New Hire Onboarding

1. 10176 Corporate Square Dr. Suite 220 Creve Coeur, MO 63132 (p)314-395-9375 (f)314-395-9381 Hours of Operation 8am-6pm New Hire Onboarding Welcome to BIS!

2. Agenda for the day! JOE DOUGLAS 9:00-9:10am -Collect the rest of paperwork & introductions LYNN BROOK 9:10-10:30am -First section of Orientation packet BERLY FORSYTHE 10:30-12:30pm -Policy & Procedure LUNCH 12:30-1:30pm -Food JOE DOUGLAS 1:30-2:00pm -Double check all paperwork & collect JAMIE KLAMERT 2:00-5:00pm -ISL Orientation -Therap Training -WhenToWork Training HERE WE GO!

3. Intro The Mission Our mission is to help each individual we serve reach their highest potential in life by overcoming barriers and promoting independence, achievement, and inclusion.  We utilize proven and positive behavior change strategies to reach this goal, while including all team members, friends, and family in the process. Defy Limits, Exceed Expectations…

4. What are the three most popular services at BIS? • Individualized Supported Living (ISL) • Natural Home Personal Care Assistance • Other Services - • Health and Wellness Classes – For Clients and Staff • Yoga, Cooking, Fun with Fitness • Social Skills Opportunities • Person Centered Strategies Consultant (PCSC) • Counseling and Support Groups • Applied Behavior Analysis (ABA) • Behavior Therapy via our BCBA, BCaBA

5. 2004 NOW • BIS was founded in 2004 • We have experienced substantial growth since its beginning and have changed locations three times • We currently hover around 130 Direct Support Professionals (DSPs) and 190 total employees • We are one of the largest providers of Behavior Therapy in the state of Missouri!

6. BIS Directors • Bachelors in Psychology and Sociology from Maryville University • Over 20 years of experience in the field of developmental disabilities • Associate Executive Director for 18 years at Creative Concepts for Living • Oversees the day-to-day operations at BIS • Bachelor in Psychology from St. Louis University • Masters in Applied Behavior Analysis from University of Nevada, Reno • Received her BCBA in 2004 • Started Behavior Intervention Services • Started as a full time PCA in 2006 • Promoted to Staffing Coordinator and Human Resources in 2008 • Been in the field of developmental disabilities since1993 & HR since 1996 • Promoted to Human Resource Director in 2011 • Came to Behavior Intervention Services in 2006 as an ABA Implementer • Promoted to Public Relations and Human Resources in 2008 • Promoted to Director of Administration in 2011 • Oversees office business, plans functions, & manages recruitment • Graduated from University of Dayton with BA In Psychology; Started at BIS in August 2011 as DSP • Became Home Supervisor in January 2012-May 2012 • Held Position of CIST from May 2012-November 2012 • Became ISL Assistant Director in November 2012-Novemeber 2013; Became ISL Director November 2013 • Supervises FCAs • Assigns FCAs to client caseloads • Performs phone screenings and forwards Applicants to FCAs

7. Board Certified behavior analysts Sherrie Shannon BCBA, LBA Shannon Riemersma BCBA Kyler Hasl-Wright BCaBA Andrea Mazo BCaBA Maija Graudins BCBA, LBA Lindsay Brefeld BCBA Beth Munkwitz BCBA, LBA Melissa Atis BCBA, LBA

8. Board Certified Behavior Analyst • Requires a minimum of a Bachelor’s degree in a human services field and a Master in Applied Behavioral Analysis as well as Board Certification • Makes initial contact with all potential clients • Completes interviews with client and family and completes assessments to determine the needs of the client • Develops a behavior plan to address all applicable behavioral needs • Provides initial and ongoing training of all staff on client specific behavior plan

9. Therapy Support Staff BCBA Board Certified Behavior Analyst BCaBA Board Certified Assoc. Behavior Analyst PCSC Person Centered Strategies Consultant DSP Trainer Direct Support Professional Trainer Gina Noble PCSC, DSP Trainer

10. ISL Leads *Hedge ISL *Turf ISL *Mehlville ISL *Redbird ISL *Hazelwood ISL *Wise ISL *O’Fallon ISL *Ridge ISL *St. Charles ISL *King ISL *Fenton ISL *Crestwood ISL *Rock Hill ISL

