HomeMy WebLinkAbout270361 AMENDMENT II TO AGREEMENT
2 THIS AMENDMENT, hereinafter refe1Ted to as Amendment II, is made and entered into this
3 I o·h'l day of December, 2013, by and between the COUNTY OF FRESNO, a political subdivision
4 of the State of California, hereinafter referred to as "COUNTY", and each Provider listed in Attachment
5 A, attached hereto and by this reference incorporated herein, collectively hereinafter referred to as
6 "PROVIDER(S)", and such additional PROVIDER(S) as may, from time to time during the term of
7 this Agreement, be added by COUNTY. Reference in tilis Agreement to "party" or "parties" shall be
8 understood to refer to COUNTY and each PROVIDER, unless otherwise specified.
9 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
10 No. 07-290, effective July 10,2007, and Amendment I, No. 07-290-1, effective September 29,2009,
11 hereinafter referred to as the "Agreement"; and
12 WHEREAS, COUNTY is auti10rized through its Negotiated Net Amount (NNA) Drug Medi-Cal
13 Agreement with the State of Califonlia, hereinafter refeJTed to as State, Department of Alcohol and Drug
14 Programs (ADP), to subcontract for Drug Medi-Cal services in Fresno Cotmty; and
15 WHEREAS, PROVIDER(S) are certified by the State to provide services required by
16 COUNTY, pursuant to the terms and conditions of this Agreement; and
17 WHEREAS, the parties desire to amend ti1e Agreement regarding changes as stated below and
18 restates the Agreement in its entirety.
19 NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
2 0 hereinafter set fmih, the sufficiency of which is acknowledged, the parties agree as follows:
21 I. That ti1e following text in the existing COUNTY Agreement No. 07-290, Page One (I),
22 beginning with Paragraph One (1), Line Seventeen (17) with the words "OBLIGATIONS OF THE
2 3 PROVIDERS" and ending on page Two (2), Line Twenty (20) with the word "term" be deleted and
2 4 the following inse1ied in its place:
25 "1. OBLIGATIONS OF THE PROVIDER(S)
26 A PROVIDER(S) shall provide Drug Medi-Cal substance abuse services at
2 7 State-certified locations to eligible beneficiaries in Fresno County.
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1 B. PROVIDER(S) shall comply with all of the provisions set forth in
2 Exhibits Band D to the COUNTY/State DMC/NNA Agreement, attached hereto and by this reference
3 incorporated herein as Attachments B and C respectively. PROVIDER(S) are refelTed to therein as
4 "Subcontractors" and COUNTY is refelTed to therein as "Contractor".
5 C. PROVIDER(S) should follow the guidelines in the "Youth Treatment
6 Guidelines," Attachment G, attached hereto and by this reference incorporated herein, in developing
7 and implementing youth treatment programs funded under this Agreement until such time new Youth
8 Treatment Guidelines are established and adopted. No fonnal an1endment of this contract is required
9 for new guidelines to apply.
10 D. PROVIDER(S)' representative, who is duly authorized to act on behalf of
11 the PROVIDER(S), shall attend, as determined necessary by COUNTY'S DBH Director, or her
12 designee, regularly scheduled (monthly) Alcohol and Drug Advisory Board Meetings.
13 E. PROVIDER(S) shall maintain, at PROVIDER(S)' cost, a computer
14 system with Windows 2000 or above, compatible with COUNTY'S Substance Abuse Information
15 System (SAIS), and high-speed internet connection for the purposes of submitting infonnation required
16 under the terms and conditions of this Agreement.
17 F. PROVIDER(S) shall submit all information and data required by the
18 State, including, but not limited to the following:
19 1.) Drug and Alcohol Treatment Access Report (DATAR) and
2 0 Provider Waiting List Record (WLR) in an electronic fommt provided by the State;
21 2.) Cal OMS Treatment-Submit Cal OMS Treatment admission,
2 2 annual update, discharge, or "provider no activity report" record in an electronic format through
2 3 COUNTY's SAIS system on a schedule as determined by the COUNTY which complies with State
2 4 requirements for data content, data quality, reporting frequency, reporting deadlines , and report
25 method.
26 3.) Cost Reports for each Fiscal Year: Eligible NTP Providers may
2 7 submit a Performance Repmi in lieu of a Cost Report.
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1 4.) PROVIDER(S) agree to submit all data requested in (1), (2) and
2 (3) in the manner identified, or on forms provided by the State, by the applicable due dates given by
3 COUNTY.
4 "2. TERM
5 This Agreement shall become effective July I 0, 2007 and shall terminate on June
6 30, 2010. This Agreement shall automatically be extended for five (5) additional twelve (12) month
7 periods, pending funding availability, upon the same terms and conditions herein set forth, unless
8 written notice of non-renewal is given by COUNTY or COUNTY's DBH Director or her designee not
9 later than thirty days prior to the close of the current Agreement tenn."
10 2. That the following text in the existing COUNTY Agreement No. 07-290, Page Three
11 (3), begitming with Paragraph Four (4), Line Fourteen (14) with the word "INVOICING" and ending
12 on Page Four (4), line Fourteen (14) with the word "services" be deleted and the following inserted in
l3 its place:
14 "4. INVOICING:
15 COUNTY agrees to pay PROVIDER(S) and PROVIDER(S) agree to receive
16 compensation at State established Medi-Cal rates as follows: prior to PROVIDER(S) submitting
17 invoices for reimbursement. PROVIDER(S) will submit records to COUNTY's DBH Director or her
18 designee for review. Once it has been determined that the records meet the criteria of billable services
19 according to applicable regulations, COUNTY'S DBH Director or her designee will notify the
2 0 PROVIDER(S) that services are approved for reimbursement. PROVIDER(S) shall enter billing
21 information into the COUNTY's Substance Abuse Information System by the fifteenth (15'h) of every
2 2 month.
23 5. FUNDING
2 4 A. Compensation-In no event shall reimbursement for services performed by
2 5 PROVIDER(S) under this Agreement exceed the reimbursement rates set forth in the COUNTY/State
2 6 DIVICINNA Agreement for each term of this Agreement. It is understood that all expenses incidental to
2 7 PROVIDER(S)' performance of services under this Agreement shall be borne by PROVIDER(S).
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1 1) Reimbursement for Drug Medi-Cal Services is limited to the maximum
2 allowable rates set by the State.
3 2) COUNTY shall reimburse Narcotic Treatment Program (NTP)
4 PROVIDER(S) the lesser of the Unified Statewide Monthly Reimbursement (USMR) rate or the
5 provider's usual or customary charge to the public less the maximum allowable COUNTY
6 administrative fee.
7 3) COUNTY shall reimburse non-NTP PROVIDER(S) the lesser of the
8 projected cost of services or the State maximum rate allowance, less a 10% COUNTY Administrative
9 fee.
10 4) COUNTY shall no longer reimburse PROVIDER(S) for Non-Medi-Cal
11 Minor Consent services effective January 1, 2014.
12 5) Payments by COUNTY shall be in arrears, for services provided during the
13 preceding month, within fmty-five (45) days after receipt, verification and approval ofPROVIDER(S)'
14 12 invoices by COUNTY's DB I-I. If payment for services are denied or disallowed by State; and
15 subsequently resubmitted to COUNTY by PROVIDER(S), payments will not be issued to
16 PROVIDER(S) until COUNTY has received reimbursement from State for said services."
17 That the following text in the existing COUNTY Agreement No. 07-290, Page Nine
18 (9), beginning with Paragraph Eleven ( 11 ), Line Twenty (20) witl1 the words "Professional Liability"
19 and ending on Page Nine (9), line Twenty-Four (24) with tl1e word "aggregate" be deleted and the
2 0 following inserted in its place:
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"C. Professional Liabilitv
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N.,
L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with limits of not less than
One Million Dollars ($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual
aggregate. CONTRACTOR agrees that it shall maintain, at its sole expense, in full force and effect for
a period of three (3) years following the termination of this Agreement, one or more policies of
professional liability insurance with limits of coverage as specified herein."
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2 4. That the following text in existing County Agreement No. 07-290-1, Page 18, beginning
3 with Paragraph Thirty (30), Line One (1) with the words "HIPAA-BUSINESS ASSOCIATE
4 LANGUAGE CONFIDENTIALITY" and ending on Page Twenty (20), Line Eleven (11), with the
5 word "Agreement" be deleted and the following inserted in its place:
6 "30. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
7 A The parties to this Agreement shall be in strict confommnce with all
8 applicable Federal and State of California laws and regulations, including but not limited to Sections
9 5328, 10850, and 14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1 and 431.300 et seq.
10 of Title 42, Code of Federal Regulations (CFR), Section 56 et seq. of the Califomia Civil Code,
11 Sections 11977 and 11812 of Title 22 of the California Code of Regulations, and the Health Insurance
12 Portability and Accountability Act (HIP AA), including but not limited to Section 1320 D et seq. of
13 Title 42, United States Code (USC) and its implementing regulations, including, but not limited to Title
14 45, CFR, Sections 142, 160, 162, and 164, The Health Infonnation Technology for Economic and
15 Clinical Health Act (I-IITECH) regarding the confidentiality and security of patient infonnation, and the
16 Genetic Infom1ation Nondiscrimination Act (GINA) of 2008 regarding the confidentiality of genetic
17 information.
18 Except as otherwise provided in this Agreement, PROVIDER(S), as a Business
19 Associate of COUNTY, may use or disclose Protected Health Information (PHI) to perform functions,
2 0 activities or services for or on behalf of COUNTY, as specified in this Agreement, provided that such
21 use or disclosure shall not violate the Health Insurance Portability and Accountability Act (HIP AA), 42
2 2 USC 1320d et seq. The uses and disclosures of PHI may not be more expansive than those applicable
23 to COUNTY, as the "Covered Entity" under the HIPAA Privacy Rule (45 CFR 164.500 et seq.), except
2 4 as authorized for management, administrative or legal responsibilities of the Business Associate.
25 B. PROVIDER(S), including its subcontractors and employees, shall
2 6 protect, from unauthorized access, use, or disclosure of names and other identifying information,
2 7 including genetic infmmation, conceming persons receiving services pursuant to this Agreement,
2 8 except where permitted in order to cany out data aggregation purposes for health care operations [ 45
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1 CFR Sections 164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i)] This pertains to any and
2 all persons receiving services pursuant to a COUNTY funded program. This requirement applies to
3 electronic PHI. PROVIDER(S) shall not use such identifying infom1ation or genetic infonnation for
4 any purpose other than can·ying out PROVIDER(S)'s obligations under this Agreement.
