HomeMy WebLinkAbout87-0505 Forest Health AGREEMENT
PROVIDING FOR THE ADMINISTRATION OF AN
EMPLOYEE ASSISTANCE PROGRAM
THIS AGREEMENT made and entered into this ` day of M ;
1987 by and between the CITY OF ELGIN, an Illinois Municipal
Corporation, (hereinafter referred to as Elgin) and FOREST HEALTH
SYSTEMS, a/k/a Lovellton, with offices at 600 Villa Street, Elgin,
Illinois 60120 .
WHEREAS, it is recognized that many personal problems not
associated with an employee ' s position or office may effect the
performance of his duties ; and
WHEREAS, it is necessary and desirable to assist in the
resolution of employee personal problems so as to promote an
efficient and effective level of governmental services for the
general public ; and
WHEREAS, Elgin desires to have an Employee Assistance Program
to be administered by Forest Health Systems ; and
WHEREAS, the parties are in agreement as to the terms and
conditions of any. Employee Assistance Program (hereinafter re-
ferred to as EAP) .
NOW, THEREFORE, in consideration of the mutual promises and
convenants contained herein, the parties hereto agree as follows :
A. Program Goals and Obiectives :
1 . It is the goal of this proposed program to provide
professional assistance to Elgin ' s employees experiencing alcohol ,
drug, emotional , family or other personal problems that interfere
with job performance.
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2 . It is the objective of the program to help the individual
resolve these problems before they become costly and extreme.
3 . The services offered to the employees and their immediate
families will be assessment and referral services. . Individual em-
ployees and their family. can contact the EAP themselves, or be
referred by a supervisor, the union or a significant other. Once
the individual contacts the EAP, trained professional personnel will
conduct an intake interview; help the individual assess the 'prob-
lem; refer the individual for further counseling, treatment or
service (if required) to an appropriate resource in the community;
coordinate the employee ' s benefit package; keep- client records ;
and evaluate the .program.
B. Services to be Provided:
Forest Health Systems will provide the following services
through its facility in Elgin - Lovellton Treatment Center. •
1 . Assist Elgin ' s personnel in developing a statement
of policy regarding the operation of an EAP and in defining specific
Operational goals .
2 . Assist Elgin in developing a statement regarding em-
ployee ' s rights and confidentiality.
3 . Provide supervisory and union personnel with training
regarding the identification of the "problem employee" , work per-
formance criteria to be used, documentation procedures, and re-
ferral methods . •
4 . Develop an .ongoing informational and educational pro-
gram directed to the employees and their families in order to make
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them aware of the EAP services, understand the referral process,
and take advantage of the service .
5 . Work closely with the city manager, adriiinistrative staff,
and union officials in order to maintain support -for the EAP and
maximize benefits .
6 . Develop. an *up-to-date, appropriate referral network
so- employees may be offered efficient, convenient, and economic
treatment and service in the event of need for additional help.
7 . Provide 24 hour telephone contact service. (Appoint-
ments for EAP service will be handled by a 24 hour staff . Crisis
calls will be handled immediately by trained Lovel-lton mental health
staff rather than EAP resource personnel) .
8 . Provide assessment and referral service to Elgin' s
employees and their families .
9 . Assist the -referred. employee in coordinating in-
surance package benefits if additional treatment is required.
10 . Provide Elgin employees and - their families with in-
formation regarding such areas as stress management, effective
.parenting, resolution of marital conflicts, and dealing with drug
problems . This information will be available as written material
and periodic lectures and seminars . Resources from the. entire
Forest Health System network will be utilized to provide a com-
prehensive scope of presentations.
11 . . Follow-up service to all referral with post-treatment
contact when needed. - •
12 . Evaluation of the program including penetration rate,
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type of problems addressed, type of referral , and status of terrain-
ation of treatment.
C. Who Qualifies, Cost, and Service Providers :
1 . All Elgin employees and their immediate family members
qualify for EAP services.
2 . The above listed EAP services will be provided to
Elgin at no cost.
3 . The above .listed EAP services will be provided to -
Elgin ' s employees and their families at no charge. Additional
service, counseling or treatment will be the responsibility of
the individual , however, EAP personnel will aid in coordinating
insurance benefits .
4 . Services will be provided by James E. Soukup, Psy.D. ,
and a staff of professional personnel who have master' s level
training in the mental health profession, CAC, or equivalent ex-
perience. A staff psychiatrist, R. Menezes, M.D. , will provide
psychiatric backup service if required. Counseling will be off-
site, at the Lovellton facility in Elgin, or if more convenient,
one of the Forest Health System offices in either Elmhurst, Des
Plaines or Buffalo Grove. (See Rider A attached to and made a
part hereof) .
D. Confidentiality:
All referrals are handled on an individual and highly
confidential basis. Individual treatment records are not avail-
able to the employer. Employees will be asked to sign release of
information forms relating only to information required for program
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evaluation such as whether a contact was made, a referral recom-
mended, and/or treatment completed.
E. Insurance Requirements :
In the performance of the work covered by this agreement
unless otherwise provided for, Forest Health Systems shall act as
-an independent -contractor and maintain full and complete control
over all their employees . During the performance of the work,
Forest ,Health Systems shall obtain and maintain the following in-
surance:
1 . Hospital Professional Liability .with limits of
$1 , 000, 000 per occurrence .
2 . General Liability Insurance with coverage to
$1 , 000, 000 per occurrence.
F. Term:
This agreement shall be in full force and. effect for one
calendar year from the date of execution.