11. FCATeam Central, South County, West County West County South County, Illinois St. Charles County, North County, West County St. Charles County Central, West County Wes County, Central, South County St. Charles County Central West County Central, West County, Jefferson County

12. Family Care Advocates • Meet with all Natural Home Families on their caseload to discuss services and to create a schedule within allotted funding • Meet will all Natural Home DSPs to discuss client specific training and schedules • Ensure all allotted funding is used appropriately • Work 20 hours per week of direct care or supervision shifts within their caseload • Available for emergency coverage when necessary • Collect Daily Progress Notes from each household within their caseload and compile these notes into summaries for DMH • Create time sheets for DSPs based on time in/time out on Daily Progress Notes • Provide positive and constructive feedback to DSPs working within their caseload • Work with DSPs and Families ongoing to ensure proper services are being rendered • Help families receive additional resources for services when necessary

13. Office Support Team

14. Direct Support Professionals Natural Home DSPs • …will be contacted by the FCA to discuss scheduling, initial training dates, and shadowing of current DSP staff • …are responsible for carrying out activities or programs set forth by the client-specific behavior plan, treatment plan, or individual support plan. Programs and activities differ depending on your clients ability level and living situation but may include living skills, personal hygiene, socialization etc.. • …attend scheduled team meetings and required trainings to maintain current agency and state certifications • …are responsible for taking data per BIS and state guidelines, communicating with the family and team in a communication log, and reporting any incidents to supervisory staff (FCA or behavior support professional) • …will report directly to their client’s BT and FCA • …will be scheduled for hours based on the availability provided upon hire and client needs, and must provide two weeks’ notice for change in availability • …will keep all clients within line of sight unless otherwise dictated in the client’s BSP

15. ISL DSPs • …will be contacted by the ISL Staffing Coordinator to discuss training shift. • …will be contacted by their supervising CIST or BCBA for BSP and ISP training before initial worked shift. • …are responsible for carrying out activities or programs set forth by the client-specific Behavior Support Plan (BSP). • …will attend monthly team meetings as planned by the CIST. • …will keep all clients within line of sight unless otherwise dictated in the client’s BSP. • …will maintain required trainings to satisfy current agency and state certifications. • …are responsible for taking data per BIS and state guidelines, communicating with team in the house communication log, and reporting any incidents to the CIST. • …will be scheduled within the availability they provided upon hire and must provide two weeks notice to change that availability • …will report directly to Lead Staff and CIST. • …will treat their clients with respect. • …will nominate their coworkers for Employee of the Week to recognize a job well done!

16. NH Tier 2 First Steps, or Tier 2 DSP - Natural Home • …must have a Bachelor's degree or 60 credit hours in a Human Services Field • …must attend Discreet Trial Training (DTT) • …will be responsible for working under the assigned ABA consultant to implement discreet trial programs as well as any other programming set forth by the consultant • …must pass an FBI fingerprint background check • Please speak with Family Care Advocates about possible openings

17. From the Desk of Human Resources… Policy and Procedures overview Kim “Berly” Forsythe

18. Where do I fit in?

19. Trainings Page 10 Pre-Hire Requirements – Congratulations! - Unpaid Prerequisites • CPR/First Aid – Two year certification if taken at BIS • Mandt – Annual certification • Annual training forms: A & N, BBP, Confidentiality, HIPAA, ORR, Seizure training Orientation – Day 1 typically 9a-5p -Paid on first paycheck, min. wage • Agency Policy and Procedure • ISL Policy and Procedure training Orientation – Day 2 typically 9a-5p- Paid on first paycheck at min. wage • Behavior Management #1 & #2 • Orientation Wrap-Up Must complete prior to working any single shifts with the client: • Medication Administration Level 1 - 2-day course, 9a-5p each day, paid at minimum wage • Required in order to work in all ISL, some NH • Please make sure to turn in a timesheet for this class in order to be compensated! Must complete within 60 days of hire date • Behavior Management #3 & #4 - typically 9a-4:30p, paid at minimum wage Mandatory For Tier 2 DSPs Only, But Open To All • Discreet Trial Training (DTT) – typically 9a-5p, unpaid training

20. Funding Sources How they effect YOU

21. Work Opportunity Tax Credit • Encourages hiring of individuals with barriers to employment. • Completion of forms 8850 and 9061 is voluntary. • May assist members of Rural Renewal Counties and Empowerment Zones in securing employment.

