RFP FINAL for use.doc

COMMERCIAL ITEMS

Solicitation No. AG-82X9-S-09-0110

Project Name: Mental Health Care Services UNIT: Jacob’s Creek CCC

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

DATE

DATE

9/14/2010

NFORMATION CALL:

USDA Forest Service WO AQ Job Corps Support Branch

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UNRESTRICTED OR FORMCHECKBOX

SET ASIDE: 100% FOR

SMALL BUSINESS FORMCHECKBOX

EMERGING SMALL

BUSINESS

740 SIMMS ST., GOLDEN, CO 80401

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HUBZONE SMALL

NAICS: 621330 BUSINESS

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SERVICE-DISABLED VETERAN- FORMCHECKBOX

8(A)

SIZE STANDARD: $7 million OWNED SMALL BUSINESS

11. DELIVERY FOR FOB DESTINATION UNLESS BLOCK IS MARKED

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SEE SCHEDULE

13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 700) 13b. RATING

14. METHOD OF SOLICITATION

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RFQ FORMCHECKBOX

IFB FORMCHECKBOX

RFP

15. DELIVER TO CODE

Jacob’s Creek Civilian Conservation Center

984 Denton Valley Road Bristol, TN 37620

16. ADMINISTERED BY CODE

SAME AS BLOCK #9

17a. CONTRACTOR/ CODE FACILITY

OFFEROR CODE

18a. PAYMENT WILL BE MADE BY CODE

USDA, OFCD, COD, APB

P.O. BOX 60075

NEW ORLEANS, LA 70160

DUNS #:

TIN #

E-MAIL:

TELEPHONE N0.

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17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

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SEE ADDENDUM

Provide MENTAL HEALTH CARE SERVICES AT JACOB’S CREEK Civilian Conservation Center IN ACCORDANCE WITH ATTACHED STATEMENT OF WORK, TERMS AND CONDITIONS.

-- CONTINUED ON PAGE 2 --

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

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ARE NOT ATTACHED

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ARE NOT ATTACHED

29. AWARD OF CONTRACT: REF. OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

Lincoln S. Capstick III 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

STANDARD FORM 1449 (REV.3/2005)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA ‑ FAR (48 CFR) 53.212

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

ATTACH CURRENT CERTIFICATIONS/LICENSE WITH QUOTE

CCR REGISTRATION VALID UNTIL ________________________

SUBMIT COMPLETED EXPERIENCE QUESTIONNAIRE WITH QUOTE

SUBMIT COMPLETED FAR CLAUSES 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS

SEE SECTION M FOR EVALUATION CRITERIA

ALL INFORMATION REQUESTED ABOVE MUST BE SUBMITTED TO BE CONSIDERED TO BE RESPONSIVE TO THIS SOLICITATION.

32a. QUANTITY IN COLUMN 21 HAS BEEN

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RECEIVED

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INSPECTED

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ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ________________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

CORRECTFOR

|PARTIAL | |FINAL

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41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER

FOR PAYMENT

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

STANDARD FORM 1449 (REV.3/2005) BACK

TABLE OF CONTENTS

PART I--THE SCHEDULE

SECTION B—Supplies or services and price/costs

SECTION C—Description/specifications/statement of work SECTION D—Packaging and marking SECTION E—Inspection and acceptance SECTION F—Deliveries or performance SECTION G—Contract administration data SECTION H—Special contract requirements

PART II--CONTRACT CLAUSES

SECTION I—Contract clauses

PART III--List of documents, exhibits, and other attachments SECTION J—List of attachments

ATTACHMENT i: Wage Determination ATTACHMENT iI: Experience Questionnaire

ATTACHMENT III: Sample Invoice

PART IV--REPRESENTATIONS AND INSTRUCTIONS

SECTION K—Representations, certifications, and other statements of offerors or respondents SECTION L—Instructions, conditions, and notices to offerors or respondents Solicitation provisions SECTION M—Evaluation factors for award

PART I—THE SCHEDULE

SCHEDULE OF ITEMS

SECTION B--SUPPLIES OR SERVICES AND PRICES/COSTS

ESTIMATED QUANTITIES

The quantities listed for each item are the governments best estimates based upon past experience. The contractor will be paid based upon the actual services provided and performed pursuant to the Statement of Work.