5 C. PROVIDER(S), including its subcontractors and employees, shall not
6 disclose any such identifying information or genetic information to any person or entity, except as
7 otherwise specifically pe1mitted by this Agreement, authorized by Subprni E of 45 CFR Prni 164 or
8 other law, required by the Secretary, or authorized by the client/patient in W1iting. In using or
9 disclosing PHI that is permitted by this Agreement or authorized by law, PROVIDER(S) shall make
10 reasonable efforts to limit PHI to the minimum necessary to accomplish intended purpose of use,
11 disclosure or request.
12 D. For purposes of the above sections, identifying information shall include,
13 but not be limited to nrnne, identifying number, symbol, or other identifying particular assigned to the
14 individual, such as finger or voice print, or photograph.
15 E. For purposes of the above sections, genetic information shall include
16 genetic tests of fan1ily members of an individual or individual, manifestation of disease or disorder of
17 frnnily members of an individual, or any request for or receipt of, genetic services by individual or
18 frnnily members. Fan1ily member means a dependent or any person who is first, second, third, or fourth
19 degree relative.
20 F. PROVIDER(S) shall provide access, at the request of COUNTY, and in
21 the time and manner designated by COUNTY, to PHI in a designated record set (as defined in 45 CFR
2 2 Section 164.501 ), to rn1 individual or to COUNTY in order to meet the requirements of 45 CFR Section
23 164.524 regarding access by individuals to their PHI. With respect to individual requests, access shall
2 4 be provided within thiiiy (30) days from request. Access may be extended if PROVIDER(S) cannot
2 5 provide access and provides individual with the reasons for the delay and the date when access may be
2 6 granted. PHI shall be provided in the form and fonnat requested by the individual or COUNTY.
2 7 PROVIDER(S) shall make any amendment(s) to PHI in a designated record set at
2 8 the request of COUNTY or individual, and in the time and manner designated by COUNTY in
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1 accordance with 45 CFR Section 164.526.
2 PROVIDER(S) shall provide to COUNTY or to an individual, in a time and
3 manner designated by COUNTY, infonnation collected in accordance with 45 CFR Section 164.528, to
4 permit COUNTY to respond to a request by the individual for an accounting of disclosures of PHI in
5 accordance with 45 CFR Section 164.528.
6 G. PROVIDER(S) shall report to COUNTY, in writing, any knowledge or
7 reasonable belief that there has been unauthorized access, viewing, use, disclosure, security incident, or
8 breach of unsecured PHI not permitted by this Agreement of which it becomes aware, immediately and
9 without reasonable delay and in no case later than two (2) business days of discovery. Immediate
10 notification shall be made to COUNTY's Infmmation Security Officer and Privacy Officer and
11 COUNTY's DPH HIP AA Representative, within two (2) business days of discovery. The notification
12 shall include, to the extent possible, the identification of each individual whose unsecured PHI has
13 been, or is reasonably believed to have been, accessed, acquired, used, disclosed, or breached.
14 PROVIDER(S) shall take prompt corrective action to cure any deficiencies and any action pertaining to
15 such unauthorized disclosure required by applicable Federal and State Laws and regulations.
16 PROVIDER(S) shall investigate such breach and is responsible for all notifications required by law and
17 regulation or deemed necessary by COUNTY and shall provide a written report of the investigation and
18 reporting required to COUNTY's Infonnation Security Officer and Privacy Ofticer and COUNTY's
19 DPH HIP AA Representative. This written investigation and description of any reporting necessary
2 0 shall be postmarked within the thirty (30) working days of the discovery of the breach to the addresses
21 below:
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County of Fresno County of Fresno County of Fresno
Dept. of Public Health Dept. of Public Health Infmmation Teclmology Services
HIPAA Representative Privacy Officer Information Security Officer
(559) 600-6439 (559) 600-6405 (559) 600-5800
P.O. Box 11867 P.O. Box 11867 2048N. Fine Street
Fresno, CA 93775
H.
Fresno, CA 93775 Fresno, CA 93 727
PROVIDER(S) shall make its internal practices, books, and records
2 7 relating to the use and disclosure of PHI received from COUNTY, or created or received by the
2 8 PROVIDER(S) on behalf of COUNTY, in compliance with HIP AA's Privacy Rule, including, but not
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1 limited to the requirements set forth in Title 45, CFR, Sections 160 and 164. PROVIDER(S) shall
2 make its internal practices, books, and records relating to the use and disclosure of PHI received from
3 COUNTY, or created or received by the PROVIDER(S) on behalf of COUNTY, available to the United
4 States Department of Health and Human Services (Secretary) upon demand.
5 PROVIDER(S) shall cooperate v.~th the compliance and investigation reviews
6 conducted by the Secretary. PHI access to the Secretary must be provided during the PROVIDER(S)' s
7 normal business hours, however, upon exigent circumstances access at any time must be granted. Upon
8 the Secretary's compliance or investigation review, if PHI is unavailable to PROVIDER(S) and in
9 possession of a Subcontractor, it must certify efforts to obtain the information to the Secretary.
10 I. Safe guards
11 PROVIDER(S) shall implement administrative, physical, and technical
12 safeguards as required by the HIP AA Security Rule, Subpart C of 45 CFR 164, that reasonably and
13 appropriately protect the confidentiality, integrity, and availability of PHI, including electronic PHI,
14 that it creates, receives, maintains or transmits on behalf of COUNTY and to prevent unauthorized
15 access, viewing, use, disclosure, or breach of PHI other than as provided for by this Agreement.
16 PROVIDER(S) shall conduct an accurate and thorough assessment of the potential risks and
17 vulnerabilities to the confidential, integrity and availability of electronic PHI. PROVIDER(S) shall
18 develop and maintain a written information privacy and security program that includes administrative,
19 technical and physical safeguards appropriate to the size and complexity of PROVIDER(S)' s
2 0 operations and the nature and scope of its activities. Upon COUNTY's request, PROVIDER(S) shall
21 provide COUNTY with information concerning such safeguards.
2 2 PROVIDER(S) shall implement strong access controls and other security
2 3 safeguards and precautions in order to restrict logical and physical access to confidential, personal (e.g.,
2 4 PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include the
2 5 following administrative and technical password controls for all systems used to process or store
2 6 confidential, personal, or sensitive data:
2 7 I. Passwords must not be:
28 a. Shared or written down where they are accessible or recognizable
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1 by anyone else; such as taped to computer screens, stored under keyboards, or visible in a work area;
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b.
c.
A dictionary word; or
Stored in clear text
2. Passwords must be:
a.
b.
c.
d.
Eight (8) characters or more in length;
Changed every ninety (90) days;
Changed immediately if revealed or compromised; and
Composed of characters from at least three (3) of the following
9 four ( 4) groups from the standard keyboard:
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Upper case letters (A-Z);
Lowercase letters (a-z);
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I)
2)
3)
4)
Arabic numerals (0 through 9); and
Non-alphanumeric characters (punctuation symbols).
14 PROVIDER(S) shall implement the following security controls on each
15 workstation or portable computing device (e.g., laptop computer) containing confidential,
16 personal, or sensitive data:
17 I. Network-based firewall and/or personal firewall;
18 2. Continuously updated anti-virus software; and
19 3. Patch management process including installation of all operating
2 0 system/software vendor security patches.
21 PROVIDER(S) shall utilize a commercial encryption solution that has
22 received FIPS 140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable
2 3 electronic media (including, but not limited to, compact disks and thumb drives) and on pmiable
2 4 computing devices (including, but not limited to, laptop and notebook computers).
2 5 PROVIDER(S) shall not transmit confidential, personal, or sensitive data
2 6 via e-mail or other internet transport protocol unless the data is encrypted by a solution that has been
2 7 validated by the National Institute of Standards and Technology (NIST) as conforming to the
2 8 Advanced Encryption Standard (AES) Algoritlm1. PROVIDER(S) must apply appropriate sanctions
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1 against its employees who fail to comply with these safeguards. PROVIDER(S) must adopt
2 procedures for terminating access to PHI when employment of employee ends.
3 J. Mitigation of Harmful Etiects
4 PROVIDER(S) shall mitigate, to the extent practicable, any hatmful
5 effect that is suspected or known to PROVIDER(S) of an unauthorized access, viewing, use, disclosure,
6 or breach of PHI by PROVIDER(S) or its subcontractors in violation of the requirements of these
7 provisiOns. PROVIDER(S) must document suspected or known hannful effects and the outcome.
8 K. PROVIDERCSl's Subcontractors
9 PROVIDER(S) shall ensure that any of its PROVIDER(S)s, including
10 subcontractors, if applicable, to whom PROVIDER(S) provides PHI received from or created or
11 received by PROVIDER(S) on behalf of COUNTY, agrees to the same restrictions, safeguards, and
12 conditions that apply to PROVIDER(S) with respect to such PHI and to incorporate, when applicable,
13 the relevant provisions of these provisions into each subcontract or sub-award to such agents or
14 subcontractors.
15 L. Employee Training and Discipline
16 PROVIDER(S) shall train and use reasonable measures to ensure
17 compliance with the requirements of these provisions by employees who assist in the perfmmance of
18 functions or activities on behalf of COUNTY under this Agreement and use or disclose PHI and
19 discipline such employees who intentionally violate any provisions of these provisions, including
2 0 termination of employment.
21 M. Termination for Cause
22 Upon COUNTY's knowledge of a material breach of these provisions by
2 3 PROVIDER(S), COUNTY shall either:
2 4 I. Provide an opportunity for PROVIDER(S) to cure the breach or end
2 5 the violation and tenninate this Agreement if PROVIDER(S) does not cure the breach or end the
2 6 violation within the time specified by COUNTY; or
2 7 2. Immediately tenninate this Agreement if PROVIDER(S) has breached
2 8 a material tem1 of these provisions and cure is not possible.
