Health and Wellness Manager Orientation Shannon Bentley, RN, Nurse Specialist Melissa Cusey, RN, Nurse Specialist

Job Corps General Information America’s largest residential educational and career technical training program for economically challenged young adults aged In operation since operational centers throughout the United States and Puerto Rico Serves over 60,000 students annually 2

Job Corps National Snapshot 3

National Leadership National Office of Job Corps (Washington, D.C.) National Director Edna Primrose 4

Administration and Management National Office The National Office Health and Wellness staff are responsible for developing and implementing the policies and procedures that guide the delivery of health care on center National Office Health and Wellness staff contacts include: – Edward Benton, Division Chief – Carol Abnathy, MSW, MPH, National Health and Wellness Manager – Johnetta Davis, MPH, Program Analyst 5

Administration and Management (continued) Health Support Contractor The health support contractor works with the National Office, Regional Offices, and centers to: – Develop and enhance center health and wellness services – Develop policy – Train center health staff – Develop resource materials – Collect and analyze program data – Pilot test new health initiatives – Manage Health Specialists – Provide technical assistance – Conduct center assessments 6

Administration and Management (continued) Regional Offices Regional Offices award contracts and provide oversight, monitoring, and technical assistance Six Regional Offices, headed by a Regional Director (Boston, Philadelphia, Atlanta, Dallas, Chicago, San Francisco) Project Manager (PM)—the DOL representative and liaison who works closely with your center to ensure that you have the resources you need to do your job and that you are working successfully to meet the established program outcomes 7

Administration and Management (continued) Nurse Specialists and Health Specialists Each Region has the following Specialists: Nurse Specialist Medical Health Specialist Mental Health Specialist TEAP Health Specialist Oral Health Specialist 8

Administration and Management (continued) Nurse and Health Specialists: Provide technical assistance to center health and wellness staff – Answer questions – Clarify Job Corps policies Provide training to regional and center staff Provide up-to-date information that will assist center staff in meeting program requirements 9

Regional Office Center Assessments Every 1 to 2 years, Health Specialists and Assessors visit each center as part of a Regional Office Center Assessment (ROCA) team ROCA tools will be distributed to you and your staff to complete and return to the ROCA team prior to their visit Using the Program Assessment Guide (PAG), in conjunction with the Policy and Requirements Handbook (PRH), this team will conduct an overall assessment of your center’s health and wellness program 10

Regional Office Center Assessments (continued) Assessments highlight the strengths of your program and provide feedback about areas that could be changed or improved Expect to have your health records, appointment books, and other records audited 11

Center Health and Wellness Team All centers have the following staff as part of their health and wellness team: – Registered nurse (RN) – Staff nurse – Physician – Mental health consultant – TEAP specialist – Dentist and oral health staff – Disability coordinator Minimum health and wellness center staffing levels are determined by the center’s contracted student enrollment capacity 12

Primary Objective of Job Corps Health and Wellness Program Improve each student’s employability by establishing and maintaining the student at his or her optimal health level Achieve this through provision and/or coordination of health care including case management of chronic illness, promotion of self management of health care, and through preventive health education to instill good wellness habits and prevent avoidable illness, injury, and death Mentor, model, and monitor good employability skills 13

Wellness Philosophy Allows the roles of the health care practitioners to be redefined so they impact the student’s entire Job Corps experience, including the body, mind, heart, and spirit Health care practitioners interact with students not only when the student seeks health care due to illness, but also during times of good health Health staff may take on roles of teacher, mentor, role model, or advisor 14

Important Resources PRH—The Policy and Requirements Handbook contains the rules by which all centers operate; Chapter 6 (Sections ) provides policy on ensuring students receive health and wellness services, support, and education that will enhance their employability and encourage and maintain a healthy lifestyle PAG—The Program Assessment Guide is a companion to the PRH and contains the parameters by which the quality of each center’s program is measured; it can also be used on an ongoing basis as a tool for determining program effectiveness 15