22. New Hire Probationary Period • Every employee’s first 90 days is considered a probationary period during which at any time BIS can retract it’s original offer of employment. • Part-time employees will be scheduled between 10-29 hours per week on average. • Full-time employees must comply with all requirements to set a full-time start date. Employees may at times be asked to work over the 29 hour per week part time maximum but that does not make them full-time staff. You must submit your intent to move to a full-time position in order to start the process of moving to a full-time position if you were not hired in at full time.

23. Full-Time Employee Benefits • Must work at least 37-40 hours per week • Accrued Paid Time Off (PTO)accrued after one year of full-time employment • 5 days available after 1st year • 10 days available years 2 -4 • 15 days available years 5-9 • 20 days available 10+ years • Retirement Plan Eligible to employees that are: • 21 or older • Employed for 1 year while working a minimum of 19 hrs per week • Contribution matching of 100% of 3% and 50% of 5% • 100% vested from initial contributions • Vision and dentalinsurance 30 days after full time start date at a premium of $4.00 per pay period or $8 per month. • Healthcare benefits90 days after full time start date at a premium of $60 per pay period or $120 per month. 2 healthcare options: Group PPO coverage or Health Savings Account (HDHC)

24. Steps to move to a full-time position: Full-time positions are offered based on merit, performance and agency need.  If there is a need for additional full-time staff, employees may apply for a position by following these steps (in the order listed): • Submit a letter of intent to move to full time stating why you would be a good candidate for full time. • Have a current BIS supervisor write a letter of recommendation for you, supporting your request for full time • Secure a work schedule that is conducive to maintaining a minimum work week of 37 hours. • Schedule a meeting time with HR to set a full time start date, discuss and sign up for any full-time benefits, sign a change in status form and discuss any additional questions at that time.  (This will be scheduled after the first 3 items have been completed).

25. Failure to maintain a minimum of 37 hours for each ongoing work week will result in the following: • Immediate demotion to a part-time status • Decrease in pay rate • Limitation on hours to no more than 29 per week • Loss of all accrued PTO time • Loss of all benefits (if applicable) after last paid through date • Inability to seek a full-time position for a minimum of six months

26. All BIS Employees areMandated ReportersThis will be covered more thoroughly in Abuse and Neglect • Anyone holding any of these positions is considered by the state of Missouri to be a Mandated Reporter. As a Mandated Reporter it is your responsibility, in good faith, to report any allegation of abuse or neglect of a client to an immediate supervisor who will in turn report this allegation to the Department of Mental Health. • As a Mandated Reporter, if you negligently or intentionally fail to report you could be found guilty of a misdemeanor and be liable for damages caused by your failure to report. • As a Mandated Reporter, if you intentionally file a false report you could be liable in a civil suit for any damages suffered by the accused or the report facility • No BIS employee will be retaliated against for submitting a good faith report.

27. Abuse & Neglect (A & N) Required every June of employment Required each January of employment • Blood Borne pathogens (BBP) • Confidentiality agreement • HIPAA test • Observe, Record and Report test (ORR) • Seizure training acknowledgement

28. Professionalism • Sexual Harassment • Rate of pay • Med Administration • Client’s Siblings / own children • Name Badge • Client Transportation • Seatbelt • Driver License • Insurance • Agitated State • NO TEXTING/TALKING on phone WHILE DRIVING Page 3 • Relationship with Families • Smoking • Cell phone use • Dress code • Drug and alcohol use • Confidentiality/HIPAA • Respect • Line of Sight • Arms length • Supporting a client vs. the appearance of Sleep Page 13

29. How do I request time off? (RTO requests) • Make sure you are not scheduled for any shifts for the day you wish to take off • Log into the W2W system • Click on “Request Time Off (Full or Partial day) • Choose either full day or Partial Day or Repeating Days off • Comment as necessary • Receive approved or rejected based on previous stipulations/requirements • If you know of any days that you need off currently (within the next 4 months), please enter them into W2W as soon as you receive your log in information!

