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

2. The Policy and Requirements Handbook PRH Chapter 6, sections 6.10-6.12 Refer to PRH for policy Policy in this presentation has been paraphrased

3. PRH 6.10 Medical, Oral Health, and Mental Health Services

4. Student Health Services Requirements: –A cursory health evaluation within 48 hours of arrival on center to include: Lab work including: drug screen (urine), urinalysis, STI testing (Chlamydia and Gonorrhea), pregnancy testing, and blood work for HIV Pap for females 21 & older (may be waived by physician) Vital signs Hearing and vision screening (near, distant, and color) Tb skin test (Mantoux) Immunizations (within 14 days of arrival) Hearing screening Dental Readiness Inspection (complete by 14 th day on center) 4

5. Student Health Services Medical history (Job Corps Health History Form) Physical Exam (Job Corps Physical Exam Form) Provide one pair of ANSI approved glasses, when indicated A daily walk-in clinic outside of training hours Appointment system for follow up Off center specialist referral system 24-hour emergency care system Access to prescription medications 5

6. Student Health Services Immunizations –Applicants are required to provide Admissions Counselors with current immunization records –Records will be reviewed by center health staff on entry to determine currency of immunizations –Centers should utilize the Vaccines for Children (VFC) program to provide immunizations for eligible students according to the latest Centers for Disease Control and Prevention (CDC) guidelines. 6

7. Orientation to Wellness Center All students must receive an orientation presentation to explain what will happen during the cursory health evaluation and physical examination, and what services are offered at the health and wellness center The HIPAA Notice must be signed on the first visit to the health and wellness center; the SHR should contain a complete HIPAA Authorization and a complete HIPAA Notice 7

8. Oral Health and Wellness A dental readiness inspection An elective oral examination Dental procedures Referral agreement with community facilities 8

9. Oral Health and Wellness Orthodontics –Not paid for by Job Corps –Applicants with orthodontic appliances must have a signed agreement in place before arrival that states: all costs, including transportation, are the responsibility of the student/parent/guardian appointments will be kept and will not exceed authorized leave limits for elective dental treatment 9

10. Mental Health Program Five main components: –Assessment –Mental Health Promotion and Education* –Consultation and Training* –Disability Program Support (including applicant file reviews)* –Treatment –Note: 50% of the CMHC time must be used for a combination of the areas indicated with an * above 10

11. Mental Health Program Assessments and recommendations for Job Corps applicants Review of Social Intake Form (SIF) MSWR or medical separation for mental health issues Presentation on mental health promotion and employability to students during the Career Preparation Period (CPP) A written referral/feedback system Steps/procedures for mental health emergencies Regular case conferences for information exchange 11

12. Related Health Programs PRH 6.11

13. Trainee Employee Assistance Program (TEAP) Emphasis is on: –Prevention –Education –Identification of substance use problems –Overcome barriers to employability. Refer to PRH Chapter 6, 6.11; R1 and Exhibit 6-4 for complete details of required services 13

14. Health Aspects of Sports All students must be medically cleared to participate in organized sports activities by the center physician or designee Staff certified in CPR and First Aid are present at all sports events including practice sessions Adequate transportation must be available in the event of an emergency at all sponsored events 14

15. Tobacco Use Prevention Program (TUPP) Be aware of federal and state laws regarding use of tobacco products by minors 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 15

16. Family Planning Program A family planning program shall be provided to all students on a voluntary basis. At a minimum, this program shall include counseling, health promotion activities, and medical services, including birth control. The Center Director shall appoint a staff member to implement and monitor this program. Students who are pregnant and/or experiencing pregnancy-related medical conditions shall be afforded the same access to medical services, leave and medical separation as any other student experiencing a medical condition, unless otherwise provided by law. 16

17. Family Planning Program Once a center learns that a student is pregnant, pregnancy-related services shall include: –1. Prenatal services on center and/or in the community until separation, to include a comprehensive gestational record. –2. The center physician, in conjunction with an obstetrical/gynecological provider and the student, will agree upon a care- management and separation plan that takes into account the health and safety of the pregnant student before and after childbirth.

18. Family Planning Program The center shall identify available community health/social resources and services, and will make arrangements for transportation for the purpose of obtaining such resources and services consistent with PRH 6.6, R4 (d). In lieu of the center providing transportation, the center may approve a student’s request to be transported by a friend, partner or family member.

19. Family Planning Program The center shall not pay for an abortion unless the pregnancy is the result of rape or incest or unless a physician has certified that the student suffers from a physical disorder, injury, illness, or condition that places her in danger of death unless an abortion is performed. A student that is experiencing a pregnancy-related medical condition may be placed on paid administrative leave in accordance with PRH Exhibit 6-1. See Pay status: Paid, Duty status: Not Present for Duty-Administrative Leave with Pay.” Pregnancy-related services shall include information on the options of continuing or terminating the pregnancy. If required by applicable state laws in which the center is located, the Center shall notify the student’s parent/guardian of her pregnancy if she is a minor, and if required by applicable state law, inform the student of this requirement prior to the disclosure.”

