County, for the period from March 17, 1997 through June 30, 1997, with a payment limit of $89, 040, for the provision of psychiatric treatment services for seriously emotionally disturbed and behaviorally disordered adolescents. II. FINANCIAL IMPACT: This Contract is funded by County's Mental Health Realignment funds, and is included in the Health Services Department' s budget. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: Under this Intercounty Services Contract, Alameda County will provide four beds for the Subacute Treatment for Adolescents with Rehabilitation Services (STARS) Program for County-referred adolescents who would otherwise be hospitalized at Napa State Hospital. These STARS Program clients . will receive residential care, intensive day treatment, non-public school education, and acute psychiatric health facility services, as required. CONTINUED ON ATTACHMENT: YES SIGNATURE: V" RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIG'NATURE(S) ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS 4 UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD Contact: Donna Wigand (313-6411) OF SUPERVISORS ON THE DATE SHOWN. CC: Health Services (Contracts) ATTESTED Risk Management Phil Batchelor,&rk of th4 Board of Auditor-Controller Supervisors 2nd County Administrator Contractor M382/7-83 BY _ _ _. — DEPUTY I hereby certify under penalty of perjury that the President of the Board of Supervisors was duly authorized to execute this document on behalf of the County of Alameda by a majority vote of the Board on 3/25/97 and that a copy has been delivered to the President as provided by Gcivernment Code Section 25103. d ATTEST: Date: 3/31/97 LESLIE J.BURNS,Interim Asst.Clerk of the Board of Supervisors,County of Alameda,State of California OF qtq� � O O Y P _dt C111FOAN\ ' By 24 - 889 �ontra Costa County # Alameda County # INTERCOUNTY SERVICES CONTRACT 1. PARTIES ---The o lowing-name ounties or their respective Agencies-and Departments �- specified below,mutually-agree and promise as follows: County Providing Services: Alameda County (for its Health Care Services _1J Agency/Mental Health Services) County Receiving Services: Contra Costa County (for its Health Services Department/ Mental Health Division) 2. TERM. The effective date of this Contract is March 17, 1997 and it terminates June 301997, unless terminated sooner as provided herein. 3. OBLIGATIONS OF COUNTY PROVIDING SERVICES. Alameda County shall provide for Contra Costa County, during the term of this Contract, access to the mental health treatment services as set forth in the attached Program Description and Performance Requirements (Exhibit A), which is incorporated herein by reference. 4. OBLIGATIONS OF COUNTY_RECEIVING-SERVICES-AND-PAYMENT-LIMIT-.---Contra-Costa-- County shall pay Alameda County, as an all inclusive amount for the guaranteed access and service availability as specified in the attached Exhibit B, which is incorporated herein by reference, a maximum of$210/day for each Medi-Cal eligible client and $420/day for each non Medi-Cal eligible client placed in the program. 5. GENERAL PROVISIONS. This Contract is subject to the attached General Provisions which are incorporated herein by reference. 6. SIGNATURES. These signatures attest the parties' agreement hereto: CONTRA COSTA COUNTY ALAMEIDA COUNTY By: By: Board of Supervisors Board of Supervisors Preside t/Designee President/Designee a Mental Health ector esignee Mental Healt irector/Designee ° qqJ e ATTEST: ATT T: C rk the Board/Deputy Clerk f the Board/Depu CrL: APPROVED AS TO FORM: APPROVED AS TO FORM: Deputy County Counsel Deputy County Counsel Contra Costa County # Alameda County # GENERAL PROVISIONS - 1. Independent--Contractor-Status ---- T-his—Contract---is- by-and—between- two -independent -- - - -contractors and is-not Intended to and shall-not-be construed to create the relationship of-agent, - - servant, employee, partnership, joint venture, or association. 2. Amendments. This Contract may be modified or amended by a written document executed by each County's Board of Supervisors, or after Board approval, by their designees. 3. Indemnification. Each County and its respective employees, agents, and officers shall be indemnified and held harmless by the other County against any and all claims, demands, or causes of action arising out of any act or omission of any officer, agent, or employee of the other County while performing services under this Contract, or resulting from the condition of any property owned or controlled by the other County. Each County shall maintain a self- insurance program and/or other insurance, which maintains the following minimum coverage levels. A. Workers Compensation: Statutory requirements B. General and Automobile Liability: $3,000,000 per occurrence combined single limit bodily injury and property damage. Deductible of$5,000 or less per occurrence. C. Professional Liability: $3,000,000 per claim. Deductible of$5,000 or less per claim. Additionally, Alameda County shall require its subcontractor to name as additional insured the County Receiving Services and to maintain the above referenced coverage levels. 