30. ISL Holiday Guidelines

32. Timesheets, W2W, DPN’s and Pay: • Please clock in and out on the master timesheet located in the client binder in each home. Do not clock in before your scheduled shift time and do not clock out on the sheet until you leave your shift. • Time in and out must match your client’s Daily Progress Note (DPN) as well as your W2W shift assigned to you. • Any deviations or problems with any forms may result in a lack of pay for the shift. • DPN’s (in home only) are used as your weekly timesheets. • 2ways to receive pay: • Via mail or direct deposit – individual issues will be handled on a case by case basis. • Time must be reported in 15 min increments – do not clock into shift before your scheduled time! • DO NOT FALSIFY A TIME SHEET or a DPN – Medicaid/Insurance Fraud • Mileage logs are to be turned in at the same time as your timesheets

33. Mileage logs and guidelines To claim mileage with a Natural Home client, you must do the following: *Have a shift that is at least 3.5 hours long *Travel a minimum of 20 miles with that client within that shift *Complete mileage logs with starting and ending mileage and destinations *Failure to turn in mileage logs on time, will result in non-payment. *Mileage logs must be turned in according to pay cycle. Please refer to Pay Cycle doc for dates** *receive $4 per shift as a mileage stipend Page 11-12

34. CLIENTS DEPEND ON US!! If you are going to miss a shift with a client in the natural home setting you must….

35. Natural Home: Page 18-19

36. Attendance and Punctuality Policy Call in/shift coverage Page 18 Be sure to review and sign the form in your packet. What you need to know: • Employees that call off to a scheduled shift during the hours of Friday at 3pm to Monday at 8am will receive a first and final disciplinary action (DAF). • Employees that call off to a second shift during the hours of Friday at 3pm to Monday at 8am during a six month period will be terminated. • Employees that have three call offs of any nature during a six-month period (unless excused by a physician's note) will be terminated. • Employees that are late to three scheduled shifts in a 6 month period will receive a first and final disciplinary action (DAF). Employees that are late to an additional shift in a 6 month period and have already received a first and final warning regarding tardiness will be subject to termination. Poor attendance and excessive tardiness are disruptive. Either may lead to disciplinary action, up to and including termination of employment.

37. Any BIS employee found to be in violation of these or any policies/ procedures will be subject to disciplinary action up to and including termination. Progressive Disciplinary Action: • Verbal Feedback • Written Feedback • Action plan/suspension (Final notice for improvement) *disqualified for annual increase or pay rate for that calendar year • Termination – • Training repayment policy enforced • Recovery of any agency/client items • HIPAA and confidentiality agreements invoked Page 18

38. BIS Grievance Procedure

39. Workers Compensation All employees will sign a copy of the Workers Compensation policy stating that they understand it’s contents • If you are injured during billable time with a client you must call your immediate supervisor to start the Workers Comp process. You will be asked a series of questions and a treatment determination will be made • All Workers Compensation claims will begin with a drug test • This test must be completed within 24 hours of the incident. Workers Compensation will not cover an injury if the drug test is outside of these parameters. Should you decline to take a drug test, you must sign a waiver form or your refusal will be deemed a positive drug test and you will be terminated. • We ask that all employees visit a Urgent Care facility when possible. Emergency rooms will only be approved when the injury is classified as a catastrophic event: broken bone, large laceration to a vital area, etc. • All paperwork acquired must be presented to BIS for submission to the Insurance company • An injured employee will not be permitted to return to active duty until a letter from a health care professional has been received permitting the individual to return to work Page 14

40. Community Event Report Forms (CERF) & Medical Event Report Forms (MERF) What is considered a “Community Event” for one client may be a daily occurrence for another. Please make sure to speak with your clients Behavior Therapist or DSP Trainer to better understand your particular clients and when a CERF may be necessary. • Forms will be located in your clients home in the data binder • All CERFs must be turned in within 24 hours of the event • All CERFS must be legible and precise • If you are uncertain as to whether an CERF should be completed, please call your Supervisor for clarification

41. HR Wrap-Up Questions?

42. ISL ISL Policy & Procedures With ISL Director Jamie Klamert ISL Support Kyle Swendig

43. What is an ISL? -Individualized Supported Living -Requires staff to be committed, reliable, and enthusiastic about the Direct Support Professional position -Residential living with around the clock support staff -able to provide safe environment for our consumers -provide 24 hours behavior intervention -promotes independence and a quality lifestyle for individuals -There are specific policy and procedures of Direct Support Professionals within the ISL Department.