Important Resources (continued) COPs/SOPs—Center Operating Procedures and/or Standard Operating Procedures for the health and wellness program; these procedures define how your program will operate on a day- to-day basis, describe staff roles and responsibilities, and provide guidance on center specific documentation, reporting, and communication protocols TAGs—Technical Assistance Guides are designed to aid center staff in meeting health and wellness program requirements; they are how-to guides that offer many suggestions but no additional program requirements 16

Important Resources (continued) DRGs—Desk Reference Guides provide information and strategies to meet and exceed health-related Policy and Requirements Handbook (PRH) requirements, and contain all health and wellness program-related documents and forms. The DRGs will help new center health and wellness staff learn the foundations of their position, and experienced health and wellness staff will find the central location of forms and information useful. DRGs are located on the Job Corps Community Website under the Health and Wellness Tab. Presently there are DRGs available for HWMs, center physicians, CMHCs, center dentists, and center disability coordinators. 17

Health Directives PRH Change Notices—Contain new or revised policy with instructions to delete, replace, or add pages to the PRH Program Instructions—Provide one-time instructions with a designated expiration date and usually require center response (e.g., survey) Information Notices—Provide one-time announcements with information that is of interest to centers (e.g., data summaries, meeting or training announcement) 18

Job Corps Terminology 101 TEST YOUR SKILLS 19

What do these mean? PRH CMHC HIPAA OBS CDSS PAG PM 20 TEAP ROCA CSIO OMS CD WTR TAG

Interaction with Other Center Staff Centers with an open flow of communication between departments usually function with better morale and efficiency Develop relationships with staff from all Job Corps programs, including: – Academics – Residential Life – Vocations – Center Administration 21

Interaction with Community Contacts Establish community linkages that can enhance your program Become familiar with existing relationships (community hospitals, off-center health care facilities, local public health department, etc.) Become more connected with community resources to help increase your success in meeting the health care needs of the students 22

Components of Chapter 6 PRH: Chapter 6:

Student Health Services PRH 6.10 Health and Wellness Program Oral Health and Wellness Program Mental Health and Wellness Program 24

Health and Wellness Program (6.10, R1) Requirements: – A cursory health evaluation within 48 hours of arrival on center to include: Blood work Drug test (urine) Urinalysis (glucose/protein) STI testing (Chlamydia and Gonorrhea) Pregnancy testing Pap (may be waived by physician) Vital signs Vision screening (near, distant, and color) Cursory oral inspection Tb skin test (Mantoux) Immunizations (begin within 14 days of arrival) Hearing screening 25

Health and Wellness Program (continued) A complete physical examination (within 14 days of a student’s arrival on center) Centers may provide one pair of glasses (when indicated) A daily walk-in clinic that must be outside of training hours An appointment system for follow up during the training day Must have an off center specialist referral system 24-hour emergency care system 26

Oral Health and Wellness Program (6.10, R2) Cursory oral inspection completed within 48 hours of arrival and documented in SHR Mandatory oral examination: – Completed prior to the student’s 75th day on center – Includes bitewing x-rays, priority classification, and treatment plan – Documented on the SF-603 and SF-603A Oral health care beyond the oral examination is voluntary Productivity reports must be kept by the center dentist 27

Oral Health and Wellness Program (continued) Orthodontics – Not paid for by Job Corps – Applicants with orthodontic appliances must have a signed agreement in place before arrival that 1) all costs, including transportation, is the responsibility of the student/guardian, and 2) appointments will be kept and not exceed authorized leave days for elective dental treatment 28

Mental Health and Wellness Program (6.10, R3) Centers shall provide basic mental health services: – Should focus on prevention, identification, short- term counseling, and crisis intervention with an EAP approach – A written referral/feedback system must be in place – Steps/procedures for mental health emergencies in place to include supervision – Accommodations for students not considered a danger to self or others – Regular case conferences for information exchange (should include at a minimum counselors, TEAP specialist, and health and wellness manager, if possible). 29