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1 3. If neither cure nor termination is feasible, the COUNTY's Privacy
2 Officer shall report the violation to the Secretary of the U.S. Department of Health and Human
3 Services.
4 N. Judicial or Administrative Proceedings
5 COUNTY may tenninate this Agreement in accordance with the terms
6 and conditions of this Agreement as written hereinabove, if: (1) PROVIDER(S) is found guilty in a
7 criminal proceeding for violation of the HIPAA Privacy or Security Laws or the HITECI-I Act, or (2)
8 there is a finding or stipulation that the PROVIDER(S) has violated a privacy or security standard or
9 requirement of the HITECH Act, HIP AA or other security or privacy laws in an administrative or civil
10 proceeding in which the PROVIDER(S) is a party.
11 0. Effect of Tennination
12 Upon termination or expiration of this Agreement for any reason,
13 PROVIDER(S) shall return or destroy all PHI received from COUNTY (or created or received by
14 PROVIDER(S) on behalf of COUNTY) that PROVIDER(S) still maintains in any form, and shall
15 retain no copies of such PI-II. If return or destruction of PHI is not feasible, it shall continue to extend
16 the protections of these provisions to such information, and limit further use of such PHI to those
17 purposes that make the return or destruction of such PHI infeasible. This provision shall apply to PHI
18 that is in the possession of subcontractors or agents, if applicable, ofPROVIDER(S). If
19 PROVIDER(S) destroys the PHI data, a certification of date and time of destruction shall be provided
20 to the COUNTY by PROVIDER(S).
21 P. Disclaimer
22 COUNTY makes no warranty or representation that compliance by
2 3 PROVIDER(S) with these provisions, the HITECH Act, HIPAA or the HIP AA regulations will be
2 4 adequate or satisfactory for PROVIDER(S)' s own purposes or that any information in
2 5 PROVIDER(S)'s possession or control, or transmitted or received by PROVIDER(S), is or will be
2 6 secure from unauthorized access, viewing, use, disclosure, or breach. PROVIDER(S) is solely
2 7 responsible for all decisions made by PROVIDER(S) regarding the safeguarding of PI-II.
28 Q. Amendment
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1 The parties acknowledge that Federal and State laws relating to electronic
2 data security and privacy are rapidly evolving and that amendment of these provisions may be required
3 to provide for procedures to ensure compliance with such developments. The parties specifically agree
4 to take such action as is necessary to amend this agreement in order to implement the standards and
5 requirements of HIP AA, the HIP AA regulations, the HITECH Act and other applicable laws relating to
6 the security or privacy of PHI. COUNTY may terminate this Agreement upon thirty (30) days written
7 notice in the event that PROVIDER(S) does not enter into an amendment providing assurances
8 regarding the safeguarding of PHI that COUNTY in its sole discretion, deems sufficient to satisfY the
9 standards and requirements of HIP AA, the HIP AA regulations and the HITECH Act.
10 R. No Third-Party Beneficiaries
11 Nothing express or implied in the terms and conditions of these
12 provisions is intended to confer, nor shall anything herein confer, upon any person other than
13 COUNTY or PROVIDER(S) and their respective successors or assignees, any rights, remedies,
14 obligations or liabilities whatsoever.
15 S. Interpretation
16 The terms and conditions in these provisions shall be interpreted as
17 broadly as necessary to implement and comply with HIP AA, the HIP AA regulations and applicable
18 State laws. The parties agree that any ambiguity in the terms and conditions of these provisions shall be
19 resolved in favor of a meaning that complies and is consistent with HIP AA and the HIP AA regulations.
20 T. Regulatory References
21 A reference in the terms and conditions of these provisions to a section in
2 2 the HIP AA regulations means the section as in effect or as amended.
23 U. Survival
2 4 The respective rights and obligations ofPROVIDER(S) as stated in this
2 5 Section shall survive the termination or expiration of this Agreement.
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v. No Waiver of Obligations
No change, waiver or discharge of any liability or obligation hereunder
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1 on any one or more occasions shall be deemed a waiver of performance of any continuing or other
2 obligation, or shall prohibit enforcement of any obligation on any other occasion."
3 5. That the following Paragraph is being added to the Agreement 07-290-1 as Paragraph
4 Seventeen ( 17), Page Three (3 ), Line Seven (7). The remaining Paragraphs (Paragraphs 17
5 "ASSURANCES through Paragraph 41 "ENTIRE AGREEMENT") shall be re-numbered sequentially
6 to read as Paragraphs 18 through 42.
7 "17. CULTURAL COMPETENCY
8 As related to Cultural and Linguistic Competence, PROVIDER(S) shall comply
9 with:
10 A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45
11 C.F.R. Part 80) and Executive Order 12250 of 1979 which prohibits recipients offederal financial
12 assistance from discriminating against persons based on race, color, national origin, sex, disability or
13 religion. This is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal
14 access and participation in federally funded programs through the provision of comprehensive and quality
15 bilingual services.
16 B. Policies and procedures tor ensuring access and appropriate use of trained
17 interpreters and material translation services for all LEP conswners, including, but not limited to, assessing
18 the cultural and linguistic needs of its consumers, training of staff on tl1e policies and procedures, and
19 monitoring its language assistance progran1. The PROVIDER(S)'s procedures must include ensuring
2 0 compliance of any sub-contracted providers with these requirements.
21 PROVIDER(S) shall not use minors as interpreters.
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C.
D. PROVIDER(S) shall provide and pay for interpreting and translation
2 3 services to persons participating in PROVIDER(S)' services who have limited or no English language
2 4 proficiency, including services to persons who are deaf or blind. Interpreter and translation services shall
2 5 be provided as necessary to allow such participants meaningful access to the programs, services and
2 6 benefits provided by PROVIDER(S). Interpreter and translation services, including translation of
2 7 PROVIDER(S)' "vital docnn1ents" (fuose docwnents that contain infonnation that is critical for accessing
2 8 PROVIDER(S)' services or are required by law) shall be provided to participants at no cost to the
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1 participant. PROVIDER(S) shall ensure that any employees, agents, subcontractors, or partners who
2 interpret or translate for a program participant, or who directly conununicate with a program participant in
3 a language other than English, demonstrate proficiency in the participant's language and can effectively
4 communicate any specialized terms and concepts peculiar to PROVIDER(S)' services.
5 E. In compliance with the State mandated Cultmally and Linguistically
6 Appropriate Services standards as published by the Office of Minority Health, PROVIDER(S) must
7 submit to COUNTY for approval, within 60 days fi"om date of contract execution, PROVIDER(S)' plan to
8 address all fifteen national cultural competency standards as set forth in the "National Standards on
9 Culturally and Linguistically Appropriate Services (CLAS)" attached hereto as Attachment H, and
10 incorporated herein by this reference. COUNTY's annual on-site review of PROVIDER(S) shall include
11 collection of docmnentation to ensure all national standards are implemented. PROVIDER(S) may solicit
12 complimentary assistance from On Track Consulting (https:llontrackconsulting.org/projectslclasl) for
13 training in plan development. As the national competency standards are updated, PROVIDER(S)' plan
14 must be updated accordingly."
15 6. COUNTY and PROVIDER(S) agree that this Amendment II is sufficient to amend
16 Agreement #07-290 and Amendment I# 07-290-1, and that upon execution of this Amendment II, the
17 Agreement, Amendment I and Amendment II together shall be considered the Agreement.
18 7. The Agreement, as hereby an1ended, is ratified and continued. All provisions, terms,
19 covenants, considerations and promises contained in the Agreement and not amended herein shall remain
2 0 in full force and effect. TI1is Amendment II shall become effective upon execution by all parties.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment II to the
2 Agreement 07-290 and 07-290-1 as of the day and year first hereinabove written.
3 COUNTY OF FRESNO PROVIDER(S)
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By: =-=------=~-'u'--"'-::~c:-. .!J-.«---_-_-_-__
Henry Perea, Chairinan
Board of Supervisors
Date: _I'V_\:_ID-'\'--10 ___ _
BERNICE E. SEIDEL, Clerk
Board of Supervisors
SEE ATTACHMENT A
16 Date:
17
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PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
-15 -COUNTY 0!' l'!UiSNO
Fresno, C:\
1
2
3
4
5
12
APPROVED AS TO LEGAL FORM:
KEVIN BRIGGS, COUNTY COUNSEL
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
13 REVIEWED AND RECOMMENDED FOR
APPROVAL:
14
15
16
17
18
19
20
DA WAN UTECHT, DIRECTOR
DEPARTMENT OF BEHAVIORAL HEALTH
21 Fund/Subclass: 0001/10000
Organization: 56302081
2 2 Account/Progran1: 7294/0
23
24
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28
-16 -
Date----'-'--// f-1-!J-=3+/-'-'/J'---· __
I I
Date _ ___,_._( (_l_~___:_' /'---'1 5::___
Date _ __,l_,_·{-_l:...:,~:._-_,_()"----
COUN'IY OF FlUiSNO
Fresno, CA
1 Provider: ADDI TION RESEARCH AND TREATMENT, INC.
2
3
4 By: __ _____,1'-/'g..<=J-:;----hY=:/-'--------
5
6
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8
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23
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26
27
28
Title: _?,_te_~_l d_~:;_c_:_:_:( ___ _
Chairman of the Board, or
President, or any Vice President
Date: u(5/ I 3
'
PrintName: CDwM[I. Q.., bAI<ISON~
' rv_c,.-r-Title: _t:_. _._, _• __ l--_ ••_:_r..:J_>'t.--=-N---=C'-".P::~----
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-17 -COUNTY OF FRESNO
Fresno, CA
1 Provider: AEGIS MEDICAL SYSTEMS, INC.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Ehud Barkai
Print Name: _____________ _
President & C.E.O.