JACOB’S CREEK CCC:

Provide Mental Health Care Services at Jacob’s Creek Civilian Conservation Center in Sullivan County, Bristol, Tennessee for the period beginning November 1, 2010 through October 30, 2011 and any subsequent option periods (maximum of 60 months) in accordance with the Terms of the Contract.

Monday-Friday except Federal holidays.

No mileage or compensation will be allowed for travel to and from Jacobs Creek Job Corps.

No Facsimile proposal will be accepted!

Schedule of Items

Section B—Supplies or Services

Estimated Quantities

The quantities listed for each item are the governments best estimates based upon passed experience. The contractor will be paid based upon the actual work performed pursuant to the Statement of Work (SOW).

No mileage or compensation will be allowed for travel to and from the Jacobs Creek Job Corps Civilian

Base Period November 1, 2010- October 30 2011

Yearly Total Cost for all services

Option Year 1 November 1, 2011-October 30, 2012

Yearly Total Cost for all services

Option Year 2

November 1, 2012-October 30, 2013

Yearly Total Cost for all services

Option Year 3

November 1, 2013-October 30, 2014

Yearly Total Cost for all services

Option Year 4

November 1, 2014-October 30, 2015

Yearly Total Cost for all services

SECTION C-- CONTRACT DOCUMENTS, EXHIBITS OR ATTACHMENTS

STATEMENT OF WORK

Mental Health Consultant Section C: Statement of Work: Mental Health Consultant

C Part I: General Information

C 1: Introduction

The USDA Forest Service Job Corps Civilian Conservation Center, located at 984 Denton Valley Road, Bristol TN 37620, is a residential, educational, and vocational training facility for students’ ages 16 to 25 years of age. The Jacobs Creek Job Corps Civilian Conservation Center is the place of performance for this contract. The mission of this facility is to provide academic, career-technical training and career-success standards training to our nations’ at- risk and/or economically disadvantaged youth in order to prepare them to obtain and maintain viable employment. Services include the following: basic- academic-skills education, High School Diploma (HSD) program, General Education Development (GED) program, vocational skills training; residential living program, healthcare, recreation, and other related services.

C 2: Background Job Corps is a United States Department of Labor (DOL) program. Job Corps is designed to assist young people who both need and can benefit from the wide range of services provided at a Job Corps center. Through its centers, Job Corps offers academic, career technical skills and life skills training, using the approaches of competency-based and individualized instruction.

The majority of the students live at the Forest Service Job Corps Civilian Conservation Centers maintain academic classrooms, vocational classrooms and work areas, a cafeteria, health and wellness center, recreational facilities, and dormitories. Job Corps students are provided a limited allowance for personal expenditures; however, all room and board and other services are provided through federally appropriated operational monies. Students’ length of enrollments in Job Corps varies. Programs are designed to be self- paced and competency-based; therefore, students may spend as much as two years in the completions of Job Corps programs. Average length of enrollment is approximately eight months to nine months. Students approved for enrollment in advanced programs are granted an additional year to complete those programs.

Job Corps programs are designed to equip students with the skills needed to obtain and sustain meaningful employment or to continue their educations at institutions of advanced technical or higher learning. Students are provided with career transition services upon their completion of Job Corps.

Job Corps applicants must meet the following criteria

· Be at least 16 years of age but not yet 25 years of age

· Be a U.S. citizen, a U.S. National, a lawfully admitted permanent alien, refugee, asylum seeker, or other alien who has been authorized by the U.S. Attorney General to work in the United States.

