-Presented by- Pamela Alston, DDS, MPH - PowerPoint Presentation

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-Presented by-Pamela Alston, DDS, MPHLead oral health specialistMelissa Lorenzo, MPHSenior assessor, humanitasGary Strokosch, MDRegion V Medical Specialist/Assessor

Preparing for the Oral Health & Wellness Portion of the ROCA

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ObjectivesParticipants will be familiar with the various resources available to help them prepare for the Oral Health and Wellness Program (OHWP) portion of the ROCA.Participants will know the standardized questions regarding the OHWP during the ROCA.Participants will understand the rating system.

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OverviewBackground: What is Humanitas’ role?Pre-ROCA: Preparing for ROCAROCA: On-site assessment activitiesPost-ROCA: Scoring, Report, Report Release and Corrective Action Plan processROCA ScoresTips for surviving your next ROCA

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What is Humanitas’ Role?Role of Health Support Contractor – Works directly with the National OfficeProvides support to all Regional Offices

Provides support to all centers by helping to develop and enhance center health and wellness services

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Examples of SupportDevelop policyProvide education and trainingProvide technical assistanceReview programs… ROCAs!

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Humanitas’ Role on ROCAsTwo health assessors conduct Health and Wellness Portion of the ROCA. Assessors will review all program components in 6.10 – 6.12 over the past 12 – 24 monthsAssessors on center 2-3 daysProvide written report with findings

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Who’s Who?Assessors:Pat Jackson, RNJohn Kulig, MD, MPHLois Sacher, RNCheryl Walker, APRN, MSN, MBA

Gary Strokosch, MDMelissa Lorenzo, MPH

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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, PhDRegion 2 – Philadelphia Shannon Bentley, RN Teresa Lowery, MD, MPH Valerie Cherry, PhD Kevin Avery, DMD, PhD Diane Tennies, PhDRegion 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

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Significance of ROCAsHelps identify problems on center levelInfluence policyAssess impactShapes training

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Pre-ROCA: Preparing for the AssessmentCenter will receive Notice from Regional Office followed by an email from lead health assessor regarding the Health and Wellness Review Email will include the dates the health assessors will be on center (2-3 days)The following information is requested prior to the arrival of the assessors on center:A schedule of when the subcontractors are on centerPre-ROCA forms listed on the Job Corps Community Website

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Pre-ROCA: Dentist completes the Pre-ROCA Form Pre-ROCA Forms can be accessed at https://supportservices.jobcorps.gov/health/Pages/Documents.aspx#roca

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Center Dentist Pre-ROCA Forms

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Pre-ROCA: Oral Health Materials that will be ReviewedDentist DEA RegistrationDeclarations page of liability insuranceLicensesSubcontractsWaivers, if applicable

Personal AuthorizationsOral Health Care Guidelines (HCGs) Oral Health-related Standard Operating ProceduresPriority Classification record-keepingSpore testing log

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Pre-ROCA: Oral Health Materials that will be ReviewedMSWRs (past year)Materials Safety Data Sheet (MSDS)

Bloodborne Pathogens PlanSIRs (including nonmedical, past year)Appointment book/logQuality assuranceStudent Surveys CQI studiesReports/Surveys

Annual H&W Program Description Assessments (most recent corporate)CAP from previous ROCA

H&W quality assurance surveys/results

Health Services Utilization Report

Student Satisfaction Survey

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ROCA: On-Site ActivitiesBrief – InMeet with HWM and Center DirectorReview of student health recordsWill be randomly selectedReview of documents listed above Oral Health Personnel interviewsCenter dentist(s) on or off-center (telephone interview as a last resort), dental hygienist and dental assistant (if they are available

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ROCA: On-Site ActivitiesIndividual student interviewsStudent Focus Group Students will be randomly selected or health assessors will request for certain students to participateOn-center or off-center dental facility inspection—outdates, supplies, equipment condition, cleanliness, etc.Brief – OutBrief summary of findings from the ROCA with Center Director, HWM, Project Manager, ROCA Team Lead, corporate representatives

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ROCA Review Tool

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ROCA Review Tool

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DefinitionsWeakness/Concern/Challenge – refers to components that are non-compliant with the PRH. Strengths – refers to Best Practices that go above and beyond PRH requirements.Observations

– suggestions that can improve quality of program.

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Components of the OHWP

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PRH-6: 6.10, R2(a): Is there an emphasis on prevention/education?

Is there chairside education?Are there group presentations?Are health education materials available?

