GENERAL CLINICAL RESPONSIBILITIES

To receive clinical responsibilities at Hillcrest Educational Centers, psychiatrists must meet the general criteria established in Section 6, Human Resources, of the Policy and Procedures Manual, and the specific criteria listed below, which for psychiatrists include:

1. Current licensure as a physician by the Massachusetts Department of Education and certification or eligibility for certification by the American Board of Psychiatry and Neurology.
2. The equivalent, as determined individually for each applicant by the HEC Human Resources Dept. and/or the Medical Director, of 30 hours per year of Continuing Medical Education (CME) credits:
(a) during the previous year for those not currently privileged;
(b) during the period since completion of the last application for those currently privileged.
(Note: If it has been 2 years since the last application, 60 hours are required.)
Primary source verification of a current, valid MA license will be acceptable proof of CEUs and required training.
Qualified activities include, but are not limited to, the following:
formal education/training (self),
education/training/supervision of others,
conducting research,
readership of professional journals,
articles/books published.

GENERAL CLINICAL RESPONSIBILITIES INCLUDE:

1. Psychiatric History and Evaluation
2. Mental Status Examination
3. Comprehensive Diagnostic Assessment
4. Differential Psychiatric Diagnosis
5. Comprehensive Treatment Planning
6. Physical Examination and Medical History
7. Diagnosis and Treatment of Minor Medical Conditions
8. Psychiatric Consultation (patient-centered, worker-centered, program-centered)
9. Forensic child psychiatrist (i.e., custody, visitation, surrender, etc.).
10. Individual therapy (supportive, expressive, play therapy).
11. Life space therapy.
12. Pharmacological therapy.
13. Crisis intervention
14. Ordering Time Outs and/or Physical Restraints.
15. Admission of patients.
16. Discharge of patients.
17. Transfer of patients.

Special Clinical Responsibilities may be granted to psychiatrists and psychologists who document evidence of training/education, supervised experience, and competent practice in the service area of the Special Privilege as follows:
1. Thirty hours of education/training in the service area.
2. Six months of practice in the service area supervised by a psychiatrist, other physician, or other qualified professional.
3. Current competent, professional-level practice in the service area.

Once granted, special clinical responsibilities are renewed for psychiatrists who are recommended for the special clinical responsibilities by their supervisor and peer reviewer, and who document the equivalent of 10 hours of professional-level activities per year since the previous application to maintain and improve skills in the service area of the special privilege. Qualified activities are described above.

Pediatrician Peer Reviewer Form

GENERAL CLINICAL RESPONSIBILITIES

To receive clinical responsibilities at Hillcrest Educational Centers, pediatricians must meet the general criteria established in Section 6, Human Resources, of the Policy and Procedures Manual, and the specific criteria listed below, which, for pediatricians, include:

1. Current licensure as a physician by the Massachusetts Department of Education and certification or eligibility for certification by the American Board of Pediatrics.

2. The equivalent, as determined individually for each applicant by the HEC Human Resources and/or Education Dept., of 30 hours per year of Continuing Medical Education (CME) credits:
(a) during the previous year for those not currently privileged;
(b) during the period since completion of the last application for those currently privileged.
(Note: If has been 2 years since the last application, 60 hours are required).
Primary source verification of a current, valid MA license will be acceptable proof of CEUs and required training.

Qualified activities include, but are not limited to, the following:
• formal education/training (of self),
• education/training/supervision of others,
• research,
• reading of professional journals or related materials, and
• the publishing of professional articles/books.

3. The maintenance of a private practice in the field of Pediatrics, which is separate from and independent of Hillcrest Educational Centers, and which does not interfere with or conflict with the Pediatrician’s Hillcrest duties and responsibilities.

General Clinical Responsibilities Include:

1. Physical health history and evaluation.
2. Physical examination and medical history.
3. Comprehensive medical diagnostic assessment.
4. Differential diagnosis (includes ordering required tests).
5. Comprehensive medical treatment planning.
6. Diagnosis and treatment of medical conditions.
7. Diagnosis and treatment of minor injuries and other minor physical conditions.
8. Pediatric consultation (patient-centered, worker-centered, program-centered).
9. Pharmacological therapy.
10. Crisis intervention.
11. Referral of patients to other health care providers.

Rev: 1/10/07 CB

APPLICATION FOR REAPPOINTMENT OF CLINICAL RESPONSIBILITIES

CLINICAL RESPONSIBILITIES COMMITTEE CHECKLIST

Application For Clinical Responsibilities

Like many behavioral healthcare agencies, and particularly those operating multiple, small residential treatment programs for children, Hillcrest chooses to minimize the number of staff to whom clinical responsibilities are accorded in order to maintain simple structures, efficient administrative procedures and close supervision of the treatment of children.

Effective October 27, 2006, Hillcrest authorizes clinical responsibilities for the positions listed below.
Psychiatrist
Pediatrician
Psychologist

The criteria and responsibilities associated with each of these positions are attached as separate documents.

PEER REVIEW PROCEDURES

As noted, Hillcrest chooses to minimize the number of privileged positions in order to maintain simple structures, efficient administrative procedures and close supervision of the treatment of children. Similarly, simple and efficient Peer Review procedures are employed, while insuring the high level of professional competence and work by privileged staff, as well as full compliance with accreditation and regulatory standards.

