Advanced Directive A mental health advance directive is a written document that describes what you want to happen if you become so incapacitated by mental illness that your judgment is impaired and/or you are unable to communicate effectively. It can inform others about what treatment you want or do not want, and it can identify a person to whom you have given the authority to make decisions on your behalf. The law requires mental health providers to respect your mental health advance directive, but they are not required to follow it in all cases. If instructions or preferences in your mental health advance directive are against hospital policy, are unavailable, or would violate state or federal law or immediately endanger you or others, providers are not obligated to comply with those provisions. Also, if you are involuntarily hospitalized under the Involuntary Treatment Act, or are incarcerated in jail, your mental health advance directive may not be fully honored. Grievance Policy and Human Rights - §490. Written grievance policy. River City has a Human Rights Coordinator that can assist you with the complaint and grievance process. This person also monitors staff and all programs and services to ensure that no client or family is experiencing abuse, neglect and/or exploitation or any type. What is a Complaint? A complaint is an informal way the state allows you to express your dissatisfaction with River City and/or its affiliates. It is a good idea to try to resolve your complaint with the person directly involved or ask the River City Human Rights Advocate to assist you, before you try other things. Explain your concern. Let the person know what would work better for you. Be clear about what your complaint is. Also, be clear about what an acceptable solution will be. Try to find some ways to reach agreement that will satisfy both you and the other person. What is a Grievance? There are two types of formal complaints that you may make. One type is an appeal, which is a formal complaint about an action. An action is a denial, suspension, reduction, or termination of certain services. See below for a description of the appeal process. The second type is a grievance, which is a formal complaint about any other issue. The purpose of this policy and procedure is to prevent and resolve conflict. River City acknowledges that any client, who has a grievance or is dissatisfied with any matter concerning the programs, services or staff at River City, will have the right to lodge a grievance. River City will consider and attempt to resolve any grievance in a timelymanner. Any client or group of client may lodge a grievance with River City which is of direct concern to them in terms of the grievance procedure. Management will consider all grievances in a fair and just manner. No harassment of any client who has lodged a grievance will be tolerated. River City will allow parties to call witnesses to testify. River City will question witnesses if necessary. The investigation will not proceed if the aggrieved party is not present. Any client lodging a grievance may be accompanied and represented at any stage of the procedure by a colleague of his/her choice. The grievance procedure may be used by all client of River City. Procedure Step 1: Lodge Complaint A client who has a grievance must first notify his/her assigned counselor/case manager, who will attempt to resolve the issue within 24 hours of the issue being raised. The manager will inform Human Resources of the grievance. If the client is not satisfied with his/her counselor’s/case manager's decision, then the client will have the right to raise a formal grievance with the next level of Management within two work days of the supervisor’s/manager's decision. Step 2: Formal Grievance If the client is not satisfied with the case manager’s decision, or if the grievance poses concerns for the client’s case manager, then the client shall complete a formal Grievance Form and submit the form to the Management Team within two work days of the case manger’s decision. The Management Team will schedule a meeting within three business days after having received the formal Grievance Form. The time period may be extended upon agreement by the parties concerned. The Management Team will review the information. The individual filing the formal grievance may be called to attend a meeting if deemed necessary by the Management Team. In the event that a meeting is deemed necessary, the meeting should be attended by the client, case manager, the immediate supervisor, and will be chaired by the manager. In any meeting conducted by the Management Team, with or without the presence of the client, the manager will ensure that minutes are kept of the meeting, whether written or on a tape recording device, however, any decision made will be recorded on the Formal Grievance Form by the manager. If no satisfactory resolution or decision is reached within two work days of the meeting, The Management Team will assist the client with the next step. This will be noted on the formal Grievance Form and the client will be advised to take the issue to the Human Rights Advocate. This step should be done within two business days. Step 3: Human Rights Advocate This is the highest level within the Company's appointing authority. The management team (in step 2) will advise the Human Rights Advocate who will review all documents pertaining to the incident. The Human Rights Advocate will provide the client with the company’s decision in writing within two business days. The decision made by the Human Rights Advocate will be final. The Human Rights Advocate will advise the client of their rights if the decision reached is not found to be satisfactory by the client. The Human Rights Advocate will supply further contact information for contacting the Local and State Human Rights Committee, if necessary. Your River City Human Rights Advocates are: Community-based Services (IIH, MHSS, CS): Alison Youmell, LCSW 804-230-0999 x186 Substance Use Services (SA IOP, SACM): Tangee Augustin, LCSW 804-230-0999 x499 Residential Services: Alex McClelland, LPC 804-230-0999 x457 Outpatient Services: Madison Cully, 804-681-2525 Chief Operations Officer: Tonita Christmas, 804-230-0999 x120 The Local Human Rights Advocate is: Notice of Privacy Practices Who We Are This notice describes the Privacy Practices of River City Comprehensive Counseling Services, Inc., River City Integrative Counseling, and River City Residential Services, LLC (River City) and includes all individuals who work in or for our programs and services. Our Privacy Obligations We are required by law to keep your protected health information (PHI) private in many situations, to inform you of these practices and to follow the practices set forth. Disclosing and Using Your Information With Your Consent When you begin receiving care from River City, we will ask you (or your legally authorized representative) to sign a consent form that will permit us to provide care for you. We may also ask you to sign a reimbursement form granting us permission to obtain preauthorization for your care and/or to bill for the care provided - this may also include providing us with copies of your medical and personal information which may be use for reimbursement as needed. You may revoke your permission that allows us to use your information at any time, but you must do so in writing. Please note that revocation may affect our ability to provide you with services.