4. Termination. This Contract may be terminated by either party, at their sole discretion, upon sixty-day advance written notice thereof to the other, and may be canceled immediately by written mutual consent of each County's Mental Health Director. 5. Notices. All notices provided for by this Contract shall be in writing and may be delivered by deposit in the United States mail, postage prepaid. Notices shall be addressed as follows: Contra Costa County: Director, Contra Costa-County Mental Health 595 Center Avenue, Suite 200, Martinez, CA 94553 Alameda County: - Mental-Health Contract Office 777 Davis Street, Suite 350, San Leandro, CA 94577 6. Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties. Except as expressly provided herein, no other understanding, oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. Initials: Contra Costa Alameda EXHIBIT A COMMUNITY BASED ORGANIZATION MASTER CONTRACT -PROGRAM DESCRIPTION AND PERFORMANCE REQUIREMENTS Contractor Department: Behavioral Health Care Services Contracting Name: S.T.A.R.S. Contract Period: September 1, 1996-June 30,028 (First Clients admitted March 1997) Units of Service FY96/97 FY97/98 1. Contracted Services: Psychiatric Health Facility (16 Bed) 1,502 4,967 RCL 14 Group Home (32 Bed) 3,019 10,513 Intensive Day Treatment 3,019 12,694 Non Public School. 2,778 8,974 2. Program Name: S.T.A.R.S. 3. Program Objectives: A. To provide Alameda County with an assessment and treatment-oriented alternative to state hospitalization for seriously emotionally disturbed and behaviorally disordered adolescents who would otherwise be inappropriately placed in programs not geared_to meet their special needs. B. To provide comprehensive multidisciplinary evaluation and treatment services involving the adolescent, his/her family and community-linked agencies during an acute psychiatric episode for an average of 30 days on the PHF unit and an average 180 day length of stay in the Group Home. C. To provide a safe, protective and nuturing environment which maximizes the opportunity for the adolescent and his/her family to resolve psychopathology and.achieve-family..preser-vation with-a-maximum-length of stay of 60 days in the PHF unit and 365 days in the Group Home. D. To provide the adolescent with the necessary coping and survival skills to ensure successful.transition to a less restrictive setting in family reunification, foster family or small group home placement. - E. To involve the family (when appropriate) or staff of the discharge placement in the treatment process to maximize the success of reunification or placement and to help the adolescent maintain the gains:achieved in the A S.T.A.R.S. program — - F------T-o-ensur-e-community-support-services-are-adequately used and to assist in resolving interagency disputes affecting the treatment of the adolescent. 4. Program Description and Requirements: 4A. Members of the Board of Directors: Mary Jane Gross, RN, MN, President Ginger Sumner, Vice President Peter Zucker, Vice President , 4B. Administrator: Peter Zucker, Ph.D. 4C. Medical Director: To be announced 4D. Contract Program Director(Clinical Director):To be announced 4E. Contract Fiscal Officer: Bruce Wright, C.P.A. 4F. Program Description: The Subacute Treatment for Adolescents with Rehabilitation Services (S-T.A.R.S.) Program will be divided into four components. The first component is a 16 bed locked Psychiatric Health Facility (PHF),which will provide intensive evaluation, assessment and treatment for the seriously emotionally disturbed adolescent in acute distress. This locked unit will provide a local alternative for treatment and allow families to visit and participate in their adolescents'treatment. The PHF is licensed r.by the State Department of Mental Health. This locked component will be designated for involuntary admissions (5150/5250), and would meet CAC Title 9 requirements for use of restraint and seclusion. The second component of this program is the 32 bed unlocked not-for- profit residential Group Home licensed under Community Care Licensing (CCL). This component will meet the educational and experience-staffing and-program requirements-for-a-group home with an RCL of 14 and be certified by the Departments of Mental Health of Alameda County. The third component of the program would be the Intensive Day Treatment Program encompassing all the Group Home beds as well as eight (8) additional slots for non residents. This program would be provided seven days a week, 4+hours a day and allow for an intensive Page 2 psychiatric day treatment:milieu. This active,-reatment programming would be funded by and meet all the staffing, documentation and Program regulations of Short-Doyle/Medi-Cal. It is anticipated that approximately -- --- 95% of-the-adolescents-in this-program-would-meet the-Me&Ca1 criteria. - --Of-this percentage,half of the program costs will be offset by Federal Financial Participation(FFP). The fourth component of the program would be an on-site Non-Public