Health and Wellness Manager Orientation - PowerPoint Presentation

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Health and Wellness Manager Orientation

Shannon Bentley, RN, Nurse Specialist

Melissa Cusey, RN, Nurse Specialist

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Job Corps General Information

America’s largest residential educational and career technical training program for economically challenged young adults aged 16-24

In operation since 1964

125+ operational centers throughout the United States and Puerto RicoServes over 60,000 students annually

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National Leadership

National Office of Job Corps

(Washington, D.C.)

National DirectorEdna Primrose4

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Administration and Management

National Office

The National Office Health and Wellness staff are responsible for developing and implementing the policies and procedures that guide the delivery of health care on center

National Office Health and Wellness staff contacts include:Edward Benton, Division Chief

Carol Abnathy, MSW, MPH, National Health and Wellness Manager

Johnetta Davis, MPH, Program Analyst

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Administration and Management

(continued)

Health Support Contractor

The health support contractor works with the National Office, Regional Offices, and centers to:Develop and enhance center health and wellness servicesDevelop policyTrain center health staff

Develop resource materialsCollect and analyze program data

Pilot test new health initiatives

Manage Health Specialists

Provide technical assistance

Conduct center assessments

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Administration and Management

(continued)

Regional Offices

Regional Offices award contracts and provide oversight, monitoring, and technical assistanceSix Regional Offices, headed by a Regional Director (Boston, Philadelphia, Atlanta, Dallas, Chicago, San Francisco)Project Manager (PM)—the DOL representative and liaison who works closely with your center to ensure that you have the resources you need to do your job and that you are working successfully to meet the established program outcomes

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Administration and Management

(continued)

Regional Health Specialists

Each Region has the following Specialists:Nurse SpecialistMedical Health SpecialistMental Health SpecialistTEAP Health SpecialistOral Health SpecialistDisability Specialist8

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Administration and Management

(continued)

Regional Health Specialists:

Provide technical assistance to center health and wellness staffAnswer questionsClarify Job Corps policiesProvide training to regional and center staff

Provide up-to-date information that will assist center staff in meeting program requirements

Conduct monthly teleconferences

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Regional Office Center Assessments

Every 1 to 2 years, Health Specialists and Assessors visit each center as part of a Regional Office Center Assessment (ROCA) team

Using the Program Assessment Guide (PAG), in conjunction with the Policy and Requirements Handbook (PRH), this team will conduct an overall assessment of your center’s health and wellness program

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Regional Office Center Assessments

(continued)

Assessments highlight the strengths of your program and provide feedback about areas that could be changed or improved

Expect to have your health records, appointment books, and other records audited11

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Center Health and Wellness Team

All centers have the following staff as part of their health and wellness team:

Registered Nurse (RN)

Staff NursePhysicianMental Health ConsultantTEAP SpecialistDentist and Oral Health StaffDisability Coordinator

Minimum health and wellness center staffing levels are determined by the center’s contracted student enrollment capacity

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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

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Wellness Philosophy

Allows the roles of the health care practitioners to be redefined so they impact the student’s entire Job Corps experience, including the body, mind, heart, and spirit

Health care practitioners interact with students not only when the student seeks health care due to illness, but also during times of good health

Health staff may take on roles ofteacher, mentor, role model, or advisor 14

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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 effectiveness15

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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 protocolsTAGs—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 requirements16

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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. 17

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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)18

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Job Corps Terminology 101

TEST YOUR SKILLS19

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What do these mean?

PRH

CMHC

HIPAA OBS CDSSPAGPM 20TEAPROCACSIO

OMSCDWTR

TAG

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Interaction with

Other Center Staff

Centers with an open flow of communication between departments usually function with better morale and efficiency

Develop relationships with staff from all Job Corps programs, including:Academics Residential LifeVocationsCenter Administration21

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Interaction with

Community Contacts

Establish community linkages that can enhance your program

Become familiar with existing relationships (community hospitals, off-center health care facilities, local public health department, etc.)Become more connected with community resources to help increase your success in meeting the health care needs of the students22

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Components of Chapter 6

PRH: Chapter 6: 6.10-6.12

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Student Health Services

PRH 6.10

Requirements:

A cursory health evaluation within 48 hours of arrival on center to include:Blood work Drug test (urine)Urinalysis (glucose/protein)STI testing (Chlamydia and Gonorrhea)Pregnancy testingPap (may be waived by physician)Vital signsVision screening (near, distant, and color)Cursory oral inspectionTb skin test (Mantoux)Immunizations (begin within 14 days of arrival)

Hearing screening

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Student Health Services

(continued)

