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Chapter 5 - Urgent Events & Emergencies

Body Checks

 

a. Associated with Restraints and altercations

A body check of the student is to be conducted by the nurse within 24 hours or sooner if indicated, whenever any of the following conditions are met:

  1. A physical intervention has been difficult, severe or such that injury may have occurred, regardless of the duration of the hold or restraint e.g., the student has struggled and the staff has had to apply some degree of force to maintain safety.
  2. The student has been involved in a floor hold (i.e., prone, on the floor-not seated).
  3. The restraint exceed 20 minutes
  4. The student reports any pain or discomfort, or the student appears to be in pain or uncomfortable, regardless of whether or not he/she reports or confirms pain or discomfort.
  5. After a physical altercation between students that meets any of the criteria outlined above (i.e., difficulty, severity or duration of physical altercation; report or appearance of injury, pain or discomfort).

 

If there is no nurse on duty at the time of the incident, the on call nurse will be consulted by telephone. If it is determined that the on call nurse need not come to the program to do a body check; the body check will be done as soon as possible at the beginning of the next nurse’s shift on campus.

b. Prior to and on return from unsupervised leave of absence

A body check is also done prior to and upon returning from, an unsupervised home visit or an unsupervised off-campus visit. This is not a contraband check; it is a visual inspection looking for signs of illness or injury.

 

c. Student Refusal

If a student refuses a body check, the supervisor is notified and the event is documented on the Incident Report form and in the case record Progress Notes. Additional attempts are made until the body check is completed.

Chapter 5 - Urgent Events & Emergencies

Chemical / Mechanical Restraint & Seclusion

Chemical/Medication Restraints

 

Hillcrest does not perform chemical/medical restraints at Hillcrest Center, Highpoint, the Intensive Treatment Unit or the Hillcrest Academy. This includes the administration of non-voluntary PRN’s. If at any point a physician feels that chemical restraint is the only way to avert immediate risk then a physician’s order supersedes any and all regulation for the sake of safety.

Mechanical Restraints

Hillcrest Educational Centers prohibits the use of mechanical restraints.

Seclusion

Hillcrest Educational Centers prohibits the use of Seclusion

 

Use of any Physical Restraint in a manner inconsistent with 603 CMR 46.00 is prohibited.

Chapter 4 - Care of Students

Food & Behavior Intervention

Hillcrest policies, DEEC regulations, Joint Commission standards, and best practices for residential care and treatment all prohibit the denial of food and/or a nutritious diet as consequences for negative behavior, for disciplinary reasons, and/or as a behavior management technique (see citations below). However, this standard may sometimes be difficult to interpret and/or implement on a practical level when a student misses or refuses one or more meals or snacks, and/or requests special foods or foods at unscheduled times. This policy statement attempts to clarify some of the contingencies surrounding this issue and provide guidance on how to achieve an appropriate standard of care.

1) A student misses (but has not refused) a meal or snack.

In this case, the student has not refused food, but for whatever reason, was not able to be present when the food was provided.

If a student misses a meal or snack for a valid reason (including being involved in a treatment activity, disciplinary action or emergency intervention such as a hold), staff should provide a reasonable substitute or alternate meal or snack if the meal or snack is no longer available.

This should be done in a manner that clearly communicates to the student that the substitution is not a disciplinary action.

2) A student refuses a meal or snack.

a) If a student refuses to eat a scheduled meal, this is not denial or withholding of food. If the student later requests food at an unscheduled time, such as before the next meal or snack, staff may provide or offer any reasonable alternate form of food (e.g., fruit, sandwich, cereal) rather than providing or offering either the meal that was initially offered and refused, or any other complete meal.

If the student refuses such alternate offerings, staff are not obliged to offer or provide any additional food until the next scheduled meal.

This is consistent with policies, regulations, standards and best practices.

b) If a student refuses to eat a scheduled snack, this is not denial or withholding of food. If the student later requests food at an unscheduled time, staff should inform the student that he/she will have the opportunity to eat at the next scheduled meal. The provision of an alternate or substitute snack is neither necessary nor required.

This is consistent with policies, regulations, standards and best practices.

c) Consistent with DEEC regulations, a student has the right to refuse a meal, snack, or a specific form of food. While staff can and should reasonably encourage the student to eat at least some nutritious food, the student must not be coerced by staff to eat, and the student should not receive disciplinary action or consequences (e.g., points, restrictions) for refusing to eat.