School certified by the State of California as a special education school In this school program an Individual Educational Plan(IEP)will be developed for each seriously emotionally disturbed (SED) adolescent in cooperation with the parents and the adolescent's home school district and integrated into the child's treatment program. The S.T.A.R.S. program will individualize treatment through the multidisciplinary treatment team which will include teachers from the school program. IEP's would be completed as soon as possible either prior to or after admission to insure State financial participation with the adolescent's home school district. Out of - home placements will be authorized by home school districts for"3632" adolescents to provide integrated residential treatment services with our specialized Non-Public School in order to treat the emotional disorder as well as the learning disability or school problem, and permit an uninterrupted educational experience. Given the effective assessment and evaluation, quality residential care and intensive treatment services, most of the seriously emotionally disturbed adolescents can be expected to be restored to their highest level of independent self-care; to have their symptoms of mental disorder reduced; to experience improved quality of life, and to be discharged to the least restrictive environment in which they can live without the need of costly continued acute hospitalizations and without a return to the State Hospital. DESCRIPTION OF SERVICES Activities of Daily Living Groups Nutrition/Dietitian Services Arts and Crafts Groups Occupational/Vocational Therapy Dance/Movement Therapy Physical Examination Group Therapy Psychological Testing Individual Therapy Real Life Issues Group Individualized Treatment Plans Recreational Therapy/Physical Therapy Laboratory,X-ray and EKG Services Outings Residential Care and Supervision Medication and Medication Neurological Testing(when indicated) Monitoring Substance Abuse Groups Targeted Case Management Non-Public School Page 3 PROGRAM ELEMENTS AND SERVICES Treatment Philosonhv: The approach of the STARS program is to — - - -- --- provide-a-caring;-qualified-staff,-a-safe;-pleasing environment, a nutritionally-balanced diet with three meals-a day and appropriate snacks, and a proven treatment program. Since a single therapeutic approach does not work for everyone, program offerings are based on the needs of the individual, including group, individual therapies,behavior modification, a variety of activity therapies and one-to-one interactions with staff members and other adolescents through an approach that is solidly anchored in a well supervised therapeutic milieu. All activities and interactions are processed through this therapeutic milieu, so that everyday activities of daily living can be a source of therapeutic stabilization, impact and change. The psychiatric treatment programs initiated by STARS reflect the belief that individuals, regardless of their level of psychological impairment, can be rehabilitated to their maximum potential. The goal of treatment is to place adolescents in less restrictive facilities at a lower cost of care, as soon as the individual achieves an appropriate level of personal responsibility. 4G. Program Goals:/4H. Performance Objectives: 1. To provide Alameda County with an assessment and treatment- oriented alternative to state hospitalization for seriously emotionally disturbed and behaviorally disordered adolescents who would otherwise be inappropriately placed in,programs not geared to meet their special needs. 2.- To provide comprehensive multidisciplinary evaluation and treatment services involving the adolescent, his/her family and community- linked agencies during an acute psychiatric episode for an average period of 30 days on the PHF unit and an average 1.80 day length of stay in the Group Home. 3. To provide a safe, protective and nurturing environment which maximizes the opportunity for the adolescent and his/her family to resolve psychopathology and achieve family preservation with a maximum length ---- of stay-of 60 days in-the-PHF--unit-and 365-days-in-the-Group Home. 4. To provide the adolescent with the necessary coping and survival skills to ensure successful transition to a less restrictive setting in family reunification, foster family or small group home placement. 5. To involve the family(when appropriate) or staff of the discharge Page 4 placeme tin the txAatmepj,;process to maximize the success of reunification or placement and to help the adolescent maintain the gains achieved in the S.T.A.R.S. program. 6. To ensure_community_support services-are adequately used and to assist in resolving interagency disputes affecting the treatment of the adolescent. 