A complete physical examination (within 14 days of a student’s arrival on center)

Centers may provide one pair of glasses (when indicated)A daily walk-in clinic that must be outside of training hoursAn appointment system for follow up during the training dayMust have an off center specialist referral system24-hour emergency care system

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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 complete HIPAA Authorization should also be part of the SHR 26

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Oral Health and Wellness

Cursory oral inspection completed within 48 hours of arrival and documented in SHR

Mandatory oral examination:

Completed prior to the student’s 75th day on centerIncludes bitewing x-rays, priority classification, and treatment planDocumented on the SF-603 and SF-603AOral health care beyond the oral examination is voluntaryProductivity reports must be kept by the center dentist

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Oral Health and Wellness

(continued)

Orthodontics

Not paid for by Job CorpsApplicants with orthodontic appliances must have a signed agreement in place before arrival that 1) all costs, including transportation, is the responsibility of the student/guardian, and 2) appointments will be kept and not exceed authorized leave days for elective dental treatment28

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Mental Health Program

Centers shall provide basic mental health services:

Should focus on prevention, identification, short-term counseling, and crisis intervention with an EAP approach

A written referral/feedback system must be in placeSteps/procedures for mental health emergencies in place to include supervisionAccommodations for students not considered a danger to self or othersRegular case conferences for information exchange (should include at a minimum counselors, TEAP Specialist, and health and wellness manager, if possible).

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Related Health Programs

PRH 6.11

Trainee Employee Assistance Program (TEAP)

At a minimum shall include:AssessmentInterventionCounselingRelapse Prevention

Prevention and Education

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Health Aspects of Sports

All students must be medically cleared to participate in organized sports activities by the center physician or designee

Document on the SF-88 or use a center-generated sports clearance form with copy in chart

Notify recreation manager of any students NOT cleared or if on sports restrictionAfter one year must have another physical examination with clearance

Center must make sure that staff certified in CPR and First Aid is present at all sports events including practice sessions

Adequate transportation must be available in the event of an emergency at all sponsored events

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Tobacco Use Prevention Program (TUPP)

Be aware of federal and state laws regarding use of tobacco products by minors; minors who use tobacco products shall be referred to the TUPP

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 entrances32

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Family Planning Program

Provided to all students on a voluntary basis and shall include counseling, health promotion activities, and medical services

If student is more than 12 weeks pregnant on arrival, give MSWR

For students who are less than 12 weeks pregnant on arrival or who become pregnant after enrollment the center:Provide or arrange for prenatal careBe aware of applicable state laws on rather to notify the student’s guardianProvide a MSWR at 28 weeks

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HIV/AIDS

HIV/AIDS program includes education, testing, follow up, and counseling for all students, as well as case management for HIV positive students

Refer to PRH Change Notice No. 08-08

Be aware of state laws regarding both pre- and post-test HIV counselingBe knowledgeable of timelines for providing student with HIV-test resultsHave student sign that they received their results

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Sexual Assault Prevention

and Response

Establish a program for sexual assault prevention, counseling, treatment, and follow-up care

Form a sexual assault response team (SART) that involves center staff and outside resourcesDevelop SOP with staff designations and outlined dutiesConduct regular SART meetings to discuss prevention and education strategies

Provide yearly training to the SART members

Report sexual assaults

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Disability Program

Centers must have a disability program to provide individualized and coordinated services to all students with disabilities; this program shall include:

A disability coordinator to oversee the program

SOPs to include:Center review process of applicant foldersReasonable accommodation process

Formation of a interdisciplinary team (IDT)

A written plan to develop and maintain partnerships with outside agencies

A written center self assessment plan describing current programmatic and architectural accessibility and plan for accessibility updates

A method to accurately collect and submit al required disability data in CIS

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Regional Disability Coordinators

Boston Region – Lisa

Kosh

lisa.kosh@humanitas.com Atlanta and Philadelphia Regions – Nikki Jackson nikki.jackson@humantias.com Dallas Region – Laura Kuhnlaura.kuhn@humanitas.comChicago and San Francisco Regions – Kim Joneskim.jones@humanitas.com

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Healthy Eating and Active Lifestyles

At a minimum, this program shall include the following components:

Planning :

Establish a Healthy Eating and Active Lifestyles Committee to oversee and coordinate this program. At a minimum, this committee shall include the Health and Wellness Manager, Food Services Manager/Supervisor, Recreation Supervisor or Specialist, TEAP Specialist, Residential Manager, and student representative. Incorporate student interests and preferences when planning activities. Demonstrate collaboration between various departments on center. 38

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Healthy Eating and Active Lifestyles

Environment:

Provide a variety of fitness activities open to all students, as outlined in Section 3.18, R2. Provide healthy eating selections and limit non-nutritious eating selections, as outlined in Section 6.7, R1. Education and counseling:Provide educational activities and materials to all students that support regular physical activity, nutrition, and achieving a healthy weight, as outlined in Section 3.17. Provide individualized weight management programming and/or counseling. Student participation in this program is highly recommended. Incorporate motivational interviewing and goal setting at student’s level of readiness for change. 39

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Healthy Eating and Active Lifestyles

Assessment:

Document, monitor, and assess program

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Health Administration

PRH 6.12

Staffing

Refer to Exhibit 6-5 for health and wellness center staffing requirementsMinimum staffing qualifications are listed in Exhibit 5-3All subcontracted staff must be reviewed (license, contract ,insurance, and resume) by the RO and Health Specialists PRIOR to hiringAll HWM candidates that are a direct report (administrative staff) must go through same process 41

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Administrative Tasks

Staffing

Authorizations

Basic Health ServicesExceeding Basic Health Care ServicesProfessional Standards of CareMedications/Controlled SubstancesWaiver of Medical CareFECA/OWCPHealth Care GuidelinesStudent Orientation to Health and Wellness Program 42

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Administrative Tasks

(continued)

Management and Reporting of Significant Incidents

Health Insurance Portability and Accountability Act (HIPAA)Medical SeparationsDeathCommunicable DiseasesEquipment and SuppliesContinuous Quality Improvement/Program Compliance

Health Records

Monthly Meetings with Center Director

Evaluation of Applicant Folders

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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 centerIn addition, the signed Informed Consent for Mental Health Treatment must be placed in the SHR before arrival of the new student on center44

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Basic Health Services

Provided by Job Corps

Center operators are responsible for providing and paying for

basic health care as detailed in Exhibit 6-4Center not responsible to pay for any health-related costs incurred by a student while on authorized leave or passNot responsible for non-resident students after training hours unless participating in center activities 45

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Health and Medical Costs Exceeding Basic Health Services Provided by Job Corps

Centers should assist students in seeking third-party health insurance coverage that will be available should the student have medical needs or costs beyond the basic health services provided by the center

If a Job Corps student experiences a medical emergency or unanticipated serious illness requiring off-center treatment:

Evaluate the student’s medical condition to determine if a MSWR is appropriateRequest third-party payment only for services beyond those basic services stipulated in the center operator’s prime contract

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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; must be in SOAP format

Document all labs and results in the SHRCheck off physician orders

Follow current standards of care

Have copies of current state nurse practice act for RN and LPN

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Controlled Substances

Centers must comply with all state and federal regulations regarding controlled medications

Purchase, store, administer, and document all controlled substances per 21 CFR Part 1300

Each center must maintain a controlled medication log and have a DEA registration or physician with DEA licenseOnly Class II medications can be stocked for specific studentsAll Class II, III, and IV medications must be under a double-lock system in a secured area of the health and wellness center. When dispensing, document date, time, medication, and dosage with full signature of staff giving medication. (recommend student sign for medication)48

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Controlled Substances

Two staff (one with a state license to dispense or administer) must document receipt of medications, noting the name of medication, dosage, amount, and date in narcotics log

Inventory controlled medications at least once weekly. Two staff must count and note results in narcotics log. Any miscounts or missing medication must be reported immediately to the CD and RO

Properly dispose of controlled medications; document on narcotics log with two staff signatures49

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Waiver of Medical Care

Waivers may be issued by the center physician for:

Pelvic exam

HIV testingImmunizations50

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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

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Health Care Guidelines

Health Care Guidelines (HCGs) consist of Treatment Guidelines (TGs) and Symptomatic Management Guidelines (SMGs); 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)

Memo must be submitted annually to the Nurse Specialist with any HCGs that have been modified for approval or memo stating adopted as is52

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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 examInformation on HIV and other STIsSafe sex practices and family planning servicesTEAP, mental health, and oral health servicesEmployability and good healthSigning of the HIPAA Notice

Information on specialty programs and services (TUPP, OWCP, disability/accommodations, open hours, after hours and weekend care)

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Student Introduction to Health Services

(continued)

HIPAA Notice

:Must be posted in the health and wellness centerPrivacy Officer and Complaint person for HIPAA must be posted throughout the centerThe complete, signed Notice must be placed in the SHRIf student refuses to sign the Notice, then document and place Notice in the SHRFor underage students, place a copy in the SHR along with a note stating a copy has been mailed to the guardian for signature