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PRH-6: 6.10, R2(a): Is the general emphasis of the oral health and wellness program on early detection?Job Corps students’ typical history:Less likely to have a regular source of care

Less likely to receive preventive careMore likely to delay care, including dental care due to cost Safety net population

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Job Corp Health History FormIn the past 2 weeks, have you had any untreated dental pain or swelling in the mouth that has interfered with sleeping, eating, or ability to function?Do you need to talk with someone about something related to your mouth today?

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JC Health Questionnaire (ETA 6-53)Are you currently under the care of a dentist?

In the past 2 years, have you had a serious dental problem or problems such as untreated dental infections, missing teeth, or unresolved severe toothaches?

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Physical Exam FormEarly Detection

Hole in toothMod-to-severe painJaw or mouth swellingSoreBleeding in mouthNo obvious issuesDental Readiness Inspection

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PRH-6: 6.10, R2(b): DRI completed within 14 days after students arrive by DDS or designee?ComplianceCompleted within 14 daysCompleted by center dentist; alternatively by nurse or dental auxiliary under authorization

Weakness/ConcernNot completed within 14 daysNot documented on the physical exam formDone by nurse or dental auxiliary without signed authorization

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Oral ExaminationConsent to oral exam

Documented on oral exam form

Perio

diagnoses and caries risk categories can

b

e delayed if probing and caries risk

a

ssessments are done later by the RDH.

This is not a mandatory form.

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Oral Examination

Strengths

Students receive copy of treatment plan

Weaknesses/concerns

Exam is incomplete (unless provision for completion later)

Exam is not elective

Documentation is incomplete unless it is stated that parts are deferred

X-ray images are improperly stored

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How are digital images stored?

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Basic Oral CareVoluntaryDocumentation

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PRH-6: 6.10, R2(d):Basic services and proceduresDo the dental procedures include restorations, extraction of pathological teeth, root canal therapy on anterior/other strategic teeth, replacement of missing upper anterior teeth with a removable prosthesis, and dental hygiene treatment for periodontal disease?

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PRH-6: 6.10, R2(d):Basic services and proceduresStrengthsKept appointment incentives

Weaknesses/concernsThe full scope of basic oral care is not available

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PRH-6: 6.10, R2(e):Referrals off-center

Is there a referral arrangement with community facilities for emergent or urgent conditions treatable beyond the expertise of a dentist?Weaknesses/ConcernsStudents are given MSWR for oral health conditions that are in the scope of basic oral care with no community referral where they can access care.

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PRH-6: 6.10, R2(f):

Does the center pay for student orthodontics?Orthodontic Care Agreement form

Agreement for Enrollment with Braces

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Students under orthodontic careStrengthsIndividual oral hygiene sessions for students with bracesPriority for dental hygiene visitsMonitor students to see that they are scheduling and keeping their orthodontic appointments

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Citations in other areas of the ROCA report PRH-6: 6.12, R1 StaffingHours for center dentist, dental hygienist, and dental assistant do not meet minimum staffing levels PRH-6: 6.12, R5 Professional Standards of CareNo pain scale used to assist with pain management PRH-6: 6.12, R9 Health Care Guidelines

HCGs are not current or signed by the current center DDS

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Citations in other areas of the ROCA report PRH-6: 6.12, R10 Student Introduction to Health ServicesNo overview of the OHWP PRH-6: 6.12, R13(d) Communicable Disease and Infection ControlAutoclave is not monitored weekly There is a breach in infection control practices

PRH-6: 6.12, R14(a) Equipment and SuppliesThe center does not have root canal therapy equipment and suppliesSupplies are used beyond their expiration dates There is nonfunctional dental equipment The x-ray machine is not registered as required by State law

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Post-ROCA: ReportsTimelineMulti-tiered review process: Health Support Contractor > Lead Health Specialists > National OfficeReleased approximately 30 days after ROCA

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What to expect to be in the reportNarrativeOHW team compositionLength of time on centerOHW schedule on center & number of hoursLocation of dental facility and hoursOpen hoursDental Readiness Inspection (DRI) timeframe

DRI Inspector (personal authorization on file as applicable)Provision for students with serious health conditionsElective oral exam timeframesX-ray images and how they are storedScope of oral health careInformed consent for basic oral careProcedures that are referred off-centerArrangements for patients with emergent and urgent care needsHow the priority classification is implementedVisit volumeImpact of staff hours on program operationsParticipation in monthly oral health personnel teleconference calls

Strengths

Concerns (in order they appear in PRH)