C 2.1: Policy and Requirements Handbook (PRH) references related to the Center Mental Health Care Consultant (CMHC) The purpose of this contract is the provision of professional mental health services as outlined in the Department of Labor’s Policy and Requirement Handbook (PRH).

PRH Chapter 5: Management, Exhibit 5-3 (Page2)

Minimum Qualifications for Mental Health Consultant

Position: Center Mental Health Consultant

Primary Duties: Provides students mental health care clinical services, Trainee Employee Assistance Program (TEAP) consultation services, and staff development and training

Minimum Qualifications: Licensed Psychiatrist, Clinical Psychologist, or Psychiatric Social Worker (Department of Labor Regional Office Approval Required)

PRH, Chapter 6: Administrative Support, R3, Mental Health Program

Centers shall provide basic mental health services, as described below:

a. The general emphasis of the mental health program must be on prevention, early detection, identification of mental health problems, short-term counseling for manageable conditions, and crisis intervention (such as for rape, death, or other serious loss, or emotional reaction to HIV test).

b. A written referral/feedback system shall be established.

c. In the event of a mental health emergency, the mental health consultant or the center physician shall conduct a mental health evaluation as soon as possible, and when necessary, refer the student for psychiatric care. If the physician or mental health consultant is not available, the student shall be referred immediately to the emergency room of the nearest medical facility. If there is a life-threatening situation, 911 or the emergency response team should be called.

d. Students who are a danger to self or others must be supervised continuously until the disposition of their case is resolved.

e. Students stabilized on psychotropic medication shall be accommodated if judged not to be a danger to themselves or others by the center mental health consultant and center physician (with advice of a consulting psychiatrist, if appropriate) and approved by the center director.

f. Information exchange shall occur through regular case conferences with the mental health consultant and other appropriate staff based on individual student needs.

PRH Chapter 6.11, R1, 3b

3. A Medical Separation with Reinstatement Right (MSWR) for drug dependency can only be given if the following conditions are met:

(a) The Trainee Employee Assistance Program (TEAP) specialist and center director agree that the student has a drug problem.

(b) TEAP specialist has a documented assessment of student’s drug problem by the TEAP specialist and the center mental health consultant.

(c) Medical Separation with Restatement (MSWR) rights can only be granted to any 45-day probationary/intervention test. MSWRs cannot be granted in lieu of Zero Tolerance (ZT) separation when a positive 45-day probation/intervention test is reported.

Note: (1) Reinstated students shall not be subject to entry drug testing upon return to the center. (2) Transfer students shall not be subject to drug testing upon arrival to the center.

Both reinstated and transfer students shall be subject to testing for drugs and alcohol upon suspicion for use only.

PRH Chapter 6-11-7, d3,

3. HIV Positive Students

a. Inform and Counsel. Individually inform and counsel all students with a positive HIV test result, preferably within 24 hours, but not later than 5 calendar days, after receipt of the written positive result. The center mental health consultant must be in attendance to assist in informing and counseling.

b. Contact Notification. HIV positive students must be instructed in how to notify their sexual contacts and intravenous drug contacts that they may have been exposed to HIV infection and to refer them for counseling and testing.

The center physician or designee shall report the student’s HIV infection to the state and/or local health department, which will be responsible for contact notification both on and off center.

PRH Chapter6-12, R9

R9. Health Care Guidelines

a. All health care guidelines shall be approved and signed annually by the center physician, center mental health consultant, or center dentist, as appropriate

b. Current signed and dated health care guidelines shall be kept in the health and wellness center.

c. Annually, each center shall submit a memorandum to the Regional Office indicating which health care guidelines have been modified. Copies of any individual health staff authorizations and health care guidelines that have changed shall be sent to the Regional Office (RO) for approval.

PRH Chapter 6-12, R16

R16. Monthly Meetings with Center Director

The center director shall meet monthly with the center physician and center mental health consultant to discuss clinical and organizational issues.