If a student refuses two or more consecutive meals (meals, not snacks), nursing and the student’s Clinician should be notified and consulted.If there is concern associated with health and/or medications because the student is refusing meals, that is a medical issue rather than a disciplinary issue. In this case, disciplinary actions or consequences should not be imposed, but nursing, the Clinician and the Treatment Team should determine how the behaviors and/or concerns should be managed.

3) Food issues may be highly symbolic and meaningful for many students. Therefore, if eating patterns or food issues are causes for concern by any staff or the Treatment Team, the Team should determine how the Team will manage the behaviors or concerns in order to maintain consistency of approach.

As with other problem behaviors, consistency among staff in all disciplines is very important, and individual staff must take care not to “freelance” or unintentionally reinforce problematic behaviors.

 


 

Chapter 3 - Program Policies

Family Focused Campus Events

  1. Each campus will hold a minimum of four events annually that specifically reach out and involve the families of the students in placement at HEC.
  2. Events should include: Winter Holiday Party (Dec.)

Summer Recognition Day (June)

Spring Event (March/April) – theme to be determined by Campus

Fall Event (Sept/Oct) – theme to be determined by Campus

  1. The minimum expectations for these events are:
  • Parents and/or family members must be invited in advance (preferably 4 to 6 weeks ahead of the event).
  • Opportunities for family members to meet and exchange information with teachers and clinicians should be available at least 2 times per year.
  • At least one event should occur on a weekend day.
  • Activities for foster parent/family-child and parent/family-staff interactions should be planned for the event.
Chapter 1 - General Information

ORGANIZATIONAL STRUCTURE

Board of Directors

HEC is governed by a 15 member Board of Directors that meets monthly. These volunteers are responsible for fulfilling the overall Hillcrest mission. Each member serves at least a 3-year term. Working committees include Quality Assurance, Personnel, Finance, Development, Privileging, Auditing, and Building and Grounds.

The President/CEO of HEC reports directly to the Board of Directors.

Clinical Department

The Clinical Department is led by the Director of Student Services and is staffed by Psychiatrists, Psychologists, Assistant Clinical Directors, Clinicians, Family Permanency Specialists, the Clinical Compliance Specialist, and Clinical Assistants. Clinical administrators are independently licensed by the Commonwealth of Massachusetts, and all Clinicians are either licensed or in the process of being licensed. Each member of the Clinical Department receives individual supervision, group supervision/training on a regular basis. The Clinical Department also participates in Practicum placement supervision of students in social work and psychology.

Each student is assigned a Clinician on campus. Residential students receive individual and group therapy and family support services. Houatonic Academy students receive group therapy. Case management services are provided for each student which include family contact, liaison work with all related agencies, record keeping, documentation, report writing, etc.

The ASD Residential Program has 1 clinician assigned per 7 students. Each clinician is responsible for the student’s behavior support plans, recommendations for behavioral interventions, treatment planning, and medication review with a board certified psychiatrist. Clinical services also include crisis assessment/ support as needed, and weekly staff consultation through structures such as team meeting, milieu observations, and in-the-moment coaching to staff and students. Clinical services also include parent/guardian training, in the areas of behavioral interventions and strategies to ensure carryover when a student transitions from care. These services are provided by Masters level clinicians licensed in the area of Applied Behavior Analysis, and are Board Certified Behavior Analysts. All clinical services are supervised by the Director of Autism Services, and the Program Director. The agency’s Director of Student Services also provides consultation or support as needed.

 

Medical Department

The medical staff of HEC consists of Head Nurses, registered and licensed practical nurses, nurse practitioners, a pediatrician, who also serves as the Medical Director for the agency; psychiatrists and a registered dietitian. Nursing services are led by the Director of Nursing Services. Consultation with specialists not employed directly by HEC is coordinated with a referral from the pediatrician or psychiatrists. Emergency medical care is obtained at area hospitals and urgent care clinics. Dental needs are met by Hillcrest Dental Care located in Pittsfield, MA.