Title: _____________ _
Chairman of the Board, or
President, or any Vice President
Date: November 12, 2013
Edith Barkai
18 Print Name: ____________ _
19
20
21
22
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25
26
27
28
Secretary
Title: _____________ _
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-18 -COUNTY 01' FRESNO
Fresno, Cr\
1 Provider: ANTIOCH SUBSTANCE ABUSE PROGRAMS.
2
9
10
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12
13
14
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18
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20
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23
24
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27
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Chainnan of the Board. or
President. or any Vice President
Date: JJ fJ V, "? ;{p /.3
Print I!J/6/efm~c0 !J:cj(s on
Title: Cnu"~u,;rEJJM/
Secretary (of Corporation). or
any Assistant Secretary. or
Chief Financial Officer. or
any Assistant Treasurer
-19 -COUNTY OF FRESNO
Fre:;no, CA
1 Provider: CENTRAL CALIFORNIA RECOVERY, INC.
2
3
4
Print Name: --~-"--'-'--. ""-,..<:;::-~--"'\Jk""""'-l'-'17'-'-(-~. ___ _
5
6
7
8
9 Title: __ Q->._"_,_( -"=9./""-Y=-~-=-~='='--j'--------
10
11
12
13
14
15
16
17
18
19
Chairman of the Board, or
President, or any Vice President
.I
By: cf.J(2v6a/L<:L-
-----2 O Title: --+-/-"~-"z_'-'e'"":.."-f)-'-' . ..s;"-·"'u'--'r""C""'. t_--'-'-;-'-( ~-----";;_}_/-<;" -f 3
21
22
23
24
25
26
27
28
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-20 -COUNTY OF l·lmSNO
Fresno, CA
1 Provider: DELTA CARE, INC.
2
3
4
5
By:_C"""'"~""-f?'__;::__o~Q-__ _
6
7
8
9
10
11
12
13
14
15
16
17
Print Name: R' I A.: E:. N L1 ~ 'v~ h-
Chairman of the Board, or
President, or any Vice President
18 Print Name: t\"tA-LI fV' \ L-tA A-GIN IT
19
20
21
22
23
24
25
26
27
28
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-21 -COUN'JY OF FRESNO
Frc~no, Cr\
1 Provider: EMINENCE HEALTH CARE, INC.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
'( ............... -·~-,
\
By:C! \
~
Title: _ _,(....,;;""'---L------------
Chairman ofthe Board, or
President, or any Vice President
Date: __ _:_.:11-!{--'. ~~-+-/_,__! ='--_3-
18 Print Name: y;,, (i-cc, r rl I Dr C' s I C:i/\
19
20
21
22
23
24
25
26
27
28
Title: __ -=::C:....>F_-_'7 ________ _
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-22 -COUN.lY OF FRESNO
Fresno, C\
1 Provider: FRESNO COUNTY HISPANIC COMMISSION
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Title: :&Aom CtiAT)2..
Chainnan of the Board, or
President, or any Vice President
Date: I L /8 D3 --~~r-=-+,~~------
By: ------=---ff-6k-""----------
Title: ___ tS=x_-e=c="'=f.-'-',~!<..=.--=j)::....:.cc,'/.edo-='-'=-v--
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-23 -COUNTY OF FRESNO
Fresno, CA
1 Provider: FRESNO NEW CONNECTIONS, INC.
2
3
4
5
6
7
8
By 1!J!!d"" 'J"~'~
Print N arne: ){q..jt, / Y f/i h ""r ; d ;(_ t" r / .. ---;
/} .
9 Title: _ ___,!'-''"_,·' tc.:.~t'=.:~'->=',i&"';l-"-e"-IL""f'-l-------
10
11
12
13
14
15
16
17
18
19
Chairman of the Board, or
President, or any Vice President
2 0 Title: l\-6 1~\r,\, \ ~ \-;r, \ l\rg,
21
22
23
24
25
26
27
28
Secretary (of Corporation), or
any Assistant Secretary, or
ChiefFinancial Officer, or
any Assistant Treasurer
-24 -COUNTY OF FRESNO
Fresno, CA
1 Provider: GENERATIONAL CHANGES, INC.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Print Name: Linda Washington
Title: CEO/President
Chairman of the Board, or
President, or any Vice President
Date: /I-7-.u r5
18 Print Name: Thelma Ricks
19
2 0 Title: Secretary
21
22
23
24
25
26
27
28
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-25 -COL:NTY 01' FRI'SNO
Fresno, C-\
1 Provider: KING OF KINGS COMMUNITY CENTER, INC.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Chairman of the Board, or
President, or any Vice President
Date: //~ 7-1.5
/ j 0 '
Title:, Jeefle'f'it(;; a;· lcl/~Ad~?r--
secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-26 -COUNTY OF FRESNO
Fre:>no, CA
1 Provider: KINGS VIEW CORPORATION
2
3
4
5
6
7
8
Print Name: /c8 ()A, dj)j ·z --
' I
9 Title: ___ c_· _· .::::.&-_· _______ _
Chairman of the Board, or
President, or any Vice President
Date: __ £-1/ /'----f"-l'·/cf_(3-iJ_-_· ~_1_.:::,_7
__
I
10
11
12
13
14
:: .,£4cCffm;u,,
17
18
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20
21
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23
24
25
26
27
28
PrintNan1e: CC/4adtJ ; ~~~Jv
J
Title: & f.tufui~w_,'-1-ov
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-27 -COUNTY OF FIUOSNO
Fre;;no, CA
1 Provider: MEDMARK TREATMENT CENTERS, INC.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
By:
Title: "Pres;1 'd.ett+
Chairman of the Board, or
President, or any Vice President
Date:
\
Print Name: ])a VIA C.\ ~--~-----------------
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-28 -COUNTY OF FRESNO
Fresno, C:\
1 Provider: MENTAL HEALTH SYSTEMS, INC.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Print Name: 't\ -1 m bt) I t./
j
Title: l?residf'b'l-+ ti Ct()
Chairman of the Board, or
President, or any Vice President
Date: I \-Gr \ ·3
18 Print Name: f'il \ C \r) Q i.J \ t--\c\wlf~-
19
20
21
22
23
24
25
26
27
28
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-29 -COUNTY OF FRESNO
Fresno, CA
1 Provider: PANACEA SERVICES, INC.
2
3
4
5
6
7
8
9
10
ll
12
13
14
1 " _:o
16
17
18
19
20
21
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26
27
28
By: tl~c/?!Al~
Print Name: An ita L I UltL-to n
Title: __,fi'--Ln_._e"'"'s,__,_,j c'"""l=e.._,_,_vr__._t· _: __
Chairman of the Board, or
President. or anv Vice President
Date: // lJ U3 I I .
PrintName:Adny M!.&yne ~,/ ~,--/r,-4
Title: cs-<J;,1
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer. or
any Assistant Treasurer
-30 -COL'KTY OF FRESNO
Frc~no, C\
1 Provider: PRODIGY HEAL THCARE, INC.
2
3
4
5
6
7
8
9 Title: ___,_C,~~.,-:::0,_ _________ _
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Chairman of the Board, or
President, or any Vice President
Date: 11 /:rbol"S
~·
Print Name: , falglfel tj)hftl ·
Title: ------'C>L...f-,F_____,()'-------
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-31 -COUNTY OI'I·RESNO
Frt.!snn, CA
1 Provider: PRO MESA BEHAVIORAL HEALTH, INC.
2
3
4
5
6
7
: Title: __ /_l_;_/_9_/_:z._o_/_b ___ _:_~"--/I=~LJ!:; r ·~ Cv<-£~L
10
11
12
13
14
15
16
17
Chairman of the Board, or
President, or any Vice President
Date: -'-'-/ /_~ _j_!f_---'--/~3~-
18 PrintNarne:
19
2 0 Title: __Je f? lfvF!?-~<j
21
22
23
24
25
26
27
28
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial Officer, or
any Assistant Treasurer
-32 -COUNTY OF FRESNO
Fresno. C\
1 Provider: WEST CARE CALIFORNIA, INC.
2
3
4
5
6
7
10
11
12
13
14
15
16
17
18
19
20
21
22
Chairman of the Board, or
President, or any Vice President
Date: / 1-0 · /3
PrintName: __ji,-, ldAwwA
Title: (l·-x-p-<cjc:_ ~'-''<2_ Tc·.N
I
Secretary (of Corporation), or
any Assistant Secretary, or
Chief Financial O±licer, or
2 3 any Assistant Treasurer
24
25
26
27
28
-33 -COUNTY OF FRI·:SNO
Fresno, C\
Addiction Research and Treatment, Inc.
Remit to: (559) 498-7100
1111 Market Street
San Francisco, CA 94103
Contracted for NRT services
Remit to:
7246 Rem met Ave
Canoga Park, CA 91303
Contracted for NRT services
Remit to:
3838 N. West Avenue
Fresno, CA 93705
Remit to:
1100 W. Shaw Ave., #122
Fresno, CA 93711
Remit to:
4705 N. Sonora Avenue, Suite 113
Fresno, CA 93722
Remit to:
7225 N. First Street, Suite 101
Fresno, CA 93720
Inc.
(559) 268-6261
(559) 266-9581
(559) 229-9040
(559) 226-0809
inc.
(559) 273-2942
(559) 276-7558
(559) 221-8100
3103 E. Cartwright
Fresno, CA 93725
1235 "E" Street
Fresno, CA 93706
539 N. Van Ness
Fresno, CA 93728
3707 E. Shields
Fresno, CA 93726
3838 N. West Avenue
Fresno, CA 93705
1100 W. Shaw Ave., #122
Fresno, CA 93711
4705 N. Sonora Ave.,# 113
Fresno, CA 93722
750 Van Ness Street
Coalinga, CA 93210
2045 N. Dickenson Ave.
Fresno, CA 93723
3535 N. Cornelia Ave.
Fresno, CA 93722
1700 Anchor Ave.
Orange Cove, CA 93646
Attachment A
Page 1 of 4
10026 S. Crawford Ave.
Dinuba, CA 93618
265 Cambridge
Coalinga, CA 93210
1201 E. Parlier Ave.
Parlier, CA 93648
16875 4'" Street
Coalinga, CA 93234
Remit to:
1803 Broadway
Fresno, CA 93721
Remit to:
4411 N. Cedar Avenue, #108
Fresno, CA 93726
Generationa1
Rur1it to:
2409 rv1c:rced Street iilOG
r=,·c;no, Ct\ 9372.1
(559) 268-6475
(559) 248-1548
(559) 681-0533
3125 Wright Street
Selma, CA 93662
603 3'' Street
Parlier, CA 93648
740 West North Ave.
Reedley, CA 93654
1045 Bethel Ave.
Sanger, CA 93657
4056 North Bryan
Fresno, CA 93723
2270 Sylvia Street
Selma, CA 93662
Attachment A
Page 2 of4
6241 West Palo Alto Ave.
Fresno, CA 93722
4444 West Weldon Ave.
Fresno, CA 93722
3160 W Mt Whitney Ave.
Riverdale, CA 93656
33326 Lodge Road
Tollhouse, CA 93667
33280 Lodge Road
Tollhouse, CA 93667
6450 DeWoody
Laton, CA 93242
12 South Teilman Ave.
Fresno, CA 93706
1 Tiller Ave.
Caruthers, CA 93609
1803 Broadway, suites A, B, and C
Fresno, CA 93721
4411 N. Cedar Ave., #108
Fresno, CA 93726
1313 P Street
Fresno, CA 93721
3333 N. Bond Ave.
Fresno, CA 93726
830 Fresno Street
of
Remit to:
2302 Martin Luther King Jr. Blvd.
Fresno, CA 93706
Remit to:
1822 Jensen Avenue, #102
Sanger, CA 93657
Remit to:
401 E. Corporate Drive, Suite 220
Lewisville, TX 75057
Contracted for NRT services
iV1entall ~ieaith. Systems
Remit to:
9465 Farnham St.
San Diego, CA 92123
Panacea
Remit to:
3152 N. Millbrook, SuiteD
Fresno, CA 93703
Remit to:
7475 N. Palm Ave.,# 107
Fresno, CA 93711
:Promesa 8ehaviora~
enter. Inc.