44. Medication Administration Page 15 • Must be Med Certified to pass any medication to a consumer (this includes creams and treatments) • Must complete DMH Med Level 1 Certification Class before passing meds • Must have Supervised Medication Administration Sign-off Signed before passing meds at any ISL • Label and Storage of medications • Controlled Substances must be double locked! • All staff (med certified or not) must count controlled substances every shift • If you are not med certified: • It is a Direct Support Professional’s responsibility to ensure that a consumer receives their medication • Always check the MAR when entering the ISL. • This will inform you what time the consumer takes their medication • You must notify your CIST that you will need someone to pass meds for your consumer

46. Medication Administration Continued… • Medication Errors • The importance of the “Triple Check” • Reporting a Medication Error: 1) Inform the CIST immediately 2) Leave medication in the bubble pack 3) Fill out specific Med Error ERF

47. Med Error Policy • MEDICATION ERRORS • A medication error includes any failure to administer medication as prescribed for a particular consumer, including failure to administer the medication: • 1. To the right client • 2. Right medication • 3. In the right dose • 4. In the right route • 5. At the right time • 6. For the right reason • 7. Right response • 8. Right documentation after the medication is administered. • *Please note that documentation/charting errors are also considered medication errors. • Staff must report a medication error within one hour from the start of their shift or when first arriving at the home or they assume the same medication error as the staff who made the error and all disciplinary action that follows. • In the event of a medication error, (staff see a blank on the MAR, medication still in bubble pack, and no documentation on PRN medications or any other errors) staff are to immediately notify the QDDP. • The QDDP will notify the ISL Director. The QDDP is to determine if the error is a documentation error or a medication error. The QDDP shall then notify the parent or guardian and Community RN upon discovery of a medication error. Documentation errors will be handed by the QDDP. The QDDP or supervising employee shall document the effort to reach the parent or guardian. If there is a question of potential harm to the consumer, the QDDP or supervising employee shall also notify the consumer’s health care provider/physician. In addition, poison control can immediately be notified (1-800-222-1222), particularly if the consumer’s physician is not immediately available. • Home Supervisors or QDDP are to circle the medication error on the MAR after notification has been made to the QDDP. • Staff shall fill out a medication error form, fax it to the office and file the original form behind the MAR. • If the error is a reportable event to DMH then the QDDP or supervising employee will need to complete a Community Event Report Form within 24 hours of discovery. The Community Event Report Form should then be faxed to DMH within this timeframe. These reports shall be retained in the consumer’s permanent file at the agency location. They shall be made available to the Department of Mental Health and/or any other joint agency. • If an employee is found at fault or negligent in medication administration, that employee may be subject to any of the following disciplinary action: • 1. Involuntary unpaid meeting with QMRP, which may be handled via phone, but will include feedback form placed in employee’s permanent work file • 2. Written warning that includes 30 day probation • 3. Additional unpaid meeting/training by Community RN or the RN designee (Staff that fail to take have the meeting within seven days will be suspended without pay. • 4. Repeat of Medication 1 training/re-certification at expense of employee within 30 days. • 5. Termination for serious offense and/or intentional failure to report • -The above disciplinary action will typically occur in a sequential fashion starting with step 1 and progressing as additional medication and documentation errors occur depending on the severity of the incident. Once a period of 6 months passes, previous medication/documentation errors will be potentially disregarded when taking into account future disciplinary action at the discretion of the ISL Director and HR Director. • If the medication error is life threatening or has serious consequences to the client the disciplinary action can accelerate to termination. • If any employee has any doubt as to how to properly administer a medication, a supervisor should be contacted.

49. Restraints & Time Outs • MANDT • Last Resort • Keeping you and your client safe • Cannot be used as a punishment • Must be the choice of the consumer • Time out = No Break = Yes

50. Consumer Rights • ERF and State Documentation language: • The importance of positive language on state documents • Eliminating the words “must” “have” “don’t” “can’t” “no” “stop” from your vocabulary • Treatment of Client: • Do not say “NO!”—The use of positive talk • Consumer Rights • Consumer Rights/ Limitations • HIPPA • Role of Parents/Guardians • Rights of Parents/guardians