PRH Chapter 6, Exhibit 6-4, C (Page 2)

C. Mental Health

1. Individual assessment by center mental health consultant (e.g., psychologist) for behavior requiring emergency off-center care, or capable of being managed on center.

2. Short-term counseling for manageable conditions, such as some adjustment disorders.

3. Immediate referral for off-center emergency care

4. Training and staff development on subjects such as avoiding physical confrontations.

5. Testing/counseling for alcohol and other drugs of abuse.

6. Monitoring of students stabilized on psychotropic medications.

PRH Chapter 6, Exhibit 6-5

7. Mental Health Professional: 5 hours/100 students/week is the minimum required level of mental health coverage by a qualified licensed mental health professional. Of the minimum required coverage per week, 50 percent must be used for a combination of the following activities: weekly consultation with staff, annual trainings, disability program support, or TEAP support. Except for emergencies or consults by a psychiatrist, all mental health clinical services defined as “basic health care” in the PRH must be provided on center by the center mental health consultant (CMHC) and/or designated graduate student for centers with graduate training programs.

C 3: Scope of Work

The contractor shall provide any and all labor and services, permits, licenses necessary to provide Mental Health Services for the Center during a one year base period with four one year option periods. The contractor shall provide basic mental health services to the center’s students. The contractor will be a licensed (in the state of Tennessee) psychiatrist, clinical psychologist, or psychiatric social worker.

The purpose of Center Mental Health Consultant (CMHC) contract is to assist students in attaining and maintaining optimal health and wellness by providing professional mental health services as outlined in the Department of Labor’s Policy and Requirements Handbook (PRH) presented above. Each center is required to provide a mental health and wellness program that includes routine mental health services to include diagnosis and referral, as necessary, intervention, 24-hour emergency mental health care referral, and staff training and development. The importance of mental wellness to the students’ abilities to develop positive self-images and to succeed in Job Corps and employment after graduation is recognized as a critical element in the overall success of the Job Corps student. All Job Corps centers are required by the DOL to provide a mental health and wellness program for their students. The contractor shall provide professional mental health services under this contract at the Jacobs Creek Job Corps. This includes all labor, contractor’s transportation to include personal and incidental travel as necessary to provide successful mental health services. The Center Mental Health Consultant (CMHC) will not be scheduled to provide mental health services to the students during the center-wide student leaves--twice a year for approximately two weeks during the winter and summer breaks. However, the contractor may be required to perform staff training during these periods for the weekly hours normally covered by this contract.

In addition, the CMHC agrees to adhere to all DOL Job Corps and USDA Forest Service Job Corps policies, procedures, and guidelines; to make no public statement concerning Job Corps students or Job Corps activities without prior written approval of the Center Director (CD) or his or her designee. Any and all research or publication activities relating to Job Corps students or activities must first be processed through the National Office of the Forest Service Job Corps, Golden, CO for the final approval by the National Department of Labor Health Office, Washington, D.C.

Scope of work encompasses the following main areas: staff development, clinical services for students, Trainee Employee Assistance Program (TEAP) consultation services, review of student applicant folders and assistance with the reasonable accommodation process, adherence to the policies, procedures, program instructions, and guidelines established by Job Corps.

C 4: Applicable Documents: Regulations related to the provision of mental health services for Job Corps centers follow:

· U.S. Department of Labor, Job Corps Policy and Requirements Handbook (PRH), Chapter 6, Administrative Support, Part 6.10-6.12 Student Health Services. Document located at Job Corps Community Website: http://www.jobcorps.org

· Technical Assistance Guide, TAG D Mental Health and Wellness Program. (Note: the mental health consultant requirements will be quoted in Section 3 of this Statement of Work (SOW). http://www/jobcorpshealth.com/html/cod

· Code of Federal Regulations, CFR 670.525. Information contained in at http://www.dol.gov/allcfr/title_20Part-670/toc.htm C 5: Definitions (Acronyms)