7. To admit and treat 75 adolescents in the PHF unit and 50 adolescents in the Group Home per year. 8. To admit and treat 50 unduplicated adolescents in the PHF unit and 50 unduplicated adolescents in the Group Home per year. 9. To place 75% of discharged adolescents in more independent settings, i.e., home, foster care, small group home, etc. 4I. Discharge Criteria and Planning: Discharge planning shall be an integral part of the adolescent's treatment program at S.T.A.R.S.. Beginning at the time of pre-admission screening and throughout the course of treatment, discharge planning is addressed by the social worker in conjunction with the multidisciplinary treatment team on the adolescent's treatment plan. Continued assessment of the adolescent's discharge planning status occurs through review by the Clinical Director, the multidisciplinary treatment team and the County monitor. Alldischarges_will be.planned_in advance with every effort made to avoid precipitous discharges and/or readmissions. The objective is to provide long range planning to meet the needs of the adolescent and his/her family r as well as to take preventive measures to avoid the necessity for repeated crisis intervention at higher levels of care and to allow the adolescent and family to appropriately utilize community resources. Acute hospitalization may need to occur when dangerous, acutely unmanageable behavior -presents a serious threat to the safety of the adolescent or others and appropriate transfer will be implemented to the PHF unit. _ _.of_the_strengths_of the clinical-program will be the availability of two distinct units within which to provide intensive psychiatric inpatient treatment. Due to the nature and severity of their emotional disorders, many of the adolescents will follow the pattern of"taking two steps forward and one step back" in the course of their treatment and may move back and forth between the PHF and Group Home. The research indicates - and our experience confirms, that this pattern between locked and open Page 5 units sho4ld npt be unexpected.. ur.experience reveals.that such movement provides a stronger anchoring of the adolesceitt,witlfiess risk of failure once discharged to a lower level of care. Further, as movement ----occurs-between-the-locked-and-open units-;-the-same psychiatrist and social - ----- _ worker will-continue-to follow-the-adolescent,providing the continuity of treatment in the interdisciplinary team so,essential to progress and success. 4J. Case Management: Aftercare planning will be divided into five stages: 1. Assessing the adolescent and family needs. 2. Exploring available resources 3. Making recommendations 4. Facilitating referral 5. Follow-up - Anticipating the need for others to supplement and complement what S.T.A.R.S. provides, our staff is obliged to remain current in terms of available services and the quality of those services. The social service staff is responsible for being familiar with and knowledgeable about how other agencies, organizations and individuals are related-, either directly or indirectly, in providing mental health..services_in_both_the-public and_private----- - --=.-_-- - sectors. When the adolescent is discharged, an agreement will be made with the community resource or family receiving the adolescent that will enable them to contact the S.T.A.R.S. program personnel if any problems arise relative to the continuing care of the adolescent. The uniqueness of this agreement, and the uniqueness of the consulting and training services being - offered, cannot be overemphasized. It should be clearly understood that this aftercare opportunity will represent a major community resource for Alameda County. As a highly skilled, professionally managed program, it will not only have the flexibility to treat and care for the seriously emotionally disturbed adolescent, but it will also make the commitment and have the capability to serve-as a consulting resource to any placement institution or family member who needs assistance in the difficult task of caring for the discharged adolescent. However, the receiving facility or ---- ----------family--will-have the-responsibility to follow the treatment-plan as outlined - - by S.T.A.R.S. staff at the time of discharge. We�will expect a commitment from the family or agency to continue to work with the adolescent in the manner prescribed as being the most effective way of assisting the adolescent to adjust to the social environment to which he/she has been discharged. The S.T.A.R.S. Social Service staff will also provide the linkage of case Page 6 management services and aftercare recommendations to the family or placement agency. Meetings prior to discharge and involvementby the'-F ` family, agency or case manager will be encouraged so that services flow - - --- appropriately;supporting-the-discharged-adolescent-in-his/her new - - environment. Some adolescents who-have been-discharged to lower levels of care may remain in the Day Treatment Program and/or the non-public school to ease their transition to the community. In addition, case management services and interface with caseworkers may be provided by S.T.A.R.S. should these services not be available to the adolescent after discharge by the County. This transition will be critical for the success of high risk adolescents who need the support of S.T.A.R.S.,staff, case workers and case managers