As described above, we will use your signature on the consent form to release information for treatment, payment, or other health care operations. We may use the PHI for other reasons only when we: 1. Have specific authorization signed by you or your legally authorized representative or; 2. There is an exception as described below in section 5.
Please note: You have the right to withdraw (revoke) your permission at any time. You can do this by sending the Chief Clinical Officer of your program a written letter. Exceptions to Obtaining Your Authorization There may be times when we are unable to obtain your authorization and it is necessary for us to use or disclose your information. In this event, we will only release necessary information. Examples of when your PHI might be released without your authorization includes:
• Emergency medical treatment • Medical treatment or care required by law • Suspected abuse and neglect of children and incapacitated adults • Reportable incidents to the public health authorities to help stop the spread of diseases • If you are believed to represent a threat to the safety of yourself or others • If requested by licensing organizations such as the Department of Behavioral Health and Developmental Services, Department of Medical Assistance, etc. • In the case of death we must report to the coroner and notify the organ bank • Worker’ Compensation (only pertaining to the injury relating to the compensation) • Reports to the Food and Drug Administration regarding consumed products • May permit access to information to students, contracted agencies for the Department of Health and Human Services and others who are conducting research activities which have been approved by Administration
• You may contact the Chief Executive Officer if you want more information about your Privacy Rights or our Privacy Practices or are concerned that we have not followed our own rules. You may also file a written complaint with the Director of the Office for Civil Rights. This information is readily available upon request and we will not retaliate against you if you file a complaint of any kind. • You may request access to your PHI. All reviews are supervised. You may receive a copy of your record for a reasonable charge. We will provide a copy of your discharge summary free of charge. request or respond in writing if we do not feel that an amendment is appropriate. You have the right in either case to add your own addendum to the records. A copy of this addendum will be released whenever we release copies of your record.
• We will accommodate within reason any written request that asks us to communicate with you by a different means of communication or at a change of address. • You may request a list of recipients to whom your PHI may be released for purposes other than treatment, payment, and operations. You are entitled to one free “accounting” per 12-month period. There will be a reasonable cost for additional requests. • You must receive a copy of this notice of Privacy Policies. • You may ask, in writing, to restrict the use and disclosure of your PHI. We cannot promise to grant every written request, but in the event that the request is granted, you must abide by the agreement. • If you wish to give us access to you after you leave a hospital or other medical treatment facility, please do so in writing.
These requirements were effective as of April 14, 2003. We reserve the right to change the terms of this notice at any time. If we do so, we will place the updated version in office waiting areas and on the River City websites. You may also receive a copy of the updated notice from the Chief Executive Officer.
Client Satisfaction - §620. Monitoring and evaluating service quality. River City Counseling Group performs face-to-face, telephone, and written surveys to see how you feel about the services you are and have received. Questions are about access, quality, and appropriateness. Your participation is voluntary; however, we strongly believe that your voice is the best way to improve the system. Therefore, we hope that if you are contacted, you will take the time to respond.
General Policies and Procedures
Hours of Operation - §690. Orientation.