(559) 268-9559
(559) 875-6300
(559) 264·2700
(559) 225-9117
(559) 241-0364
(559) 439-5437
Fresno, CA 93706
2302 Martin Luther King Jr. Blvd.
Fresno, CA 93706
1822 Jensen Avenue, #102
Sanger, CA 93657
1310 M. Street
Fresno, CA 93721
Family and Youth Alternatives
3122 N. Millbrook Ave., Suites A & B
Fresno, CA 93703
Attachment A
Page 3 of 4
3152 N. Millbrook, SuiteD 4928 E. Clinton Avenue# 108
Fresno, CA 93703 Fresno, CA 93727
7475 N. Palm Ave.,# 107
Fresno, CA 93711
2910 & 2920 E. Olive Ave.
Fresno, CA 93701
6425 W. Bowles
Raisin City, CA 93624
741 Tulare St.
Parlier, CA 93648
Ht r-:
900 Newmark Ave.
Parlier, CA 93648
211 Smooth Ave.
Mendota, CA 93640
241 Smooth Ave.
Rcrnit to:
P.O. Bo~< 820
Remit to:
P.O. Box 12107
Fresno, CA 93776
(559} 892-9452
(559) 443-4850
1600 16th Street
Firebaugh, CA. 93fi22
1976 Morris Kyle Drive
Firebaugh, CA 93622
701 East Main Street
Fowler, CA 93625
611 E. Belmont
Fresno, CA 93701
Attachment A
Page 4 of4
Mendota, CA 93640
1258 E. Belmont
Mendota, CA 93640
19191 Excelsior Ave.
Five Points, CA 93624
6052 South Juanche Street
Tranquility, CA 93668
1666 Saipan Ave.
Fi1·ebaugh, CA 93622
658 East Adams
Fowler, CA 93625
3530 Couth Cherry Ave.
Fresno, CA 93706
701 East Walter Ave.
Fowler, CA 93625
1550 Herndon Ave.
Clovis, CA 93611
2727 N. Cedar
Fresno, CA 93703
13620 S. Kincaid
Caruthers, CA 93776
818 L. Street
Sanger, CA 93657
808 S. 10'" Street
Fresno, CA 93702
EXHIBITG
State of California
YOUTH
T EATME T
GUIDELINES
Revised
August 2002
Department of Alcohol and Drug Programs
1700 K Street
Sacramento, CA 95814
Youth Treatment Guidelines
Table of Contents
EXHIBIT G
Executive Summary .................................................................................... iv
Introduction ................................................................................................ v
Section I. Definitions ................................................................................ 1
Section II. Guiding Principles for Youth Treatment ........................................ 3
Section Ill. Target Population ...................................................................... 4
Section IV. Outcomes ....•....•...................................................................... .4
Section V.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
Section VI.
A.
B.
Service Components ................................................................. .4
Outreach
Screening
Initial and Continuing Assessment
Diagnosis
Placement
Treatment Planning
Counseling
Youth Development Approaches to Treatment
Family Interventions and Support Systems
Educational and Vocational Activities
Structured Recovery Related Activities
Alcohol and Drug Testing
Discharge Planning
Continuing Care
Service Coordination and Collaboration ..................................... 12
Case Management and Complementary Services
Critical Linkages
ii
EXHIBITG
Table of Contents (continued)
Section VII. Culture and Language .............................................................. 13
Section VIII. Health and Safety Issues .......................................................... 14
A. Care and Supervision
B. Medication Management
C. Emergency Services
D. Detoxification Services
E. Buildings/Grounds
Section IX. Legal and Ethical Issues .......................................................... 16
A.
B.
C.
Section X.
A.
B.
c.
Voluntary Treatment
Consent, Confidentiality, and Criminal Reporting
Notice of Program Rules, Client Rights, and Grievance Procedures
Administration ........................................................................ 17
Program Rules and Procedures
Program Staffing
Program Data Collection and Reporting
ADP PUBLICATION #8566
Resource Center
State of California
(800) 879-2772 (California Only)
(916) 327·3728
FAX: (916) 323-1270
TIY: (916) 445·1942
Internet: hl1p:/lwww .ndp.statc.cu.us
E-Mail: ResourceCenter@adp.state.ca.us
Alcohol and Drug Programs
1700 K Street
First Floor
Sacramento, CA 95814
iii
EXHIBITG
EXECUTIVE SUMMARY
Numerous studies periodically document the substantial prevalence of alcohol and other
drug (AOD) use among youth. Alcohol remains the most widely used substance among
youth, and marijuana is the most frequently used illicit drug among older students.
Inhalants are most popular among younger students and its use is at an all time high.
Recent trends indicate that the onset of AOD use is occurring at younger ages, and
there are alarming increases in the use of "club drugs" such as methamphetamine,
MDMA (ecstasy), gamma-hydroxybutyrate (GHB), Rohypnol and Ketamine.
Far from being an isolated problem, early and persistentAOD use is part of a syndrome
of problem behaviors that affect not only the youth themselves, but their families and
communities as well. Academic difficulties, criminal activity, health-related
consequences, poor peer and family relationships, mental health issues, early sexual
activity and teen pregnancy often accompany AOD use. Adolescence is an important
time of physical growth and psychosocial maturation, and AOD use interferes with these
normal developmental phenomena. AOD use can cause delays or long-term deficits in
normal physical, intellectual, social, and emotional development. When AOD use
begins at an early age, it can result in permanent developmental and neurological
damage.
Most systems serving youth report that AOD use is a major problem among the youth
they serve; however, those in need of treatment are not consistently identified or
referred for services. Generally, only those youth which cause serious problems in
relation to their AOD use tend to be identified and receive services, usually in the most
restrictive settings (group homes, juvenile hall, or correctional institutions). This lack of
intervention and treatment results in a huge cost to society, which escalates over time
as these youth reach adulthood and enter the criminal justice system or require more
serious and costly services.
For the most positive outcomes among youth experiencing AOD-related problems, they
must have access to age-appropriate intervention and treatment, practical support such
as life skills training and employment, and meaningful opportunities for involvement and
leadership. Youth need programs that address their developmental issues, provide
comprehensive and integrated services, involve families, and allow youth to remain in
the most appropriate, but least restrictive setting, so they can be served within the
context of their families, classroom and community. Historically, the AOD treatment
service system has not served youth well because it was designed and intended for
adults.
California has a pressing need for a coordinated system of treatment services designed
specifically for youth with AOD problems. The model system will provide multiple and
diverse services and treatment approaches to holistically address a youth's AGO-
related problems, surround youth with opportunities to succeed, and prevent more
severe problems in adulthood. These guidelines are an important part of a long-term
effort targeting the youth population with comprehensive and integrated services.
iv
EXHIBIT G
INTRODUCTION
In 1998, the California Legislature enacted the Adolescent Alcohol and Drug Treatment
and Recovery Program Act (Assembly Bill1784, Baca, Chapter 866, Statutes of 1998),
better known as the Baca bill. Approximately $5 million annually was designated to
support comprehensive alcohol and other drug (AOD) treatment for adolescents.
Twenty counties were funded with Adolescent Treatment Program (ATP) funds based
on an index of need indicators (adolescent deaths, hospitalizations, arrests, automobile
collisions, and school incidents, related to adolescent AOD use.)
The Baca bill authorized the Department of Alcohol and Drug Programs to develop
standards and procedures to implement the ATP. The Department established a
standards development workgroup. This workgroup was comprised of representatives
from various disciplines and county systems, with a wide range of expertise in areas
such as youth AOD abuse and treatment; adolescent development; youth mental health
issues; child welfare, family reunification, and foster care; juvenile justice and probation;
education; and, research and evaluation. The first meeting of the standards workgroup
was held in March 2000.
Until recently, there were few AOD treatment programs designed specifically for youth
and no standards of practice for youth or safeguards to ensure their safety and
protection. As counties and providers began to develop new youth programs, this lack
of standardization and youth treatment resources presented implementation problems.
Current AOD standards and regulations offered little assistance, as they have no
specifics related to youth and their unique needs. Therefore, the immediate goal of the
workgroup was to identify and document the treatment models and intervention
research had found to be effective with youth. These best practices were included in
this document to ensure that youth intervention and treatment services are safe,
appropriate, and cost effective. They were developed and intended to be used in
conjunction with, not to conflict with or duplicate, other applicable laws, regulations or
standards that govern programs serving youth.
These guidelines focus on ways to specialize treatment for youth and provide guidance
to counties and providers as they develop and operate their youth treatment services. It
is hoped that the guidelines will also serve as: 1) an educational resource for
policymakers and professionals working in other youth services systems; 2) a guide for
juvenile and family court judges for choosing and placing youth in effective programs;
and, 3) a benchmark for counties and programs to establish their own written protocols
for youth AOD treatment services based on local need.
v
SECTION I. Definitions
"ADA" means the federal Americans with Disabilities Act.
"Adolescence" means the period of life between puberty and maturity, which is
generally accepted as the ages 12 through 17, inclusive.