Jeopardy Questions What is the timeframe for completing the entrance physical examination? 1)5 days 2)14 days 3)30 days 30

Jeopardy Questions True or False? The CMHC should have a written referral/ feedback system in place. 31

Jeopardy Questions When should the mandatory oral examination be completed? 1)On day 5 2)3 months after entry 3)Prior to the 75 th day 32

Related Health Programs PRH 6.11 Trainee Employee Assistance Program (TEAP) Health Aspects of Sports Tobacco Use Prevention Program (TUPP) Family Planning Program HIV/AIDS Sexual Assault Prevention and Response Disability Program 33

Trainee Employee Assistance Program (6.11, R1) At a minimum shall include: – Assessment – Intervention – Counseling – Relapse Prevention – Prevention and Education 34

Health Aspects of Sports (6.11, R2) All students must be medically cleared to participate in organized sports activities by the center physician or designee Document on the SF-88 or use a center-generated sports clearance form with copy in chart Notify recreation manager of any students NOT cleared or if on sports restriction After one year must have another physical examination with clearance Center must make sure that staff certified in CPR and First Aid is present at all sports events including practice sessions Adequate transportation must be available in the event of an emergency at all sponsored events 35

Tobacco Use Prevention Program (6.11, R3) Be aware of federal and state laws regarding use of tobacco products by minors; minors who use tobacco products shall be referred to the TUPP Promote smoke-free environment or no smoking during the training day If center operators choose to allow smoking and use of tobacco products, designated smoking areas must be located at least 25 feet away from all building entrances 36

Family Planning Program (6.11, R4) Provided to all students on a voluntary basis and shall include counseling, health promotion activities, and medical services If student is more than 12 weeks pregnant on arrival, give MSWR For students who are less than 12 weeks pregnant on arrival or who become pregnant after enrollment the center: – Provide or arrange for prenatal care – Be aware of applicable state laws on rather to notify the student’s guardian – Provide a MSWR at 28 weeks 37

HIV/AIDS (6.11, R5) HIV/AIDS program includes education, testing, follow up, and counseling for all students, as well as case management for HIV positive students Refer to PRH Change Notice No Be aware of state laws regarding both pre- and post-test HIV counseling Be knowledgeable of timelines for providing student with HIV-test results Have student sign that they received their results 38

Sexual Assault Prevention and Response (6.11, R6) Establish a program for sexual assault prevention, counseling, treatment, and follow-up care Form a sexual assault response team (SART) that involves center staff and outside resources Develop SOP with staff designations and outlined duties Conduct regular SART meetings to discuss prevention and education strategies Provide yearly training to the SART members Report sexual assaults 39

Disability Program (6.11, R7) Centers must have a disability program to provide individualized and coordinated services to all students with disabilities; this program shall include: A disability coordinator to oversee the program SOPs to include: – Center review process of applicant folders – Reasonable accommodation process – Formation of a interdisciplinary team (IDT) A written plan to develop and maintain partnerships with outside agencies A written center self assessment plan describing current programmatic and architectural accessibility and plan for accessibility updates A method to accurately collect and submit al required disability data in CIS 40

Jeopardy Questions True or False? The TEAP Specialist should focus primarily on treatment. 41

Jeopardy Questions When should you place a student with a normal pregnancy on MSWR? 1)At 16 weeks 2)At 28 weeks 3)At 38 weeks 4)Immediately 42

Jeopardy Questions Where is the list of Basic Health Services located in the PRH? 1)Chapter 5 2)Chapter 6 Exhibit 6-4 3)Chapter

Jeopardy Questions True or False? A waiver of medical care be granted for HIV testing. 44