Community-based Service Hours: 365/24/7 days weekly Residential Treatment Program Service Hours: 356/24/7 days weekly
River City Comprehensive Counseling Services: www.rivercityccs.com
River City Integrative Counseling: www.rivercityic.com
River City Residential Services: www.rivercityresidentialservices.com Access to After-Hour and Emergency Services - §540. Access to telephone in emergencies; emergency telephone numbers. River City defines an emergency or crisis as: “a situation in which a client presents an immediate danger to self or others or is at risk of serious mental or physical health deterioration placing them at immediate risk of out-of-home placement.” Medical Emergency is an injury or illness that is acute and poses an immediate threat to a person's life or long-term health. Psychiatric Emergency: Symptoms and conditions behind psychiatric emergencies may include attempted suicide, substance dependence, alcohol intoxication, acute depression, presence of delusions, violence, panic attacks, and significant, rapid changes in behavior. These behaviors are self-injurious, assaultive, or cause serious property damage and other severe behavior problems that are pervasive and maladaptive for which instructional/ behavioral approaches specified in the client’s ISP are found to be ineffective. In an Emergency:
• Call 911 for assistance if the emergency is life threatening, or may result in immediate physical harm to another person or yourself; • Then please call your River City counselor, case manager, or program contact. If they are unavailable, you may contact the following general numbers:
o River City Comprehensive Counseling Services: 804-230-0999 o River City Integrative Counseling: 804-681-2525 or 804-230-0999 o River City Residential: 804-799-9001; 804-799-1993 (Hungary); 804-799-1478 (Putney)
Important numbers: All important numbers will also be posted in each facility-based Programs:
Richmond Police Non-Emergency 804-748-1251 or 804-748-1431
Henrico Police Non-Emergency 804- 501-5000
Poison Control 1-800-222-1222
RBHA Crisis Hotline 804-819-4000
Henrico Crisis Hotline 804-261-8484
After-Hours Local Crisis Hotline 804-966-2496
National Suicide Crisis Hotline 1-800-784-2433
Richmond Department of Social Services 804-646-7212
Richmond Department of Social Services – Family Violence Intervention Program 804-646-7183
Henrico Department of Social Services 804-501-4001
Virginia Family Violence and Sexual Assault Hotline 1-800-838-8238
Disaster Relief (local American Red Cross) 804-780-2250
Behavior Management Philosophy and Policy - §800. Policies and procedures on behavior management techniques. River City’s philosophy and policy regarding behavior management techniques focuses on assisting the client to access their innate abilities or those taught to manage their own behaviors. We believe that each client has the ability to modulate their emotional states for improved behavioral outcomes with or without River City assistance and support. River City will always utilize the least restrictive method of assisting a client in managing their behavior and gaining self-control in their life. We wholeheartedly believe that the client and collective relationships that we foster lay the groundwork of mutual respect and trust. Physical restraint will only be used to control unpredictable behavior that poses clear and present danger of serious physical harm to the individual or others or serious property damage and that cannot be immediately prevented by a response less restrictive than the temporary application of a technique used to contain the behavior. In the event that a physical restraint becomes necessary, staff will only implement Crisis Wave, a non-invasive restraint in which all staff members are fully trained to safely implement. The Human Rights Advocate will be contacted immediately and a report will be filed. Further assistance such as police may be notified depending on the severity of the incident. Weapons Policy - §310 Weapons of any kind are strictly prohibited while you are receiving services from River City. You may not have any type of weapon in our facilities, on our grounds, within 500 feet of our facilities and grounds, or while receiving services in the community. If it is suspected that you have a weapon or item that may used as a weapon, River City staff will ask you to store this item elsewhere and/or contact the police, if necessary.