EXHIBIT G
"Assessmenf' is an ongoing process by which the treatment team collaborates with the
youth, family, and others to gather and interpret information necessary to determine
their level of problem severity, match their clinical needs to the appropriate level of
treatment, and evaluate progress in treatment.
"AOD" means alcohol and other drugs.
"ASAM" means the American Society of Addiction Medicine.
"Case managemenf' means an ongoing process by which the program establishes
linkages with other service systems and its providers, acts as liaison between the youth
and those other systems, and coordinates referrals to ensure access to necessary
services to assist youth and their families to address their special needs.
"Clinically managed residential treatment" means the level of care equivalent to
Adolescent Level Ill in the ASAM PPC-2R. This level of care is provided in either a
facility licensed by the Department of Social Services or in a Department-licensed adult
alcoholism or drug abuse recovery or treatment facility with an approved waiver to serve
adolescents.
"Co-existing disorders" means the co-existence of both a DSM IV-deiined substance
related disorder and an Axis II, Ill, IV, or V mental health disorder.
"Co-morbidity" means the co-existence of both a DSM IV-defined substance related
disorder and an Axis I major mental health disorder (also known as dual diagnosis).
"Continuum of care" means a full range of AOD services available to address the
diverse needs of youth. A full continuum of care generally includes prevention,
intervention, and treatment, with a variety of settings and services included within each
category.
"Departmenf' means the Department of Alcohol and Drug Programs.
"Detoxification" means acute abstinence syndrome requiring medical monitoring and
management.
"Diagnosis" means a process of examination to determine the nature of a problem or
set of problems, and the decision or opinion based on that examination.
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"DSM IV" means the Diagnostic and Statistical Manual of Mental Disorders IV.
"Early Intervention" (or secondary prevention) means the level of care equivalent to
Adolescent Level .05 in the ASAM Patient Placement Criteria for the Treatment of
Substance Related Disorders. Second Edition-Revised (PPC-2R). This level of care is
delivered in a variety of settings and usually consists of brief contact or a series of
contacts designed to explore and address problems or risk factors that appear to be
related to substance abuse. It is most appropriate for youth with low AOD problem
severity (experimental and regular use) and those who do not meet the diagnosis for a
substance related disorder.
"Family" means the nuclear family (parents, grandparents, siblings, stepparents,
adoptive parents, foster parents, or legal guardians), extended family (aunts, uncles,
cousins), significant others, mentors, or persons viewed as family members when a
youth has no identifiable family.
"Group home" means a facility licensed by the Department of Social Services, which
provides 24-hour nonmedical care and supervision to children in a structured
environment.
"Intensive outpatient treatment" (or day treatment) means the level of care equivalent
to Adolescent Level II in the ASAM PPC-2R. This level of care is usually provided in a
school or community-based program that extends the school day to include a wide array
of services. It is appropriate for youth with severe problems related to their AOD use
that have the potential to distract from recovery efforts.
"Medically-managed residential treatment" means the level of care equivalent to
Adolescent Level IV in the ASAM PPC-2R, and is appropriately provided only in a
hospital setting.
"Outpatient treatment" means the level of care equivalent to Adolescent Level I in the
ASAM PPC-2R. This level of care may be provided in any age-appropriate setting and
is appropriate for youth with low to medium problem severity.
"Screening" means the use of a brief and simple questionnaire to identify youth that
may need AOD treatment by uncovering indicators of ADD problems.
"Substance abuse" means alcohol and other drug abuse.
"Youth" means the period of life between childhood and maturity.
"Youth development philosophy" means a concept that promotes developmental
asset building, social supports and services, and job skill and workforce opportunities to
help reduce problem behaviors and produce positive long-term outcomes for youth.
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"Youth in at-risk environments" are minors whose environment increases their
chance of using alcohol and other drugs, dropping out of school, teen pregnancy, and
involvement in criminal activity.
SECTION II. Guiding Principles for Youth Treatment
These guidelines incorporate scientific research and clinical practice from both the AOD
treatment field and children's service systems. They reflect the overarching principles
of AOD treatment that characterize the most effective approaches and interventions,
and the philosophy of care for children that recognizes their developmental and multiple
needs, involves families, and assures child safety.
AOD abuse and dependence among youth is a complex problem. It is generally the
result of multiple factors, including: 1) a biological predisposition toward substance use
or other problem behaviors; 2) psychological factors such as depression or distress;
and, 3) social factors such as family, community, and peer relationships.
Biopsychosocial factors should be considered in order to maximize the benefit youth will
obtain from treatment. The biopsychosocial model integrated into these guidelines will
help draw attention to the complexity of factors that lead to substance related disorders
and aid in understanding and treating these disorders.
Substance-related disorders among youth occur in varying degrees of severity. A
youth's AOD use can range from experimental use with minimal consequences to
abuse and dependence with continued severe consequences. The level and type of
treatment provided should be consistent with the youth's degree of AOD problem
severity. The adolescent criteria in ASAM's Patient Placement Criteria for the
Treatment of Substance Abuse Related Disorders is available to determine appropriate
placement.
A full continuum of care should be available to address the varying levels of services
needed by youth, and allow for movement back and forth across levels as treatment
progresses or regresses. In addition to formal treatment, the continuum of care for
youth and their families should include pre-treatment options (mentoring, brief
interventions, harm reduction, etc.), relapse prevention (either before, during, or after
formal treatment), and aftercare services.
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SECTION Ill. Target Population
A. The target population for youth treatment is individuals ages 12 through 17
(inclusive).
B. To serve youth ages 18 through 21 and individuals younger than age 12, the
program should:
1. Document clinical appropriateness individually for each client; and,
2. Have a written protocol that addresses developmentally appropriate
services for that age group.
EA'HIBITG
C. Admission priority should be based on program design, client assessment, and
clinical judgement.
SECTION IV. Outcomes
A. Counties should assess the desired system level outcomes, such as:
1. increases in youth-specific programs/treatment capacity;
2. increased access to youth specific services;
3. increased quality of services; and,
4. achieving and maintaining a continuum of care for youth.
B. Programs should assess the desired client level outcomes for youth in treatment,
such as:
1. reduction and/or elimination of AOD use;
2. improved level of functioning in major life domains; and,
3. placement and safe treatment in the most appropriate, least restrictive
settings.
SECTION V. Service Components
A. Outreach
1. Counties should provide or arrange for outreach services that identify
ADD-abusing youth and encourage them to take advantage of treatment
services.
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2. Outreach efforts should target youth in at-risk environments.
3. High priority should be placed on. linking with public systems already
serving youth with ADD problems, such as schools, child welfare, public
health, mental health, and juvenile justice.
4. Outreach activities should also include educating professionals and policy
makers in these systems so that they become referral sources for
potential clients.
B. Screening
Youth are far less likely than adults to be referred to treatment by a parent, family
member, or self. Therefore, it is important that professionals who work with
youth be able to identify youth ADD problems and refer these youth for further
assessment and/or treatment. A high priority should be placed on identifying
children with ADD problems within other public service systems, such as
schools, child protective services, county mental health, perinatal ADD programs,
probation, and, Medi-Cal and Healthy Families programs.
1. Youth who have been identified to be at risk for ADD problems should be
screened, using a tool designed for adolescents, to uncover indicators of
ADD and related problems. Youth with possible ADD problems as
identified through the screening should be referred for a more
comprehensive assessment for substance related disorders, as described
in "C" of this Section.
2. The screening tool should be brief and simple and should be easily
administered with minimal training.
3. The screening tool should have applicability across diverse populations
and be developmentally appropriate.
C. Initial and Continuing Assessment
Assessment is not a single event upon the youth's admission to the program, but
an ongoing process to gain insight into a youth's unique abilities, strengths, and
needs. Assessment should be comprehensive, multi-faceted, and culturally, as
well as developmentally, appropriate. Assessment should be used in the
treatment planning of each individual admitted to treatment, and incorporate
contextual factors contributed by family/caregiver circumstances.
1. Except for early intervention programs, the program should complete a
comprehensive assessment on all youth with indications of possible ADD-
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related problems (as a result of a brief screening), including those being
admitted to treatment.
2. After screening indicates a probable need for treatment, the assessment
should provide the information necessary to determine and document the
level of severity of the youth's ADD-related problems and specifically
address the level of care he/she should receive, as described in "E" of this
section.
3. The assessment tool should be designed specifically for the developing
adolescent, have established reliability and validity, and capture data
related to the major life domains of an adolescent. This assessment tool
should include, but not be limited to, issues of substance abuse, mental
health, physical health, legal, development, school/education/employment,
and family/peer relationships. The assessment tool should also be
strength-based in order to accurately assess the youth's unique abilities
and needs. As recommended, a staff person qualified to administer the
instrument should perform assessments.
4. The assessment should include a health screening (including a medical
health history, disease screening, dental, and mental health). (Programs
assessing a youth should seek advice from public health professionals
whenever appropriate.) If the health screening identifies an issue that
warrants further evaluation, the program should provide or arrange for a
physical examination and/or referral to the public health department or
other appropriate care site, and take reasonable steps to assist the minor
in accessing and receiving necessary care. Programs should develop and
keep current lists of adolescent health provider referrals and provide
appropriate assistance in accessing necessary health care services based
on health assessment findings.
5. The assessment should include an evaluation of the youth's
developmental and cognitive levels; and social, emotional, communication
and self-help/independent living skills.
6. As soon as possible, the program should assess and identify safety
issues, such as risk of suicide; current, or history of, physical and/or
sexual abuse; or perpetration of physical or sexual abuse on others. The
assessment should include an evaluation of risk to self and others. If the
assessment indicates high risk of danger to the youth or others, an
appropriate referral should be made immediately and the family/guardian
should be notified. The assessment should be conducted with appropriate
consent as provided by law.
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7. The initial assessment should be completed as soon as possible, with the
initial assessment occurring no later than 30 days after admission.
Programs should attempt to gather as much information as soon as
possible, and keep updating as more information is obtained (it may take
some time to build trust and rapport with the youth before he/she will
reveal more detailed and honest information).
D. Diagnosis
1. As part of the comprehensive assessment described in "C" of this Section,
youth should be assessed to determine whether they meet the diagnostic
criteria of a substance related disorder in DSM IV.
2. Except as provided in 3 and 4 below, all youth accepted for treatment in
outpatient, intensive outpatient, and residential treatment should meet
diagnostic criteria for a substance related disorder in the OSM IV.