Observations

Score

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Post-ROCA: Corrective Action PlanCorrective Action Plan (CAP) process Center must submit a CAP to the Regional Office 45 days after the ROCA report is releasedCAP should address impact of ROCARegional health specialists and assessors review and approve the CAPIf CAP is not received in 45 days, the National Office will be

notifiedCAP is available to assessors for following ROCAs to determine if CAP was carried outGeneral follow-up

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Technical AssistanceWhen are TA visits requested/done?Program areas are significantly out of complianceNew employeesWho requests them? What is the approval process?Center/Center Operator/PM/Assessor Regional Office Director

National Office

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ScoringJob Corps uses a Program Rating System (PRS) as a qualitative measure of performance for center/OA/CTS operations (PAG, pg 4, Aug 2008).

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ScoringPRS Rating Definitions:Exceptional (8-9) – Programs, procedures, and systems are well organized, clearly communicated, and administered to ensure quality delivery of all requirements and achievement of quality indicators. Innovative approaches result in program enhancements and improved outcomes. Through rigorous self assessments and quality assurance, the operator safeguards program assets and maintains the integrity of program data.

Very Good (6-7) – Programs, procedures, and systems are consistently in place to ensure delivery of requirements and achievement of quality indicators. Some innovative approaches are employed to promote continuous improvement. A viable quality assurance plan ensures integrity and accountability of program assets and data.

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ScoringPRS Rating Definitions cont’d:Satisfactory (4-5) – Requirement and quality indicators are generally evident in applicable program areas with minor exceptions. A quality assurance plan is in place that demonstrates adequate controls to ensure integrity and accountability of program assets and data.Marginal (2-3) – Requirements and/or quality assurance indicators are missing or minimally evident in applicable program areas. Quality assurance is minimal resulting in inconsistencies in accountability and integrity of program assets and data.

Unsatisfactory (0-1) – Critical requirements are missing or minimally evident. Quality indicators are not achieved. The program lacks procedures and controls necessary to ensure compliance, quality, and data integrity.

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ScoringUnsatisfactory (0/1)Critical requirements are missing or minimally evident. Quality indicators are not achieved. The program lacks procedures and controls necessary to ensure compliance, quality, and data integrity.

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ScoringMarginal (2/3)Requirements and/or quality indicators are missing or minimally evident in applicable program areas. Quality assurance is minimal, resulting in inconsistencies in accountability and integrity of program assets and data.

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Scoring Satisfactory (4/5)Requirements and quality indicators are generally evident in applicable program areas with minor exceptions. A quality assurance plan is in place that demonstrates adequate controls to ensure integrity and accountability of program assets and data.

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ScoringVery Good (6/7)Programs, procedures, and systems are consistently in place to ensure delivery of requirements and achievement of quality indicators. Some innovative approaches are employed to promote continuous improvement. A viable quality assurance plan ensures integrity and accountability of program assets and data.MUST LIST STRENGTHS TO USE THIS RATING

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Exceptional (8/9)Programs, procedures, and systems are well organized, clearly communicated, and administered to ensure quality delivery of all requirements and achievement of quality indicators. Innovative approaches result in program enhancements and improved outcomes. Through rigorous self-assessments and quality assurance, the operator safeguards program assets and maintains the integrity of program data.MUST LIST STRENGTHS TO USE THIS RATING

Scoring

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Quality Indicators6.10Q1. Students are aware of the center’s health-care delivery system and understand how to seek on-center health care.Q2. Students demonstrate a clear understanding of their individual health condition and treatment prescribed.Q3. Students’ health status will be maintained or improved while they are at Job Corps.6.11Q1. Student can describe appropriate lifestyle choices.

Q2. Students take personal responsibility for maintaining good health.Q3. Students are able to identify and access appropriate health-related programs to meet individual needs.6.12Q1. Students utilize available health services appropriately.Q2. Students are satisfied with the quality and delivery of health services.

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Quality RatingBest PracticesWhat is being done that goes above and beyond program requirements? ObservationsSuggestions that can improve quality of programFocus group + student interviewsDo students know Oral Health and Wellness personnel?

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How do oral health personnel move students beyond ambivalence?

Do the oral health and wellness personnel make the connection to employability?Do they use motivational interviewing skills?

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Tips for surviving your next ROCAHave pre-ROCA forms complete and available to assessors prior to ROCAList Best Practices!Participate on monthly conference callsReview this webinarDocument, document,

DOCUMENT!

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Questions?