1. PRESENTED BY MELISSA LORENZO, MPH SENIOR ASSESSOR ROCAs: Health and Wellness Common Concerns

2. Overview Purpose of the ROCA Report Card  Data from ROCAs Common Concerns  Significant findings  Easy fixes Tips for next ROCA

3. Purpose of ROCA What is the Regional Office Center Assessment (ROCA)?  The ROCA is a thorough evaluation of Job Corps centers and is conducted every 12 to 24 months. Job Corps Regional Offices (ROs) are charged with the responsibility of providing federal oversight of the Job Corps program to ensure that it is delivered with compliance, quality, and integrity.”

4. Who’s Who? Assessors: Lois Sacher, RN Pat Jackson, RN Cheryl Walker, APRN, MSN, MBA Gary Strokosch, MD Melissa Lorenzo, MPH

5. Who’s Who? Region 1 – Boston Shannon Bentley, RN John Kulig, MD, MPH David Kraft, MD, MPH Maria Acevedo, PhD Kevin Avery, DMD, PhD Diane Tennies, PhD Region 2 – Philadelphia Shannon Bentley, RN Teresa Lowery, MD, MPH Valerie Cherry, PhD Kevin Avery, DMD, PhD Diane Tennies, PhD Region 3 – Atlanta Melissa Cusey, RN Teresa Lowery, MD, MPH Suzanne Martin, PsyD, MPH Kevin Avery, DMD, MPH Christy Hicks, MSW Region 4 – Dallas Shannon Bentley, RN Drew Alexander, MD Lydia Santiago, PhD Kevin Avery, DMD, MPH Christy Hicks, MSW Region 5 – Chicago Melissa Cusey, RN Gary Strokosch, MD Helena Mackenzie, PhD Pamela Alston, DDS, MPP Christy Hicks, MSW Region 6 - San Francisco Melissa Cusey, RN Sara Mackenzie, MD, MPH Vicki Boyd, PhD Pamela Alston, DDS, MPP Diane Tennies, PhD

6. Job Corps uses a Program Rating System (PRS) as a qualitative measure of performance for center/OA/CTS operations (PAG, pg 4, Aug 2008). Take home message: A satisfactory program meets PRH requirements. Scoring

7. Report Card 2012 Total number of centers reviewed: 63

8. Report Card 2013 Total number of centers reviewed: 58

9. Significance of ROCAs Helps identify problems on center level Influence policy Assess impact Shapes training

10. Definitions Challenge/Weakness/Concern – refers to components that are non-compliant with the PRH. Notable Positives/Strengths – refers to Best Practices that go above and beyond PRH requirements. Observations – suggestions that can improve quality of program.

11. IF IT’S NOT DOCUMENTED, IT WAS NEVER DONE! Common Concerns: Significant Findings

12. Concern #1 Case management of chronic health problems not documented: PRH states [see 6.10, R1 (b,4)]: Students identified as having chronic health problems during the cursory or entrance physical shall be monitored as directed by the center physician or other appropriate center health-care provider. How is compliance determined?  Review of student health records (chronic care management plans, documentation in chronological medical record or SF-600)  Student interviews Recommendation: Document case management in student health record. Documentation should include regular monitoring and education regarding the importance of self-responsibility and how chronic illness may affect maintaining employment.

13. Concern #2 Missing documentation from off-center referrals  PRH states [see 6.10, R1 (j) or 6.12, R5(d)]: An off-center specialist referral system –or– Following current standards of care when providing health services and treating illnesses and injuries. How is compliance determined?  Review of student health records Recommendation: Request documentation from all referral sources to ensure that information on the current health status of the student is complete and available. Send a signed authorization for release of information along with the student when he/she goes off center for medical reasons.

14. Concern #3 Lack of weight management program: PRH states [see 6.11, R7(c,2)]: Provide individualized weight management programming and/or counseling. How is compliance determined?  Interview HEALs coordinator or Wellness staff member a part of HEALs committee and/or oversees weight management program  Review curriculum  Interview students with BMI greater than 30 to determine if weight management programming and/or counseling was offered Recommendation: Along with healthy food options and adequate options for physical activity, a weight management program is an integral part of HEALs. Review the Job Corps Health and Wellness website to incorporate ways to structure a weight management program.

15. Concern #4 Authorizations and/or health care guidelines (HCGs) are not up to date PRH states [see 6.12, R9 (a,b,c)]: All health care guidelines shall be approved and signed annually by the center physician, CMHC, or center dentist, as appropriate. Current signed and dated HCGs shall be kept in the Health and Wellness Center. Annually, each center shall submit a memorandum to the Regional Office indicating which HCGs have been modified. Copies of any individual health staff authorizations and health care guidelines that have changed shall be sent to the Regional Office for approval. How is compliance determined?  Review of health care guidelines (to include all authorizations, treatment guidelines and symptomatic management guidelines) Recommendation: Update health care guidelines as new ones become available. Have new subcontractors sign authorizations.

16. Concern #5 Lack of continuous quality improvement (CQI) activity or study: PRH states [see 6.12, R15]: Center health staff shall seek feedback from students, employ mechanisms to document quality of care provided, and document quality improvement activities. How is compliance determined?  Review student surveys  Review student health records for chart audits  Interview Wellness staff members (HWM, subcontractors) to determine if there are CQI activities being done on center; review documentation Recommendation: Incorporate a regular study of one of the treatment protocols to learn if the desired outcomes are being maintained. If the desired outcomes are met, move on to another issue; if not, determine what changes can be made to meet the desired result. Consider reviewing CQI webinar available on Health and Wellness website.

17. Common Concerns and Observations: Easy Fixes

18. Easy Fixes 6.10 Student Health Services Oral Health and Wellness Program  Treatment plan not developed or documented – See 6.10, R2(c)  No documentation that students have been informed about the elective oral examination (observation)  No documentation that students consent to basic oral care (observation) Mental Health and Wellness Program  CDP, CTP presentations not done – See 6.10, R3(c,2)  No documentation of case conferences - See 6.10, R3(d,5)

19. Easy Fixes – 6.11 Related Health Programs TEAP – See 6.11, R1(b,2):  CTP, CDP presentations are not done HIV/AIDS – See 6.11, R5(a,4):  HIV testing is not done when a student is diagnosed with a newly contracted STI. TUPP – See 6.11, R3(f):  Minor students are not provided with a referral to TUPP unless given a write-up. Family Planning Program – See 6.11, R4(d,2(a)):  Gestational records of pregnant students not available in SHRs.

20. Easy Fixes – 6.12 Health Administration Professional Standards of Care – See 6.12, R5(d)  Lack of problem list or not consistently updated (Observation)  CMHC or TEAP specialist do not document on the main chronological record or progress note (SF-600) (Observation)

21. Tips for your next ROCA Review Webinar: Preparing for the Health and Wellness ROCA Review common concerns, particularly easy fixes, make sure they are done! Have pre-ROCA forms complete and available to assessors prior to ROCA List Best Practices! Document, document, DOCUMENT!

22. CONTACT INFORMATION: MELISSA LORENZO, MPH MELISSA.LORENZO@HUMANITAS.COM Questions?