Health and Wellness Manager Orientation

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

2. Job Corps’ Mission • As a national, primarily residential training program, Job Corps' mission is to attract eligible young adults, teach them the skills they need to become employable and independent, and place them in meaningful jobs, higher education, or the military.

3. 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

4. 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

5. Health Specialists • Each Region has the following health specialists: • Nurse Specialist • Medical Health Specialist • Mental Health Specialist • TEAP Health Specialist • Oral Health Specialist

6. Center Health and Wellness Team • All centers have the following staff as part of their health and wellness team: • Health & Wellness Manager/Registered nurse (RN) • Staff nurse (LPN/RN) • Physician, Nurse Practitioner, Physician Assistant • Mental health consultant • TEAP specialist • Dentist and oral health staff • Disability coordinator

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

8. 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 14th day on center)

9. 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

10. 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.

11. 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

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

13. 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

14. 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

15. 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

16. Related Health ProgramsPRH 6.11

17. 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

18. 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

19. 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

20. Family Planning Program • Provided to all students on a voluntary basis include: • counseling • health promotion activities • medical services • Students more than 12 weeks pregnant on arrival are placed on MSWR • Students 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

21. 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 (Best 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.

22. 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)

23. HEALS • At a minimum the HEALs Programs should consist of: • Planning • Environment • Education and Counseling • Assessment • Center director establishes a Healthy Eating and Active Lifestyles Committee to oversee and coordinate this program.

24. Health AdministrationPRH 6.12

25. 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

26. Administrative Tasks • The HWM has oversight of the health and wellness program and its staff.

27. 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

28. 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

29. 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).

30. 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

31. 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

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

33. FECA/OWCP • 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

34. 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)

35. 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

36. 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: • Medical separation • 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

37. 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

38. 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.

39. 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.

40. 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

41. 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

42. 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

43. Student Health Records • 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

44. Student Health Records • Student Health Records • All health and wellness staffshould follow center procedures for health and wellness documentation • All entries 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 • Organization of the Student Health Record: • Can be organized by center to meet needs but all must be in the same format • 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 write allergies on the front • May use a color code on the front to indicate if student is a minor or has insurance

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

46. 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

47. 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

48. 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.

49. 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)

50. PRH and Exhibits Revisions • PRH Change Notice 12-10 released January 11, 2013 and associated Appendices and Exhibits • PRH Change Notice 12-14