in their placement. In all cases, a follow-up will continue for ninety(90)days subsequent to the discharge to insure effective placement. Recent regulations of the Department of Health Services approved Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services that can be provided offsite from the-Day-Treatment Program. This would enable the S.T.A.R.S. staff to provide FFP reimbursable SD/MC case management, individual, family and rehabilitative services in the placements of the adolescent discharged from this program-whether this be in the home, school, or foster placement of the adolescent. These comprehensive case management services for_-high risk adolescents will provide a total managed system of care. 4K Limitations of Service: The Psychiatric Health Facility is limited by.its State license and cannot accept children whose primary diagnosis is an Eating Disorder, Substance Abuse, Conduct Disorder, Pervasive Developmental Disorder or Attention Disorder. 4L. Patient Record Requirement: The Contractor will maintain patient records in a safe place in locked files, retain, dispose and transfer records according to applicable County, State,and Federal laws and regulations and maintain confidentiality of records. The records will be in sufficient detail to make an evaluation of contract services possible. The Contractor will permit authorized-personnel-designated by the Local Mental health Director to make periodic inspections and to furnish those designated personnel such information and patient records as they may require to monitor, review and evaluate fiscal and clinical effectiveness, appropriateness, and timeliness of the services being rendered under this contract. 4M. Quality Assurance: Page 7 Quality,Assurance Activities: Quality Assurance regulations, as promulgated.by Alameda County, the State of California and the facility itself include but are not limited to Peer Review, Medication Monitoring and Utilization Review. The _----facility-will-adhere-to-County reporting--requirements as provided-in the County's State-approved Quality Assurance Plan. 1. Medication Monitoring: All psychotropic or psychoactive medications will be monitored on an on-going basis through Utilization Review,but also on a quarterly basis for the Quality Assurance Committee by the Medical Director. Medications will be monitored for appropriateness, interaction with other medications, effectiveness and drug sensitivity. Physicians will be provided with information and counseling regarding their use of medications as it relates to program and community standards. 2. Peer Review: All professional disciplines (physicians, psychologist, licensed nurses, social workers,rehabilitation therapists)will take part in the peer review process. Department heads will be responsible for reviewing the medical records of individual staff on a quarterly basis based on standards or criteria provided by the County or-prepared by the facility and reporting to the Quality Assurance Committee. Feedback, counseling, and ongoing education will be provided as necessary to maintain standards of care. 3. Utilization Review: The medical record of each adolescent admitted will be reviewed against admission criteria for medical necessity within 3 days of admission and once per week thereafter on the PHF unit and within 15 days of admission on the Group Home and then every 30 days thereafter. The initial admission review will focus on the appropriateness of the treatment plan in relation to the diagnosis,while the continuing stay review will focus on the continuing need for the level of service as defined by.the treatment plan and the response of the adolescent to the treatment, as well as the appropriateness and effectiveness of the _ level of,treatment and the availability of alternative resources. All disciplines will be represented on the Utilization Review Committee. Documentation deficiencies noted by the Committee will require corrective action by facility staff, and results and action of the Utilization Review Committee will be reported quarterly to the Quality Assurance Committee. 4N. Minimum Staffing Qualifications: ' Staffing shall provide a sufficient number of staff to provide the services described ---—-____ .herein, consisting of- Board fBoard Certified or Board Eligible Psychiatrists Pediatrician Licensed Psychologist Social Workers Rehabilitation Therapists Rehabilitation Aides Page 8 Registered Nurses 3 ' License&Vocational Nurses/Licensed Psychiatric Technicians Youth Counselors All of the professionalstaff will be degreed,-licensed and/or-registered. Youth Counselors and Rehab Aides are expected to have a Bachelor's degree in a behavioral science and at least two years experience. Students and volunteers will be utilized only under supervision of facility staff and will not be used to replace regular, employed staff. During the term of any resultant contract, STARS shall maintain and provide upon request to authorized representatives of the County, a list of all persons by name,title,professional degree, and experience who are providing