Education Department

The Education Department is led by the Director of Education and Assistant Director of Education who supervise the education programs and services at each program. The Education Department has certified teachers, or teachers who are in the process of becoming certified, who have specialty training and expertise ranging from special needs, vocational and physical education, to  art. While a student is enrolled at Hillcrest Educational Centers the emphasis is placed on providing appropriate instruction in core subject areas that are in alignment with the Common Core standards and the Mass. Curriculum Frameworks. Our curriculum provides instruction that also aligns with the student’s High School graduation requirements. Unless otherwise indicated, our students work toward earning their High School diplomas through their Local Education Agency (LEA).  Students are prepared to take state mandated testing in their part of the requirements for earning their diploma. A majority of our students have been identified with an educational disability and are therefore entitled to an Individualized Education Plan (IEP). We work closely with the LEA to develop appropriate and realistic plans. Along with academic expectations, emphasis is placed upon the development of independent living skills, self-esteem, personal development, pre-vocational skills, and community awareness. During academic hours, the low ratio of staff to students allows each student to have a significant amount of individual attention and instruction, with teachers supported by Teacher Assistants.

Rehabilitation Department

The Rehabilitation Department is staffed by professionals licensed in speech and language therapy.  Additionally, we contract for any services required by a student’s IEP. Contracted services may include speech and language therapy, occupational therapy and physical therapy.

Workforce Learning Department

In order for Hillcrest Educational Centers to fully achieve its mission, our direct care and professional staff receive extensive training on a continuous basis.

The Workforce Learning Department provides all full time employees with a minimum of 24 hours of training annually. The ongoing training programs are created and delivered using the expertise of all departments to ensure quality care and consistency among the campuses. An on-line learning management system is also available to all staff.

In 2008, HEC initiated the Learn More – Earn More positional career ladder system. LM-EM enables most staff in the agency to grow and advance within their direct service/non-managerial roles, and training and staff development play a core role in the advancement system.

The Workforce Learning Department also provides classes associated with the Residential Child & Youth Care Professional (RCYCP) accreditation, a national accreditation program sponsored by the University of Oklahoma’s prestigious National Resource Center for Youth Services.

Maintenance and Grounds

The Maintenance Department is led by the Director of Facilities , who reports to the Chief Financial Officer, and who supervises both generalist and specialist staff at all campuses. The Maintenance Dept. is responsible for overall maintenance, repair and upkeep of all grounds and buildings; building renovations; vehicle maintenance and repair.

Food Service and Housekeeping

The Manager of Foodservice and Housekeeping leads the Housekeeping Supervisor and all other Food Service and Housekeeping staff at the campuses. Cooks at each campus provide all meals and snacks for students and working staff, while Housekeepers at each campus provide general cleaning, special project work, and trash removal.

Chapter 2 - Intake & Admissions

Campus Functions

Processing the Referral

The referral process procedures vary somewhat from campus to campus, contingent on such conditions as management structure and staffing. The general procedures described below represent a typical procedure.

Note regarding Policy and Procedure Manual:

Prior to admission, parents/guardians, as well as the local school district of accepted students shall receive written notification that a copy of Hillcrest’s Policy and Procedures Manual and Student Handbook is available upon request. Additionally, Hillcrest maintains a copy of their Policy and Procedure Manual on site.

Policies and Procedures as they pertain to the admission of their child/client include, but are not limited to:

  1. The school’s statement of purpose;
  2. The type of services provided;
  3. Admission criteria;
  4. Parent’s rights ;
  5. Health care, including provisions for emergency health care and/or hospitalization;
  6. Planning for both foreseen and emergency terminations;
  7. Discipline and behavior management, including physically abusive behavior by a student to himself/herself or others, and proper use of non-violent restraints;
  8. Activities related to daily living skills;
  9. Contractual obligations with regard to payment for services. The school shall inform, in writing, any party, other than a local school district, responsible for placement of a student that said party is financially responsible for any costs incurred as a result of any placement not made;
  10. Clothing requirements;
  11. A description of normal daily routines;
  12. Any specific treatment strategy employed by the facility;
  13. A description of any normally occurring religious practices;
  14. Visiting hours and other procedures related to communication with students and the facility;
  15. Name and telephone number of a staff person whom the parents may contact on an ongoing basis;
  16. A description of a procedure which the parents or student may use to register complaints regarding the student’s education and care at the facility;
  17. A copy of the approved school calendar

 

  1. Upon receipt of the referral from the Admissions Coordinator the Program Director or designee, responsible for Intake and Discharge reviews the material and circulates it to the designated department heads for expeditious review. Any questions or concerns generated during these reviews are communicated to the Admissions Coordinator and/or interviewer prior to the interview of the prospective student by the Director of Admissions.
  2. If requested by the referring agency or prospective student’s guardian, an on-campus interview is arranged by the Admissions Coordinator. The on-campus interview will generally include a tour of the campus and the participation of the PD or designee and  department heads, as appropriate.