Health Administration PRH 6.12 Staffing Authorizations Basic Health Services Health and Medical Costs Exceeding Basic Health Services Professional Standards of Care Controlled Substances Waiver of Medical Care FECA/OWCP Health Care Guidelines Student Introduction to Health Services Medical Separations Death Communicable Disease and Infection Control Equipment and Supplies Continuous Quality Improvement Monthly Meetings with Center Director Reporting 45

Staffing (6.12, R1) Refer to Exhibit 6-5 for health and wellness center staffing requirements Minimum staffing qualifications are listed in Exhibit 5-3 All subcontracted staff must be reviewed (license, contract,insurance, and resume) by the RO and Health Specialists PRIOR to hiring All HWM candidates that are a direct report (administrative staff) must go through same process 46

Authorizations/Consent for Treatment (6.12, R2) Centers must ensure proper authorizations are obtained prior to delivery of health services The signed ETA 6-53 serves as authorization for basic routine health care; it must be placed in the SHR before the arrival of the new student on center In addition, the signed Informed Consent for Mental Health Treatment must be placed in the SHR before arrival of the new student on center 47

Basic Health Services Provided by Job Corps (6.12, R3) Center operators are responsible for providing and paying for basic health care as detailed in Exhibit 6-4 Center not responsible to pay for any health-related costs incurred by a student while on authorized leave or pass Not responsible for non-resident students after training hours unless participating in center activities 48

Health and Medical Costs Exceeding Basic Health Services Provided by Job Corps (6.12, R4) Centers should assist students in seeking third- party health insurance coverage that will be available should the student have medical needs or costs beyond the basic health services provided by the center If a Job Corps student experiences a medical emergency or unanticipated serious illness requiring off-center treatment: – Evaluate the student’s medical condition to determine if a MSWR is appropriate – Request third-party payment only for services beyond those basic services stipulated in the center operator’s prime contract 49

Professional Standards of Care (6.12, R5) All subcontracted staff must have a copy of current license and malpractice insurance in health and wellness center; center physician must also have current copy of DEA registration Must document all prescribed medication and treatment in the SHR; must be in SOAP format Document all labs and results in the SHR Check off physician orders Follow current standards of care Have copies of current state nurse practice act for RN and LPN 50

Controlled Substances (6.12, R6) Centers must comply with all state and federal regulations regarding controlled medications Purchase, store, administer, and document all controlled substances per 21 CFR Part 1300 Each center must maintain a controlled medication log and have a DEA registration or physician with DEA license Only Class II medications can be stocked for specific students All Class II, III, and IV medications must be under a double- lock system in a secured area of the health and wellness center. When dispensing, document date, time, medication, and dosage with full signature of staff giving medication. (recommend student sign for medication) 51

Controlled Substances (continued) Two staff (one with a state license to dispense or administer) must document receipt of medications, noting the name of medication, dosage, amount, and date in narcotics log Inventory controlled medications at least once weekly. Two staff must count and note results in narcotics log. Any miscounts or missing medication must be reported immediately to the CD and RO Properly dispose of controlled medications; document on narcotics log with two staff signatures 52

Waiver of Medical Care (6.12, R7) Waivers may be issued by the center physician for: – Pelvic exam – HIV testing – Immunizations 53

FECA/OWCP (6.12, R8) Students are considered federal employees for purposes of the Office of Workers Compensation Program (OWCP) Refer to the Medical Transfer, Separation, and Referral; Management of Student Injury and Death TAG for details 54

Health Care Guidelines (6.12, R9) Health Care Guidelines (HCGs) consist of Treatment Guidelines (TGs) and Symptomatic Management Guidelines (SMGs); must be reviewed and approved by center physician, CMHC, and dentist annually HCGs must be kept in the health and wellness center (copies of Symptomatic Management Guidelines should be available in the dorms, recreation, safety, and education) Memo must be submitted annually to the Nurse Specialist with any HCGs that have been modified for approval or memo stating adopted as is 55