any services. Additional qualified staff, as may be determined from time to time in the sole discretion of the Director of Mental Health, shall be provided by STARS. Because medication administration is a integral part of S.T.A.R.S., specifically trained licensed nurses or licensed vocational nurses or licensed psychiatric technicians will be employed on each shift, seven days a week to administer and monitor the side effects and effectiveness of psychoactive medications as prescribed by the physician, as well as to direct and monitor nursing services provided to the adolescents. The S.T.A.R.S. facility will be organized using a departmentalized organizational structure. Each department will have a full time department_head_responsible_for . the operation of the department. All departments will report to the Administrator who has overall responsibility for the facility. Job descriptions, including minimum qualifications for employment and duties performed for all personnel shall be on file with the Administrator. Individual department's job descriptions will also be available in each department. An orientation of sixteen(16)hours, consisting of an explanation of the goals and objectives of the program, a description of the individual departments, and an explanation and demonstration of fire, safety, emergency, Patients Rights and infection control requirements and procedures, will be provided to every new employee. An additional twenty(20)hours of orientation to the Treatment Planning Process, documentation requirements, and Professional Assault Response Training (PART)will be provided for every clinical staff member. An annual reorientation of four(4)hours will be required of all employees to re-emphasize the goals and objectives of the program and fire, safety, emergency, Patients .Rights and infection control requirements-and procedures. Formal education and training occur at inservice and continuing education sessions offered by the Director of Staff Development,with additional training provided by department heads, physicians and consultants. The Director of Staff Development is responsible for designing and conducting the orientation and re-orientation program, the inservice training and continuing education for all staff members, - students and volunteers. S.T.A.R.S. provides for a full time licensed nurse Staff Page 9 Developer whose primary responsibility willbe to conduct mandatory orientation s� and annual inservice education to staff including basic nursing ad behavioral techniques, as well as modifying staff behavior with continuing education and —inservice education-that may result from internal quality-assurance audits. However, the S.T.A.R.S. Program is not dependent only on the Staff Developer for staff training. STARS believes that staff training is an ongoing responsibility of all program management with the Staff Developer's training being augmented by training from the Psychiatrists, Psychologists, Rehab Therapists, and Social Workers. The partners of STARS will-supply their considerable expertise in the areas of behavioral management, management of assaultive behavior(P.A.R.T.), medical-legal documentation, treatment plan preparation, and personnel and financial supervision and management. In addition, STARS believes in utilizing local experts to provide staff education, including the Red Cross, Public Health Department, Mental Health Advocates, the State Department of Mental Health, Probation Department and Department of Children and Family Services. 40. Organizational Chart: (See Attached) 5. Hours/Days of Operation: The facility will be open-and staffed 24hrs/day, 7/days/week- 6. Reporting Requirements: Contractor will comply with any reporting requirements required by County, State or Federal funding sources as a condition of funding. Contractor will input client data into the PSP system and keep its own statistical information which will be presented in the form of an Annual Report to the County. Contractor will provide any special reports requested by financial or program monitors. 7. Evaluation Requirements: Contractor will submit to periodic and/or annual reviews of program delivery and fiscal reporting as required by County, State and Federal funding sources. 8. Certification/Licensure: The following licenses and certifications will be maintained during the contract period: Licensed Psychiatric Health Facility by State Department of Mental Health Licensed Group Home by State Department of Community Care Licensing Certified Nonpublic School by State Department of Education Certified RCL 14 Group Home by Alameda County Mental Health Page 10 Certified Intensive D.ay lreatment Program;by-State,Dept. MH MediCal Certified PHF Program by State Dept. MH Medical' 9.- -.