G. Compensation:
For and in consideration of the faithful performance of
the covenants and conditions contained herein, Elgin shall pay
- Forest Health Services the sum of $5, 500 . 00 . Elgin shall pay
$2, 750 . 00 upon the execution of this agreement and $2, 750 . 00 on
August 11 , 1987 .
H. Extent of Authority:
This agreement does not negate .any ordinance or ad-
.ministrativ.e -policies or procedures of Elgin unless specifically
indicated herein. . Compliance with the ordinances and admini-
strative policies or. procedures currently in effect or hereinafter
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amended or adopted are made part of this agreement.
I . Entirety Of Agreement:
This agreement constitutes the entire agreement between •
the parties and supersedes all previous agreements and understandings
with respect to the subject hereof.
J. Assignment:
Forest Health .Systems shall not assign' .this contract in
whole or in part .without the .prior written consent of Elgin. Any
such assignment without Elgin' s prior written consent shall be
void and of no effect.
IN WITNESS WHEREOF, the parties hereto have executed this
agreement as of the day and year first hereinabove written which
shall be deemed- the effective date.
FOREST HEALTH SYSTEMS CITY OF ELGIN
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By: Tb ` 45;;;LL42
1/z-:": 111/4-644434/.:7-
ATTEST: �,
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RIDER A
Employee Assistance Program Staff:
1. James E. Soukup, Psy. D. Clinical Coordinator
Education:
Doctor of Psychology Forest Institute of Professional Psychology
M.A. (Counseling) Forest Institute of Professional Psychology
M.B.A. Indiana University
B.S. (Business) Indiana University
Training and Experience:
Counterpoint Intervention Drug Treatment Center, Chicago
Seven Springs MHC, Des Plaines (Psychotherapy)
Mount Prospect Police Department (Program development, psychotherapy,
referral services)
Loretto Hospital Drug Unit (Education, psychotherapy, community education)
Forest Psychiatric Hospital (Therapy, psychological testing, program devel-
opment)
Present Employment: Seven Springs Health Resource Center (An affiliate of
Forest Health Systems) - Clinical Coordinator
Park West Mental Health Clinic, Elmhurst, IL - Clinician
2. Mary Jane Such, B.S.N. Administrative Director
Education:
B.S.N. - Loyola University 1964
Alfred Adler Institute (candidate status)
Experience:
Health Care Service Corporation, Chicago, IL - Psychiatric Nurse Consultant
Malayali Cultural Association, Chicago, IL - Program Coordinator
Chicago Read Mental Health Center, Chicago, IL - Nursing Supervisor, Assis-
tant Chief of Services
Present Employment:
Administrative Director - Lovellton and Forest Hospital
3. Ralph C. Menezes, M.D. Psychiatric Consultant
Education:
Pre-medical - St. Peter's College, Colombo, Sri Lanka
Aquinas University, Colombo, Sri Lanka
Medical Education - University of Ceylon
Post-Graduate Training and Experience:
General Hospital, Negombo, Sri Lanka
Government Hospital, Imaduwa, Sri Lanka
St. Stephen's Hospital, Chelsea, London, U.K.
St. John and St. Elizabeth Hospital, London, U.K.
Residency in Psychiatry - Chicago Medical School
Present Employment:
Forest Hospital - Program Director - Chemical Dependency Unit
Private Practice
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RIDER A
4. Other personnel connected with EAP service provision will be supervised
by Dr. Soukup and have Master's level training in mental health, CAC, or
equivilent training.
• AMERICAN HOME ASSURANCE COMPANY
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NOTICE: THE POLICY PROVIDES THAT THE LIMITS OF LIABILITY AVAILABLE TO PAY JUDGEMENTS OR SETTLEMENTS SHALL BE REDUCED BY AMOUNTS
INCURRED FOR LEGAL DEFENSE. FURTHER NOTE THAT AMOUNTS INCURRED FOR LEGAL DEFENSE SHALL BE APPLIED AGAINST THE DEDUCTIBLE
AMOUNT. NOTE ALSO THAT A SMALLER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL
MISCONDUCT(SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). - - - -- - - -
- DECLARATIONS
POLICY NO: :•, 's —7 1 ; ACCOUNT NO: T L_
ITEM.1. NAME AND ADDRESS OF INSURED: ADDITIONAL NAMED INSUREDS:
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IL• 113151
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TYPE OF ORG: •
rEM 2. ADDITIONAL INSUREDS: • •
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EM 3. POLICY PERIOD: FROM: i 1/i'1/ o . TO:- 11/u 1/S 7
12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN:
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EM 4. LIMITS OF LIABILITY: . • $ EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED
OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE
$ 1 • .� U t :•' AGGREGATE
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EM 5. DEDUCTIBLE • � • • EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED
OR INTERRELATED WRONGFUL.ACTS OR OCCURRENCE
EM 6. PREMIUM SCHEDULE: •
CLASSIFICATION NUMBER RATE ANNUAL PREMIUM
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SS 1 _ . _ LS
t'�YCHI_L 1:�I ',I • 1 7.ii;.•J; 70C. 00
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TOTAL PREMIUM: 7OC.pn
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M 7. POLICY FORMS AND ENDORSEMENT ATTACHED TO THIS POLICY:
:.43L71 =12-35 FUR:': t�4327Z 12-85 FJti;'I ' 31 ) Y) 3-81
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THIS IS NOT A BILL. ` vark ►
•UTHORIZED COMP•iY REPRE. NTIVE
PREMIUM HAS BEEN PAID. . 1