Tobacco-Free Environment Policy River City offices are tobacco free environments. We want to maintain an attractive facility for everyone and assist you with achieving and maintaining your health. There is no smoking in the front or sides of our building. A designated smoking area with smoke receptors will available for you to use as needed or applicable to your program. If you are interested in a smoke-free lifestyle, please speak to River City staff for assistance with smoking cessation strategies. Emergency Preparedness and Response Plan - §530 The primary purpose of River City’s Emergency Response Plan is to establish a strategy that ensures the safety and well-being of clients receiving services and our employees in the event that an emergency occurs. Our management team stays abreast of national, state and local news and works with local authorities to coordinate our Emergency Preparedness Plan. We also ensure that our employees maintain a state of readiness and ability to respond to emergencies through training and development initiatives. In the event of an emergency, your assigned River City staff may contact you with instructions and/or an “emergency message” with instructions will be available at 804-230-0999. Please note: River City Residential and Community Stabilization Staff is available 24 hours daily, 7 days weekly and 365 days yearly for your health and wellness. Building Layout and Evacuation Plans - §690. Orientation; §280. Physical environment. Every building and facility used by River City will have appropriate building layouts and evacuation plans clearly displayed in open areas. All buildings and facilities will be handicapped accessible and will be an environment conducive to treatment. Routine fire, evacuation, and emergency drills will be a part of residential programs and all staff and clients will be made aware of proper routes for evacuation of a building in case of emergency in our facility based programs. In the event of any emergency, clients will evacuate the building according to the evacuation plan. Staff will ensure the safety of all clients and call 911 or other appropriate emergency numbers. Inclement Weather Policy When the weather is severe enough that Henrico County Public Schools (RPS) cancels school, certain programs facilitated by River City Comprehensive Counseling & River City Integrative Counseling will be cancelled. Clients can call the office at 804-230-0999 by 8:00 AM to confirm the list of services that will be cancelled. Community-based programs such as intensive in-home and mental health support services will continue as scheduled with potential modifications. Residential programs will also continue as scheduled with potential modifications to the daily schedule. Financial Policy River City and Focused Outreach Richmond programs accepts self payment, Medicaid, state financed insurance (other than Medicaid), private health insurance and military insurance (e.g., Va., Tricare) as forms of payment, as well as VISA, MasterCard, and personal checks. A sliding fee scale (fee is based on income and other factors) is also available for payment assistances if applicable. You may use your insurance to pay for services or you may choose to pay out of pocket for your treatment. Some patients have no insurance and pay for treatments themselves. You may be responsible for paying your co-payments while you are attending the program. To find out the cost of this option, make financial arrangements, and payments prior to starting the program, you would need to contact our Business Office at 804-230-0999. Understanding Your Insurance Benefits You will meet with the Office Specialist prior to your intake assessment so that they can determine your insurance benefits and help you plan your financial options. Feel free to ask about any concerns you have regarding financial matters. Most medical insurance plans require pre-certification, meaning that the particular insurance company must be contacted prior to services and given clinical information to determine if services meeting their criteria for treatment. Each insurance company has their own policy. Many insurance companies have contracted with another company that specializes in managing access to treatment, and this company can approve, decline, and limit the treatment for which they are willing to pay. When you come into the program, if they approve your participation, they usually give authorization for you to come for a specific amount of time, typically 1 to 10 days initially and will then schedule a date to review your progress and determine whether you can continue with services. The Business Office manages all these calls for authorization. If you have questions about insurance authorization, please contact your Clinical Care Manager. Pricing for Services - §230. Written fee schedule. §240. Policy on funds of individuals receiving services. As stated in the Client Bill of Rights and Responsibilities, it is your right to understand all of your financial charges or potential charges as it relates to your case. We do not supply specific information related to service billing in this handbook as all service prices are subject to change according. Please see your direct care worker, program manager, to contact the office directly for specific pricing information. Release of Liability - §220. Indemnity coverage. As a voluntary participant of River City Programs, you have signed a release of liability to include transportation, consent to search, proper use of restraint, photography of clients, and use of medical care as necessary. This release is for any and all liability for personal injuries (including death) and property losses or damage occasioned by, or in connection with any activity or accommodations for this event. The undersigned further agrees to abide by all the rules and regulations promulgated by River City and Focused Outreach Richmond and/or its affiliate groups and vendors. Staff Introductions Upon intake, each client will be introduced to their assigned Staff Member, Group Administrator, or Therapist. Contact numbers of applicable and appropriate staff will be given to every client in order to schedule appointments, arrange transportation, or to assist with crisis emergency situations. Closing Word On behalf of the staff at River City Comprehensive Counseling Services, Inc., River City Integrative Counseling Services, Inc., and River City Residential Services, LLC, we wish to thank you for choosing our services. Whether you are an adult, child or parent, we aim to offer you comprehensive services specifically tailored to meet your individual needs. We believe the client comes first and are dedicated and committed to working with you side by side to deliver the most effective treatments that will allow you to live the best life possible. We hope that this handbook has answered some of your questions regarding programs and services offered by River City Comprehensive Counseling Services, Inc. Your interest, involvement, and participation will be key to your continued success. We look forward to working with you to meet all of your treatment goals.