3. A youth whose AOD use symptoms are severe, but who does not meet
the diagnostic criteria, may be appropriate for admission to outpatient
treatment for further evaluation.
4. If the presenting AOD history is not adequate to substantiate a diagnosis,
the program may use material submitted by collateral parties (family
members, legal guardians, etc.) that indicates a high degree of probability
of such a diagnosis.
E. Placement
Individuals and agencies making placement decisions for youth needing
treatment should do the following:
1. Make every effort to keep the youth in the least restrictive environment,
unless moving them into a more restrictive program is the only way to
protect themselves or others from harm, or if all potential less restrictive
environments have proven ineffective. ASAM's PPC provides a guideline
for determining treatment setting and service matching.
2. Take into consideration the age, developmental stage, gender, culture,
and behavioral, emotional, sexual or criminal problems of the youth and
existing clientele, to ensure that the youth and other clients would not be
adversely impacted by their interaction.
3. Except for early intervention programs, a program should serve male
youth only, or female youth only, unless:
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a. the program addresses gender-specific issues in determining
individual treatment needs and therapeutic approaches; and,
b. the program provides regular opportunities for separate gender
group activities and counseling sessions.
F. Treatment Planning
EXHIBITG
1. Except for early intervention programs, programs should develop a written
individual treatment plan for each youth, based on information collected in
the comprehensive assessment.
2. The treatment plan should be developed in conjunction with the youth and
involve the youth in recognizing and appreciating his/her unique strengths
and assets as well as clarifying needs.
3. The treatment plan should address multiple problems experienced by the
youth (including but not limited to mental health, education, family, medical
illness, legal issues), and the complementary services needed to deal with
these problems.
4. Services and therapeutic approaches identified in the treatment plan
should reflect the youth's gender, and chronological, emotional, and
psychological age.
5. A physical health questionnaire designed for client and/or parent/guardian
self-administration should be used and discussed with the youth by an
appropriately trained staff member in the context of treatment plan
development. Treatment plans should contain specific goals for achieving
physical health based on the identified needs and treatment plan priorities.
6. The treatment plan should include goals with realistic objectives and
timeframes for completing. These should be mutually agreed upon by the
program, the youth, and, whenever possible, his or her family/caregiver.
7. The initial treatment plan should be completed at least within 30 days of
admission. Progress in treatment should be regularly monitored and
treatment plans modified as needs arise or change during treatment, at
various stages of the youth's development and recovery, or at least every
six months.
G. Counseling
1. Except in early intervention programs, each youth should be assigned a
primary counselor when admitted to treatment The primary counselor is
responsible for building the youth's emotional trust and safety, recognizing
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the youth's individual strengths and assets, and assisting him/her to
achieve success appropriate for his/her developmental stage.
EXHIBITG
2. The program should provide individual counseling sessions as clinically
appropriate and specified in the treatment plan, but at least:
a. upon admission to treatment to help orient the youth to treatment;
b. to develop and revise treatment plans;
c. as needed for youth who are uncomfortable with the group process
or unready to discuss specific issues in a group setting;
d. for crisis intervention; and,
e. for discharge planning.
3. Programs should provide group counseling sessions as clinically
appropriate and as Identified in the treatment plan.
4. The program should provide didactic groups as clinically appropriate and
as identified in the treatment plan.
H. Youth Development Approaches to Treatment
1. Programs should integrate a youth development philosophy as the
foundation of treatment for youth. Youth development approaches include
the following:
a. assessment and treatment planning processes that are strength-
based rather than deficit-based;
b. uncovering what is unique about the youth and building on his/her
individual abilities and strengths;
c. frequent expressions of support and consistent, clear and
appropriate messages about what is expected of the youth; and,
d. encouragement and assistance in developing multiple supportive
relationships with responsible, caring adults.
2. Programs should provide or arrange for opportunities for youth to:
a. advise and made decisions related to program policies and
procedures that impact them;
b. plan, organize, and lead program activities and projects;
c. develop social skills and decision-making abilities;
d. learn values and marketable skills for adulthood; and,
e. contribute to their community and serve others.
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I. Family Interventions and Support Systems
Research has found that effective treatment for youth almost always involves the
family, and the effectiveness of family therapy has been documented extensively,
especially among those youth who are normally the most difficult to treat.
Therefore, whenever possible, parents/caregivers should participate in all phases
of their child's treatment. However, it makes no ethical or legal sense to insist on
the involvement of estranged parents in decision-making regarding their child's
treatment. Instead, the program should create new opportunities for youth to
develop supportive relationships with appropriate adults who will remain involved
in their lives, both during treatment and recovery, and beyond.
1. Programs should make efforts to:
a. identify family dynamics, engage and include the family in the
youth's treatment as early as possible (as part of the intake and
assessment process), if clinically appropriate and specified in the
treatment plan; and,
b. provide individual family counseling, multi-family groups, and
parental education sessions as clinically appropriate and specified
in the treatment plan.
2. The program should assist the youth in developing a support system to
help reinforce behavioral gains made during treatment, and provide
ongoing support to prevent relapse.
J. Educational and Vocational Activities
1. Programs should fully integrate the youth's educational program into the
youth's clinical program by:
a. providing youth access to educational instruction while in treatment,
in accordance with state law;
b. working with the educational system to address the youth's school
related problems; and,
c. developing a plan to assist the youth to successfully transition back
into the community educational system, if appropriate.
2. Programs should provide or arrange for educational sessions and
culturally appropriate materials that address issues such as HIV/AIDS and
other health matters (Sexually Transmitted Diseases (STDs), tuberculosis,
hepatitis, nutrition), as well as, sexuality/family planning, violence
prevention, independent Jiving skills, and smoking cessation.
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3. As appropriate, programs should provide or arrange for academic and
work-readiness skills, career planning, and job training for youth. The
program should also develop and maintain collaborations with local
vocational programs and the workforce investment board and its youth
council.
K. Structured Recovery-Related Activities
EXHIBITG
Intensive outpatient and residential programs should provide or arrange for both
therapeutic and diversionary recreation. Therapeutic activities include art
therapy, journal writing, and self-help groups. Diversionary recreation activities
include sports, games, and supervised outings.
L. Alcohol and Drug Testing
1. Except for early intervention programs, programs should provide or
arrange for alcohol and drug testing for all youth.
2. The frequency of alcohol and drug testing should be determined
individually for each youth based on clinical appropriateness, and should
allow for rapid response to the possibility of relapse.
3. Alcohol and drug test results are meant to assist in diagnosis, confirm
clinical impressions, help modify the youth's treatment plan, and
determine the extent of the youth's reduction in AOD use. Clinical
decisions should not be based solely on these results.
M. Discharge Planning
1. Except for early intervention programs, programs should, in cooperation
with youth, develop a written discharge and/or aftercare plan that contains
elements to sustain gains made in treatment.
2. The adolescent patient discharge criteria contained in ASAM's Patient
Placement Criteria for the Treatment of Substance Abuse Related
Disorders is available to help determine length of stay and discharge
readiness.
3. Programs should complete a written summary for each youth discharged
from treatment that contains client profile information consistent with
standard data sets. The summary should document progress towards
goals and measurable outcomes during treatment, and characterize the
youth's long-term success or need for further assessment and/or referral.
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N. Continuing Care
Programs should provide or arrange for continuing care services to youth after
the completion offormal treatment, and whenever professional intervention is
needed, to prevent relapse and support the youth's transition into recovery.
Continuing care services may include, but are not limited to, coordination of
goals, identification of signs of relapse and a plan to respond to such signs,
family involvement, linkages to other services as necessary, aftercare sessions,
transition and emancipation options, and, self-help and peer support groups.
SECTION VI. Service Coordination and Collaboration
A. Case Management and Complementary Services
Except for early intervention programs, programs should provide or arrange for
case management services for every youth in treatment. If the case manager
function is provided directly by the treatment program, the case manager should:
1. Have training and skills in the following areas:
a. AOD treatment, an understanding of addiction, and the
intergenerational nature of AOD abuse;
b. familiarity with community resources and other youth service
systems (education, child welfare, juvenile justice, mental health,
etc.);
c. physical and sexual abuse;
d. family dynamics; and,
e. legal issues (informed consent for minors, disclosure of confidential
information, child abuse/neglect reporting requirements, and duty-
to-warn issues).
2. Arrange for, ensure access to, and coordinate complementary services
identified in the youth's treatment plan. If allowed by specific funding
requirements (i.e., State General Fund or federal Substance Abuse
Prevention and Treatment Block Grant), youth treatment funds may be
used for necessary complementary services if alternate funding is not
available.
3. Communicate regularly with the primary counselor to coordinate and
monitor the services and activities for the youth and his/her family, as
identified in the youth's treatment plan.
4. Be the youth's advocate and liaison with other systems, help the youth
and family negotiate the various service systems, and coordinate referrals.
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5. Network and communicate with other community agencies providing
services to youth in the program (including schools, child welfare, juvenile
justice, employment development, mentoring, mental health, primary
medical care, etc.), and as much as possible, coordinate case
management with these various other agencies/systems, which may
include group case management meetings.
B. Critical Linkages
1. The program should develop strong linkages with existing health, mental
health, social, educational, mentoring, and employment development
programs that provide services to youth. This includes the AOD services
system as well, since AOD prevention programs and perinatal treatment
programs provide opportunities for identification and referral of youth with
AOD problems.
2. The program should collaborate with other agencies providing services to
the youth as indicated by the client's needs and in order to ensure a
coordinated approach. These may include, but should not be limited to,
Department of Health Services, Department of Social Services (foster care
and child welfare), Employment Development Department (work
development and training), Department of Education, Department of
Mental Health, juvenile justice (courts and probation) and other community
based organizations providing services to youth.
3. . When applicable, and in accordance with state and federal laws regarding
disclosure of confidential information, the program should include
representatives from these other agencies during case conferences and
treatment planning.
SECTION VII. Culture and Language
A. Programs that serve youth whose primary language is not English, including sign
language, should have or make available, as needed, skilled bilingual staff and/or
interpreters.
B. Staff should be trained in specific cultural issues, traditions, and beliefs in order
to provide the most appropriate treatment for youth within the community.
C. All print and audio-visual materials used for educational purposes should be
culturally, linguistically, and literacy appropriate for the youth and families being
served.