---__Target Population:. All adolescents will be approved and referred to the S.T.A.R.S. program from the ACMHS Mental Health Childrens System Access Committee, the ACMHS Children's Specialized Services Unit, or the Interagency Children Committee. Most adolescents will be admitted voluntarily,with court supervision of wards and dependents of the court under W&I Code Section 6552 or as LPS conservatees, either public or private, under W&I Code section 5350 or Probate Code section 1801 et seq., or with adolescents between the ages of 14 and 17 years old admitted by their parent under Roger S. procedures. Adolescents under 14 years of age who are not wards or dependents of the court may be admitted voluntarily by their parents. Adolescents may also be admitted involuntarily under W&I Code section 5585 (adolescent equivalent to 5150) and 5250. All adolescents referred to the S.T.A.R.S. program will have a DSM IV primary diagnosis of mental disorder, a history of prior acute care psychiatric hospitalization, and a variety of characteristics, including the following: Physically assaultive Suicidal ideations and gestures Self destructive/abusive behavior Chronic elopement Sexually acting out Fire setting Socially inappropriate conduct Explosiveness Borderline personality disorders Marginally functional, anti-social behavior Actively psychotic(but not in acute stage) Verbally abusive _ Multiple previous hospitalizations Failed placements Alienated or conflicting family relationships Fragmented, multiple prior community agency contacts Periodic need for seclusion, restrain or psychotropic medications History of paranoia, delusions or hallucinations Depressed/withdrawn behavior In some instances, adolescents with episodic psychiatric disorders may have accompanying medical problems which will be monitored and treated by the facility's physicians and nursing staff. Adolescents will have a physical examination on admission and annually thereafter with medical follow-up by a contract pediatrician, as well as periodic dental, - vision and hearing examinations. Other professionals such as podiatrists, audiologists and 11 speech pathologists will be available for consultation. It is possibleI�mt some adolescents maybe wheelchair bdund,-and the facility shall meet requirements of The Americans with Disabilities Act. The facility's professional staff will be appropriately trained to meet the behavioraltreatmentneeds of-the disabled: While most physical disabilities can be -- accommodated in the facility, the following would be exceptions: a. Those adolescents whose medical needs requiring nursing and/or medical attention to the extent that the other adolescents would be significantly affected; or, b. Those adolescents whose medical complications are primary and deemed to require the services of a medical unit. The program will treat adolescents of any ethnic or ancestral group, race, sex, sexual orientation, religion, or national origin and will provide culturally oriented programming for that population. 10. Service Area: S.T.A.R.S. is located in the city of San Leandro, however, it serves children from all parts of Alameda County. 11. Service Delivery Site: Principle delivery site is: 15400 Foothill Blvd. San Leandro, California 94578 12. Service Criteria: Eligibility requirements are determined by Alameda County, as,only children identified and referred by the County will be considered for admission. All clients must meet the criteria identified above in Section 9 Target population, to be considered for admission. Admission could occur 7 days/week, 24 hrs/day, however, normally admissions will occur weekdays between Sam- Spm. 12 F: S.T.A.R. _: Organizational Chart S.T.A.R.S. Board of Directors Peter Zucker, Ph.D. Administrator Clinical Director Ancillary Department Heads Exhibit B Terms & Conditions 1 Contractor: Alameda County Service(s): Access to Subacute Children's Program provided by S.T.A.R.S., Inc. Period: March 17, 1997 through June 30, 1997 TERMS AND CONDITIONS OF PAYMENT In return for access to the aforementioned services as set forth in Exhibit A of this agreement, the County agrees to reimburse the Contractor on the following basis: 1. Total Remuneration Medi-Cal eligible $210/day Non Medi-Cal eligible $420/day 2. Basis for Final Reimbursement Contractor shall be reimbursed on the basis of a negotiated net amount specified in Paragraph 3. County shall consider this amount as net final reimbursable cost. 3. ReimbursementMethod(s) During Contract Period County acknowledges the necessity of providing a cash flow to Contractor to enable Contractor to pay program operating and other expenses of S.T.A.R.S., Inc. herein after referred to as the program provider. Therefore, to establish the aforementioned cash flow, County shall pay Contractor for services in accordance with the following reimbursement method(s) and payment schedules: Net negotiated amount of$89,040 for access to 4 Medi-Cal eligible bed(s) at the Subacute Children's Program operated by S.T.A.R.S., Inc. based upon start date of March 17, 1997. Schedule of payments: An invoice will be submitted to-Contra Costa County by AAgril 21, 1997 based upon the actual start date of the program to be paid on or before May 9. 1997. 4. Submittal Deadline for Claims - Contractor shall submit claim(s) for payment to County 30 days prior to the payment date(s) as specified in Paragraph 3.