1. Pediatrician.
Beginning in 2003, Hillcrest will contract for appropriate outside consultation for the minimally biannual review of the Pediatrician.

2. The Psychiatrists are reviewed by a licensed and certified consulting psychiatrists at least every 2 years.

3. The Psychologist is reviewed at least every two years by a licensed and certified Psychologist.

Note: In January 2002, when Hillcrest was reviewing Privileging and Peer Review, the Standards Clarification Unit of the Joint Commission confirmed that it is acceptable for non-privileged supervisees of the same discipline to participate in a peer review of their privileged supervisor’s professional competence in their shared discipline.

Credentialing
This process ensures the competence of licensed independent practitioners. Human Resources performs primary source, or other acceptable verification of the licensure, certification, or registration. Through the interview process, the appropriate supervisor accesses competency, and references are checked by Human Resources. Continued assessment of competency is done through trainings, continued education, supervision and evaluation.

Clinical Responsibilities

The Board of Directors, based on the recommendations of the Executive Vice President and the Senior Management Team, will determine which positions are to be granted HEC privileges. The Licensed Independent Practitioner in these positions will obtain the application for Clinical Responsibilities from Human Resources.

As of March 1,2002 the following positions will be privileged at Hillcrest Educational Centers, Inc.:
1. Psychiatrist
2. Pediatrician
3. Psychologist

The Director of Human Resources will complete the Human Resource Section of the application, will attach the necessary documents, and will submit the application to the appropriate supervisor.

The supervisor will complete the appropriate section and will return to Human Resources, along with a current evaluation.

Human Resources will obtain a peer review for those being reviewed. The packet will be reviewed by the Quality Assurance & Clinical Responsibilities Committee of the Board of Directors for final approval, or for denial of Clinical Responsibilities.

Granting Temporary Clinical Responsibilities

Temporary Clinical Responsibilities may be granted once we have received primary source verification of current licensure to meet the important needs of clients for a limited period of time, not to exceed 6 months.

New LIPs may be granted Temporary Clinical Responsibilities upon primary source verification of licensure, verified education, training and/or experience, meeting expectations for current competence and ability to perform the clinical responsibilities requested.

New LIPs must actively pursue the application process for Clinical Responsibilities during this temporary period, including a complete application, no current or previously successful challenge to licensure or registration, not been subject to involuntary termination of professional or medical staff membership at another organization, when applicable to the discipline, and not been subject to involuntary limitation, reduction, denial, or loss of clinical responsibilities, when applicable to the discipline.

Temporary Clinical Responsibilities may also be given to LIPs who have accepted permanent positions and who will apply for Clinical Responsibilities. For physicians, verification of privileged status at a hospital, primary source verification of licensure and including verification that there are no previous, current or pending successful challenges to licensure or registration, not been subject to involuntary termination of processional or medical staff membership at another organization, when applicable to the discipline, and not been subject to involuntary limitation, reduction, denial, or loss of clinical responsibilities, when applicable to the discipline.

Appealing the Denial of Hillcrest Clinical Responsibilities:

Should the application or reapplication for HEC Clinical Responsibilities be denied at any step in the process, the applicant will be contacted by the Director of Human Resources and will be given written documentation regarding the reason for rejection. The applicant may appeal the decision to deny Clinical Responsibilities in the following manner

Step 1:

The applicant may appeal the decision to deny Clinical Responsibilities to the Executive Vice President. The appeal must be in writing and must include a copy of the application and the letter from the Director of Human Resources, along with any supporting documentation for reversing the original decision. The VP will set up a meeting with the applicant within 2 weeks of receiving the written appeal. The Director of Human Resources will also participate in the meeting. The VP’s written decision on the appeal will be sent to the applicant within 5 working days of the meeting.
 
Step 2:

If the applicant’s appeal is denied by the VP and the applicant wishes to continue the appeal process, the applicant must send a written appeal to the President/CEO within 5 working days of receipt of the decision of the VP. The appeal must include copies of the original application, the letter from the Director of Human Resources, along with supporting documentation for reversing the decision, and a copy of the letter from the VP. The President/CEO will meet with the applicant within 2 weeks of receiving the written appeal and the decision will be communicated in writing within 5 working days of the meeting. Both the VP and Director of Human Resources may be included in the meeting.

Step 3:

If the applicant’s appeal is denied by the President/CEO and the applicant wishes to continue the appeal process, the applicant must send a written appeal to the Personnel Committee of the Board of Directors within 5 working days of receipt of the decision of the President/CEO. The appeal must include copies of the original application, the letter from the Director of Human Resources, along with supporting documentation for reversing the decision, and copies of the letters from the VP and the President/CEO. The Committee Chair will schedule a meeting with the applicant within 4 weeks of receiving the written appeal. The Committee’s decision will be communicated to the applicant in writing within 5 working days of the meeting.

The decision of the Personnel Committee of the Board of Directors is final. Every effort will be made at that time to find a position for which the employee is qualified. However, if no position is available, the employee will be expected to resign.