Student Introduction to Health Services (6.12, R10) An overview of health services must be provided to new students by health and wellness staff during the CPP (before cursory) and include the following: – Explanation of procedures/tests that are performed as part of the medical and oral exam – Information on HIV and other STIs – Safe sex practices and family planning services – TEAP, mental health, and oral health services – Employability and good health – Signing of the HIPAA Notice – Information on specialty programs and services (TUPP, OWCP, disability/accommodations, open hours, after hours and weekend care) 56

Student Introduction to Health Services (continued) HIPAA Notice: – Must be posted in the health and wellness center – Privacy Officer and Complaint person for HIPAA must be posted throughout the center – The complete, signed Notice must be placed in the SHR If student refuses to sign the Notice, then document and place Notice in the SHR For underage students, place a copy in the SHR along with a note stating a copy has been mailed to the guardian for signature The HIPAA Authorization is signed during the OA process and must be placed in the SHR before arrival of the new student on center 57

Medical Separations (6.12, R11) Medical separations are initiated by health and wellness center staff Medical separations occur when students have significant health problems that preclude participation in career training, are too complex to manage on center, or are unusually costly. There are two options for medical separation: (1) Medical separation: A decision to medically separate should be made if a medical assessment and functional evaluation indicate that a student's medical, dental, or mental health condition is unable to be ameliorated within 180 days Any student receiving a medical separation is eligible to reapply to Job Corps one year following the date of his/her separation 58

Medical Separations (continued) (2)Medical separation with reinstatement rights (MSWR): A decision to medically separate with reinstatement rights may be used if the health care provider estimates that the student's condition will be resolved and the student will be able to return to the center within 180 days For both types of separation, a detailed health assessment and functional evaluation, conducted by the appropriate provider, must be performed prior to every medical separation The center director must approve all medical separations The HWM should gather all needed information from the health care provider, obtain the center director's decision, notify required parties, make referrals, and document all actions For MSWR, students are contacted monthly by the HWM to assess progress and plan their return to Job Crops within the 180 days allowed 59

Death (6.12, R12) In the event of a student's death, the center director must notify multiple parties, arrange for the remains to be sent home, and forward student records to the National Office A significant incident report (SIR) must be submitted Refer to the Medical Transfer, Separation, and Referral; Management of Student Injury and Death TAG for details 60

Communicable Disease and Infection Control (6.12, R13) Report cases of communicable diseases to state and local health departments based on state and local laws Manage all cases of communicable disease and use protective measures as recommended by the CDC Follow infection control measures as mandated by state and federal law Biologically monitor the function of autoclaves and maintain a log of spore test results. 61

Equipment and Supplies (6.12, R14) Maintain records on the dispensing, inventory, and disposal of medical and dental supplies and medications Purchase from government supply service centers (GSA, HHS, VA) when possible Purchase major dental equipment according to the current dental equipment list published periodically by the National Office. 62

Continuous Quality Improvement (6.12, R15) Seek feedback from students through surveys Employ mechanisms to document quality of care provided and document quality improvement activities Utilize the Student Government Association’s Health and Wellness Committee to develop a quality management system that works for your center Conduct regular chart audits 63

Monthly Meetings with Center Director (6.12, R16) The CD shall meet monthly with the center physician and CMHC to discuss clinical and organizational issues Meeting minutes should include documentation of attendees and items discussed 64

Reporting (6.12, R17) Refer to Exhibit 5-2 for required reports Health and Wellness Center Annual Program Description – Due August 15 th each year; provides an overview of the health and wellness program and staffing Health Services Utilization Report – Monthly reports that provide statistical data collected from the mental health, oral health, and medical programs (these reports remain on center for review by the Regional Office Center Assessment team) 65