20. HIV/AIDS HIV/AIDS program includes: –Education –Testing –Provide pre- and post-test counseling according to your state and local laws –Follow up –Case management for HIV-positive students Have student sign that they received their results (Promising practice) Submit specimens for HIV testing to the nationally contracted laboratory. Centers shall not be reimbursed for HIV tests performed at other than the nationally contracted lab. 20

21. Sexual Assault Prevention and Response Establish a program for: –Prevention –Counseling –Treatment –Follow-up care Form a sexual assault response team (SART) that involves center staff and outside resources Report sexual assaults: –To law enforcement authorities as required by state and local law –As significant incidents (see Chapter 5, Section 5.5, Management and Reporting of Significant Incidents) 21

22. HEALS At a minimum the HEALs Programs should consist of: 1.Planning 2.Environment 3.Education and Counseling 4.Assessment Center Director establishes a Healthy Eating and Active Lifestyles Committee to oversee and coordinate this program. 22

23. Health Administration PRH 6.12

24. Staffing 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 24

25. Authorizations and Consent for Treatment 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 25

26. Basic Health Services Provided by Job Corps 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 26

27. Health and Medical Costs Exceeding Basic Health Services Provided by Job Corps Assist students in seeking third-party health insurance coverage If a student is determined to have a pre-existing or acquired health condition that significantly interferes with or precludes further training in Job Corps, or if a student is determined to have a health problem that is complicated to manage or for which necessary treatment will be unusually costly, the center must follow medical separation procedures (Section 6.12, R11, and Section 6.4, R4.c.5) and determine whether referral to the Office of Workers’ Compensation Programs (OWCP) is required (Section 6.12, R8). 27

28. Professional Standards of Care 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; recommended to be in SOAP format Document all labs and results in the SHR Follow current standards of care 28

29. Controlled Substances Comply with all state and federal regulations 21 CFR Part 1300 Maintain a controlled medication log and have a DEA registration or physician with DEA license Only Schedule II medications can be stocked for specific students Double-lock system in a secured area of the health and wellness center. Document date, time, medication, and dosage with full signature of staff giving medication (recommend student sign for medication) Two staff must document receipt of medications and also inventory controlled medications at least once weekly. Notify CD and RO immediately of any miscounts or missing medication Properly dispose of controlled medications; document on narcotics log with two staff signatures 29

30. Waiver of Medical Care Waivers may be issued by the center physician for: –Pelvic exam –HIV testing –Immunizations 30

31. FECA/OWCP Students are considered federal employees for purposes of the Office of Workers Compensation Program (OWCP) Refer to the FECA/OWCP TAG, revised and released December 2014 31

32. Health Care Guidelines Health Care Guidelines (HCGs) consist of: –Treatment Guidelines (TGs) –Symptomatic Management Guidelines (SMGs) HCGs 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) 32

33. Student Introduction to Health Services 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 –Information on specialty programs and services (TUPP, OWCP, disability/accommodations, open hours, after hours and weekend care) –Signing of the HIPAA Notice 33

34. 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 (2)Medical separation with reinstatement rights (MSWR) Initiated by health and wellness staff Center director must approve all medical separations Health and social service referrals are provided for all separated students For MSWR, students are contacted monthly by the HWM to assess progress and plan their return to Job Crops within the 180 days allowed 34

35. Medical Separations Health and Wellness staff approve a student’s transportation plan for medical separation. Center staff must submit a request to the Regional Office to extend an MSWR beyond 180 days for extenuating circumstances. The request should be accompanied by supporting documentation from the student’s health-care provider verifying that extension of leave is medically necessary. Requests will be reviewed on a case-by-case basis.

36. Death 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 36

37. Communicable Disease and Infection Control 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. 37

38. Equipment and Supplies 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. 38

39. Continuous Quality Improvement 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 39

40. Monthly Meetings with Center Director 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 40

41. Reporting Refer to Exhibit 5-2 for required reports –Health and Wellness Center Annual Program Description –Monthly Health Services Utilization Report (HMIS) Monthly –Quarterly Alcohol Testing Summary Report Significant Incident Reports –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 41

42. Confidentiality of Records/ HIPAA Regulations Health Insurance Portability and Accountability Act (HIPAA) Protection of personally identifiable information (PII) [Program Instruction Notice NO. 06-23] 42

43. Important Resources PRH—The Policy and Requirements Handbook contains the rules by which all centers operate; Chapter 6 (Sections 6.10-6.12) 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 43

44. 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. 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 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 44

45. Additional Appendices to PRH Appendix 601: Student Rights to Privacy and Disclosure of Information Appendix 605: Definitions and Documentation Requirements Related to Reasonable Accommodations for Applicants and Students With Disabilities 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 Appendix 609: Individualized Assessment of Possible Direct Threat Appendix 610: Exceeds Health Care Needs Assessment Appendix 107: Applicant File Review Process Guidance