The HIPAA Authorization must be the SHR before arrival of the student on center

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Medical Separations

Medical separations are initiated by health and wellness center staff

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: A decision to medically separate should be made if a medical assessment and functional evaluation indicate that a student's medical, dental, or mental health condition is unable to be ameliorated within 180 days

Any student receiving a medical separation is eligible to reapply to Job Corps one year following the date of his/her separation

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Medical Separations

(continued)

Medical separation with reinstatement rights (MSWR):

A decision to medically separate with reinstatement rights may be used if the health care provider estimates that the student's condition will be resolved and the student will be able to return to the center within 180 daysFor both types of separation, a detailed health assessment and functional evaluation, conducted by the appropriate provider, must be performed prior to every medical separationThe center director must approve all medical separations

The HWM should gather all needed information from the health care provider, obtain the center director's decision, notify required parties, make referrals, and document all actions

For MSWR, students are contacted monthly by the HWM to assess progress and plan their return to Job Crops within the 180 days allowed

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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 details57

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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 lawBiologically monitor the function of autoclaves and maintain a log of spore test results. 58

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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. 59

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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 centerConduct regular chart audits

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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 discussed61

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Reporting

Refer to Exhibit 5-2 for required reports

Health and Wellness Center Annual Program Description

Due August 15th each year; provides an overview of the health and wellness program and staffingHealth Services Utilization Report

Monthly reports that provide statistical data collected from the mental health, oral health, and medical programs (these reports remain on center for review by the Regional Office Center Assessment team)

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Reporting

(continued)

Alcohol Testing Summary Report

Your center will prepare and submit online a quarterly report on suspicion testing for alcoholSignificant 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

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Charting

Student Health Records

Center physicians should follow center procedures for health and wellness documentation

Physician and nursing notes should be brief, clear, legible, and consistentAll entries should be signed and dated (including the hour) in ink by the person making the entry 64

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SOAP

The problem-oriented record system (SOAP notes) is the recommended format for all health record entries:

S = Subjective

—What symptoms are described by the student?O = Objective—What signs are detected upon physical examination?A = Assessment—What is the medical diagnosis?P = Plan—What interventions, treatment, or referrals will be performed, recommended, or prescribed?

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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 care66

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Student Health Records

(continued)

Organization of the Student Health Record:

Can be organized by center to meet needs but all must be in the same format In addition:Place the student's name on every sheetPlace center photos of student on the inside of the folder to help avoid fraudulent care Use a folder that fits the needs of the center 67

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Student Health Records

(continued)

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 place a color code on the front to indicate insuranceMay write allergies on the front in red68

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Student Health Records

(continued)

Check each folder on every visit that:

All visits are entered in the record, regardless of how minor the problem may seem at the time Record format complies with the center's policy Entries contain all required information Record Maintenance:Health and wellness staff should review the record each time a student reports to the health and wellness center

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Student Health Records

(continued)

Every record documents continuity of care by nursing, medical, dental, mental health, and TEAP professionals

When a student is separated, the record should be reviewed for completeness, sealed in an envelope, and forwarded to the appropriate department (e.g., student records) for storage except in the case of an HIV positive student or student's death when the health record is sent to the National Office [PRH-6: 6.12, R12 and Appendix 601]70

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Confidentiality of Records/ HIPAA Regulations

Health Insurance Portability and Accountability Act (HIPAA)

Protection of personally identifiable information (PII) [ REFER TO Program Instruction Notice NO. 06-23]

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SOPs/COPs

Suggest review and modification with any PRH changes

Must be individualized to meet center’s needs

Should be a blueprintShould have at least one for each PRH requirement, more based on center policiesShould have a SOP for all services provided by the health and wellness centerSent for approval to RO yearly or with any changes72

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Cost Saving Strategies

Develop community connections

See if local hospital will allow center to use “indigent program”, sliding fee scale, give discounts

Check local mental health agencies for victim services that are provided through grants, provision of speakers for groups, assemblies, pamphletsDo a MOU with Voc Rehab (refer to Program Instruction Notice No.99-03)Look at other local, state, or National ResourcesUse Health Department servicesUse Wal-Mart $4.00 prescription plan when possibleUse student insurance to purchase their medication when possiblePartnership for Prescription Assistance:https://www.pparx.org/intro.php or www.needymeds.org

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PRH and Exhibits Revisions

PRH Change Notice 10-07 (released October 28, 2010)

PRH Chapter 6: Sections 6.10-6.12

PRH Exhibit 6-4: Job Corps Basic Health Care ResponsibilitiesPRH Exhibit 6-5: Center Health Services Staffing Requirements

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New Appendices to PRH

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

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HWM Orientation

ROUND TABLE DISCUSSION

Questions & Answers76