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D. Staff should foster an environment of acceptance of different sexual orientations
and should be prepared to address issues of sexuality and sexual identity,
including those of gay, lesbian, and bisexual youth.
E. The program must comply with all ADA requirements.
SECTION VIII. Health and Safety Issues
A. Care and Supervision
1. The program should provide a reasonable level of age-appropriate
structure, care, and supervision to ensure the safety and security of youth
and staff at all times while on the program site. Appropriate care and
supervision includes the maintenance of rules for the protection of youth;
supervision of youth schedules and activities; monitoring of food
intake/special diets (when meals or snacks are served); and storing,
distribution, and assistance with taking medications (see "B" of this
Section).
2. Youth have the right to be accorded dignity in their personal relationships
with staff and other persons, and to be free from corporal or unusual
punishment, exploitation, prejudice, infliction of pain, humiliation,
intimidation, ridicule, coercion, threat, sexual harassment, mental abuse,
or other actions of a punitive nature.
4. Program consequences/discipline for a youth's inappropriate behavior in
the program must be non-violent, age/developmentally appropriate, non-
aversive, and clearly stated in the program's rules and procedures.
5. Programs should have written procedures for signing youth in and out of
program sites. Program staff should ensure the availability of secure, safe
and reliable transportation for youth to and from the program site and to
supportive services. The program should never leave a youth alone to
wait for his/her ride.
6. Programs, in consultation with their county agencies, should establish a
protocol for the submission of program incident reports, including the
reporting of such incidents as injuries that require medical evaluation or
treatment; suspected physical, sexual or psychological abuse;
transmissible diseases (non-STDs); and, deaths.
7. All programs should conduct a criminal record review of all staff who will
have any contact with youth while they are at the program. If the review
discloses that the individual has been convicted of or is the subject of any
criminal investigation relating to any felony or misdemeanor perpetrated
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against a child, the program shall prohibit that individual from employment
that results in any contact with youth while they are at the program. The
program should keep the results of the criminal record review in a
confidential portion of the personnel file.
B. All programs should develop training to increase staff awareness and
skills in the detection of youth injury, disease, child abuse, and neglect to
ensure youth welfare. Programs should also have written policies and
procedures concerning appropriate staff response to and preparation for
such issues.
B. Medication Management
Programs should manage youth's prescription medication in accordance with all
applicable laws (i.e., those governing school sites and residential AOD treatment
programs). Programs that are not otherwise regulated in this area should
develop and implement a written protocol for the self-administration and
management of youth's prescription medications that ensures the following:
1. medications are reviewed and documented in the youth's chart upon
admission to the program and records are periodically updated;
2. staff members directly involved in individual client care are made aware in
writing of a youth's medication regimen; and,
3. provisions are made for appropriate and secure storage and self-
management of a youth's medications to minimize risk of tampering, loss,
or contamination.
C. Emergency Services
1. At least one staff member on all shifts should be trained and certified in
first aid and cardiopulmonary resuscitation to ensure adequate emergency
services are available when youth are present.
2. All programs should develop written protocols and procedures in case of a
medical or psychological emergency. Programs should establish referral
relationships with emergency facilities. All staff involved in direct client
care should be trained in the emergency care procedures.
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D. Detoxification Services
Youth in need of detoxification services should be placed in the most appropriate
site for the provision of services.
1. When indicated, appropriately trained personnel under the direction of a
physician or other health care professional should monitor medical
detoxification with specific expertise in management of alcohol and drug
detoxification and withdrawal.
2. Written protocols should be developed and staff trained to ensure that all
programs have the capacity to adequately manage and/or make referral
arrangements for youth that appear at the program site under the
influence.
E. Buildings/Grounds
1. All residential facilities must be licensed in accordance with applicable
state licensing statutes and regulations and remain in compliance with
such requirements.
2. All facilities should be clean, sanitary, and in good repair at all times for
the safety and well being of youth, staff, and visitors.
SECTION IX. Legal and Ethical Issues
A. Voluntary Treatment
AOD treatment is a voluntary process; however, the AOD treatment system often
serves youth who "volunteer" for treatment as a choice to avoid more severe
consequences (school expulsion, juvenile detention or a felony conviction,
placement in group home, or a parental consequence). Such "coerced"
treatment can be successful, if youth are assessed and matched with the
appropriate level of treatment, and the program makes attempts to motivate the
youth to change.
1. If a youth appears to be mismatched to court-ordered treatment, the
treatment program has a right to refuse treatment based on clinical
assessment, but should make a recommendation and referral for more
appropriate placement.
2. The program should overcome resistance and encourage participation by
utilizing strategies with demonstrated effectiveness (using role models,
involving the family, motivation through positive and appealing activities).
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B. Consent, Confidentiality, and Criminal Reporting
Programs must comply with state and federal laws and regulations regarding
informed consent for children, disclosure of confidential information such as
patient-identifying information (including communication with parents, guardians,
courts), child abuse and neglect reporting requirements, and duty-to-warn issues
(threats of violence, HIV infection risk, criminal activity).
C. Notice of Program Rules, Client Rights, and Grievance Procedures
Upon admission, all youth should be personally advised of, and given a copy of,
the program rules, client rights, and the complaint and/or grievance procedures.
These should be culturally, linguistically, and literacy appropriate for the youth
and families being served. The program should post these items in a noticeable
place in the facility.
SECTION X. Administration
A. Program Rules and Procedures
The program should have written program policies and procedures, client rules
and rights, and complaint and/or grievance procedures. All staff should receive
training on the program rules, policies, and procedures.
B. Program Staffing
1. Each youth treatment program should have at least the following core
staff:
a. a program or clinical supervisor, who should have management
experience (i.e., staff supervision, fiscal operations, or business
administration), and education and experience in ADD addiction
counseling;
b. an AOD counselor, who should be certified by an AOD addiction
counselor credentialing organization; and,
c. a family therapist, who should be licensed as either a marriage and
family therapist, clinical social worker, psychologist, or a registered
intern under the supervision of a licensed therapist. The family
therapist may be a contracted employee.
2. The core staff should have training and/or skills in the following areas:
Page 17 ofl8
a. AOD treatment, an understanding of addiction, the
intergenerational nature of ADD abuse, and the dynamics of
adolescent recovery;
YOUTH TREATMENT GUIDELINES
b. effective and developmentally-appropriate interventions and
approaches for treating AOD-abusing youth;
c. assessment of AOD use disorders, mental health disorders
(psychotic, affective, anxiety, and personality), and cognitive
impairments;
EXHIBIT G
d. psychoactive medications prescribed to youth, their benefits, and
their potential side effects and interactions with other medications
or substances;
e. child development and normal adolescent growth and development;
f. therapeutic recreational therapy;
g. family dynamics;
h. detection of youth injury, disease, abuse, and neglect;
i. HIV/AIDS and other health issues (STDs, hepatitis, smoking, etc.);
j. cultural competence, including ADA requirements;
k. community resources and other youth treatment systems (schools,
child welfare, mental health, juvenile justice system, etc.);
I. methods and meanings of drug and alcohol testing, as well as the
benefits and limitations;
m. legal issues (informed consent for minors, disclosure of confidential
information, child abuse/neglect reporting requirements and duty-
to-warn issues);
n. program rules and procedures; and,
o. client rights and grievance procedures
3. Programs should retain written evidence of the required staff licensure,
skills, and training.
4. Programs should provide for or arrange for continuing education for all
clinical staff to enhance their specialty and keep up with trends, new
technology, etc.
C. Program Data Collection and Reporting
1. Counties and providers are responsible for collecting and submitting data
to the Department, such as the California Alcohol and Drug Data System
(CADDS) admission and discharge forms.
2. Counties and providers may be required to provide additional d ala for
monitoring or evaluation purposes, as requested by the Department.
Page 18 of 18
YOUTHTREATJYillNT GUIDELINES
Attachment H
Page 1 of2
National Standards for Culturally and Linguistically Appropriate
Services (CLAS) in Health Care
1. Health care organizations should ensure that patients/consumerst receive ±rom all staff members
effective, understandable, and respectful care that is provided in a manner compatible with their
cultural health beliefs and practices and preferred language.
2. Health care organizations should implement strategies to recruit, retain, and promote at all levels of
the organization a diverse staff and leadership that are representative of the demographic
characteristics of the service area.
3. Health care organizations should ensure that staff at all levels and across all disciplines receive
ongoing education and training in CLAS delivery.
4. Health care organizations must offer and provide language assistance services, including bilingual
staff and interpreter services, at no cost to each patient/consun1er with LEP at all points of contact
and in a timely manner during all hours of operation.
5. Health care organizations must provide to patients/consumers in their preferred language both verbal
offers and written notices infonning them of their right to receive language assistance services.
6. Health care organizations must ensure the competence of language assistance provided to limited
English proficient patients/consumers by interpreters and bilingual staff. Family and friends should
not be used to provide interpretation services (except on request by the patient/consumer).
7. Health care organizations must make available easily understood patient-related materials and post
signage in the languages of the commonly encountered groups and/or groups represented in the
service area.
8. Health care organizations should develop, implement, and promote a written strategic plan that
outlines clear goals, policies, operational plans, and management accountability/oversight
mechanisms to provide CLAS.
9. Health care organizations should conduct initial and ongoing organizational self-assessments of
CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related
measures into their internal audits, performance improvement progran1s, patient satisfaction
assessments, and outcomes-based evaluations.
10. Health care organizations should ensure that data on the individual patient's/consumer's race,
etlmicity, and spoken and written language are collected in health records, integrated into the
organization's management information systems, and periodically updated.
Attachment H
Pagel of2
11. Health care organizations should maintain a current demographic, cultural, and epidemiological
profile of the community as well as a needs assessment to accurately plan for and implement services
that respond to the cultural and linguistic characteristics of the service area.
12. Health care organizations should develop participatory, collaborative pminerships with communities
m1d utilize a variety of formal and informal mechanisms to facilitate community and
patient/consumer involvement in designing and implementing CLAS-related activities.
13. Health care organizations should ensure that conflict and grievance resolution processes are culturally
and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural
conflicts or complaints by patients/consumers.
14. Health care organizations are encouraged to make available regularly to the public infmmation about
their progress a11d successful ilmovations in implementing the CLAS standards and to provide public
notice in their communities about the availability of this information.