Within 24 hours of the campus tour, the PD or designee communicates the decision regarding acceptance of the referral to the Admissions Coordinator.

 

Preparing For the Admission

Note: Admission preparation procedures vary somewhat by campus. The general procedures described below represent a typical procedure.

  1. The PD arranges for one-to-one staffing of the new student for no less than 24 hours following his/her admission. The PD designates the Team, and/or bed and bureau assignments and makes all other necessary arrangements for the new student. The PD assures the student’s bedroom room is well prepared and that the student receives new bedding and storage containers as necessary.
  2. The clinical administrator informs Clinicians about the incoming student, and assigns the student to a Clinician’s caseload. They provide the referral packet to assigned Clinician and ensure that all appropriate documentation will be completed prior to the admission.
  3. At least 24 hours prior to the new student’s admission, the clinical department completes and disseminates an Intake Summary.
  4. The Education Director or designee notifies the education staff of new student’s admission date, team and class assignment. They distribute the intake information to education staff and ensure that there is adequate classroom space and equipment for new student. They arrange class changes, if necessary, with education staff, and distribute available reports and records pertaining to new student to teaching staff.
  5. The Head Nurseor designee ensures that student’s medical information required for admission to the program has been received. They notify the Psychiatrist of new student’s admission; notifies Shift Supervisors of allergies, existing medical conditions and special precautions appropriate to the new student, and notifies the Food Service staff of any special dietary needs the student may have. They prepare the Emergency Medical File for new student which includes a photograph.

 

Admitting the New Student

Note: Admission procedures vary somewhat by campus. The general procedures described below represent a typical procedure.

On the day of admission of the new student:

  1. The PD or designee greets the new student and accompanying family and placing agency staff, and discusses the program with them. The parent/guardian, and student are provided with the program handbook and a copy of the current school year calendar.
  2. A clinical representative meets with the student and the accompanying adults to determine contact and visitation arrangements, if possible.
  3. The Supervisor or designee arranges for the search and written inventory of the new student’s personal belongings, and provides 1:1 staffing for the student during unpacking and orientation.
  4. The student is checked in by the Nurse on duty within one hour of his/her admission.
  5. The campus Administrative Assistant sets up the student’s chart and takes the student’s photograph for the record within 24 hours of admission.
  6. The Supervisors or designees meet with their shift’s staff to explain the treatment plan, risks, medical issues and other relevant information.
  7. The Supervisor or designee on shift when the new student is admitted coordinates with other Youth Development supervisors to ensure that all important information is shared.
  8. The assigned clinician meets with the student to conduct a mental status exam and complete an initial risk assessment within 24 hours.

Note regarding Policy and Procedure Manual: Parents/Guardians of enrolled students receive written notification that a copy of Hillcrest’s Policy and Procedures Manual is available upon request. Additionally, Hillcrest maintains a copy of their Policy and Procedure Manual on site.

Chapter 2 - Intake & Admissions

Waiting List Policy & Procedure

Introduction & Policy Statement:

Hillcrest Educational Centers manages client waiting lists in order to ensure that clients who have been referred to and accepted for a Hillcrest program are admitted in a systematic, fair and equitable manner.

The following procedures are utilized to manage the waiting lists for the Hillcrest residential treatment programs, the Brookside Intensive Treatment Unit, and the Housatonic Academy. Waiting lists are maintained separately for each respective program.

The only clients placed on waiting lists for these programs are those clients who have been assessed and accepted for admission, with no documentation or information required for referral to the HEC program still pending.

Procedures:

The waiting list procedures for these residential and nonresidential treatment and education programs are the same.

In the event that a referred client has been accepted for admission but there are currently no appropriate openings in the program for that client, the client is placed on a waiting list for that program. Clients on a program’s waiting list are considered for admission on a chronological, “first accepted, first admitted” basis. The basis for the chronological list is the date of the client’s acceptance (rather than on the date of the referral).

Additionally, as openings in that program occur, the program considers additional factors that impact program operations, program space allocation, and student group constituency and balance. These factors, which may vary by program, include but are not limited to: the referred student’s age, gender, grade and academic functioning level, clinical and behavioral history and profile.

If for any reason the “first accepted” client is not available for admission to the program within a reasonable period of time, the next client on the waiting list will be considered for admission.

If HEC is notified that the client has been placed or admitted elsewhere, or that the client does not require Hillcrest services for any other reason, the client’s name is removed from the waiting list for that HEC program.