Reporting (continued) Alcohol Testing Summary Report – Your center will prepare and submit online a quarterly report on suspicion testing for alcohol Significant Incident Reports (PRH 5: 5.5) – Must be completed for all serious or unusual medical, mental health, sexual assault, and drug/alcohol incidents – Maintaining a significant incident log will assist you in monitoring the frequency of specific incidents which can then be part of your total quality management program 66

Student Health Records Charting – Center physicians should follow center procedures for health and wellness documentation – Physician and nursing notes should be brief, clear, legible, and consistent – All entries should be signed and dated (including the hour) in ink by the person making the entry 67

Student Health Records (continued) SOAP The problem-oriented record system (SOAP notes) is the recommended format for all health record entries: S = Subjective—What symptoms are described by the student? O = Objective—What signs are detected upon physical examination? A = Assessment—What is the medical diagnosis? P = Plan—What interventions, treatment, or referrals will be performed, recommended, or prescribed? 68

Student Health Records (continued) Documentation of health care is essential for: – Maintaining accurate chronological record of health care in progress notes – Enhancing communication among health care providers – Monitoring health provider performance – Meeting legal requirements – Standardizing care – Achieving cost benefits – Following through on treatment plans – Documenting student non-compliance with care 69

Student Health Records (continued) Organization of the Student Health Record: – Can be organized by center to meet needs but all must be in the same format In addition: – Place the student's name on every sheet – Place center photos of student on the inside of the folder to help avoid fraudulent care – Use a folder that fits the needs of the center 70

Student Health Records (continued) Place on the front of the student health record only the student’s name and student ID number to maintain Privacy Laws and PII May place a color code on the front to indicate insurance May write allergies on the front in red 71

Student Health Records (continued) Check each folder on every visit that: – All visits are entered in the record, regardless of how minor the problem may seem at the time – Record format complies with the center's policy – Entries contain all required information Record Maintenance: – Health and wellness staff should review the record each time a student reports to the health and wellness center 72

Student Health Records (continued) Every record documents continuity of care by nursing, medical, dental, mental health, and TEAP professionals When a student is separated, the record should be reviewed for completeness, sealed in an envelope, and forwarded to the appropriate department (e.g., student records) for storage except in the case of an HIV positive student or student's death when the health record is sent to the National Office [PRH-6: 6.12, R12 and Appendix 601] 73

Confidentiality of Records/ HIPAA Regulations Health Insurance Portability and Accountability Act (HIPAA) Protection of personally identifiable information (PII) [ REFER TO Program Instruction Notice NO ] 74

SOPs/COPs Suggest review and modification with any PRH changes Must be individualized to meet center’s needs Should be a blueprint Should have at least one for each PRH requirement, more based on center policies Should have a SOP for all services provided by the health and wellness center Sent for approval to RO yearly or with any changes 75

Cost Saving Strategies Develop community connections See if local hospital will allow center to use “indigent program”, sliding fee scale, give discounts Check local mental health agencies for victim services that are provided through grants, provision of speakers for groups, assemblies, pamphlets Do a MOU with Voc Rehab (refer to Program Instruction Notice No.99-03) Look at other local, state, or National Resources Use Health Department services Use Wal-Mart $4.00 prescription plan when possible Use student insurance to purchase their medication when possible Partnership for Prescription Assistance: or

PRH and Exhibits Revisions PRH Change Notice (released October 28, 2010) – PRH Chapter 6: Sections – PRH Exhibit 6-4: Job Corps Basic Health Care Responsibilities – PRH Exhibit 6-5: Center Health Services Staffing Requirements

New Appendices to PRH Appendix 606: Communicating with Persons with Disabilities Appendix 607: Transmission, Storage, and Confidentiality of Medical, Health, and Disability-Related Information Appendix 608: Maximum Benefit Separation

Jeopardy Questions What is the longest that a student can be out for a MSWR? 1)90 days 2)180 days 3)12 months 79

Jeopardy Questions True or False? The student health record is considered a legal document. 80

HWM Orientation ROUND TABLE DISCUSSION Questions & Answers 81