CO= Contracting Officer

CMHC=Center Mental Health Consultant

CFR=Code of Federal Regulations

DOL=Department of Labor

EAP= Employee Assistance Program

GED=General Education Diploma

HCO=Health Care Operations

HIPPA=Health Insurance Portability and Accountability Act

HSD=High School Diploma

JAN= Job Accommodations Network

IDT=Interdisciplinary Team

PRH= Policy and Requirements Handbook

MSWR=Medical Separation with Reinstatement Rights

SIR= Significant Incident Report

SOAP= Subjective Objective Assessment Plan

TEAP=Trainee Employee Assistance Program

TAG=Technical Assistance Guide

ZT=Zero Tolerance

C. 6. Government Furnished Property

· The center will furnish an equipped clinic facility

· The center will furnish the necessary equipment, supplies, and medication required to provide mental health services. New equipment may be acquired on an as-needed basis

· Job Corps Policy and Requirements Handbook (PRH) and all the Job Corps Technical Assistance Guidance (TAG)

· Janitorial care of the facility

· Utilities for the clinic

· Maintenance of facilities and equipment C 7: Requirements:

The following requirements for Center Mental Health Consultant (CMHC) services are extrapolated from the Department of Labor Job Corps’ Technical Assistance Guide (TAG): TAG D Mental Health and Wellness Program:

Definition of the Roles and Functions:

The format in which the CMHC provides required mental health services varies among centers. Therefore, it is essential that a new CMHC arrange to meet with the center director to define clearly the nature of his or her role.

Some center directors may have little experience integrating a mental health professional into the center program and may not have a clear vision of what the consultant can offer the center. Therefore, it is important for the CMHC to clarify and set priorities with the center director regarding the services to be provided, based upon the center’s needs and CMHC availability. It is also important to identify, at the outset, the specific mechanisms for monitoring the quantity, quality, and impact of these services. The original plan can be modified, if necessary, at subsequent periodic meetings. The Employee Assistance Plan (EAP) model should be the model of choice.

The center director and CMHC should coordinate as follows:

· Determine the consultant’s specific hours on center. The number of minimally acceptable CMHC hours per week is five (5) hours per 100 students. Of the minimum required coverage per week, 50 percent must be used for a combination of the following activities: weekly consultation with staff, semi-annual or annual training requirements, disability program support or Trainee Employee Assistance Program (TEAP) support. Except for emergencies or consults by a psychiatrist, all mental health clinical services defined as “basic health care” in the PRH must be provided on center by the CMHC and/or designated graduate student for centers with graduate training programs.

· Determine the CMHC’s sources of support required for the provision of these services. The CMHC is ultimately responsible to the center director. This relationship helps the center director oversee the mental health and wellness program while enabling the consultant to deal directly with all program components.

· Work together to support communication between the CMHC and all center staff. As part of his/her orientation to the center, the CMHC should meet key staff members as a group and individually, to promote a mutual understanding of roles and functions.

The PRH states that mental health consultants provide “prevention, early detection, identification of mental health problems, short-term counseling for manageable conditions, and crisis intervention.” However, the CMHC is also expected to provide brief treatment as part of an overall wellness care approach. Wellness focuses on helping students live a healthy lifestyle emotionally, physically, and mentally.

C 7.1: Clinical Services The CMHC clinical responsibilities shall include the following:

· Evaluation of applicant folders and disability accommodations

· Advising the center director and staff on preventive mental health measures

· Providing early recognition of behaviors requiring clinical advice or referral

· Consulting on and monitoring the mental health referral and feedback system

· Conducting clinical interviews for purposes of evaluation, diagnosis, and disposition

· Performing or arranging psychological testing services in limited situations as needed and authorized.

· Preparing case management plans with a focus on employability that identify specific expectations of staff and the student whose adjustment is at issue

· Maintaining clinical case histories and required communications, records, and forms including provisions for confidentiality

· Providing clinical support to the Trainee Employee Assistance Program (TEAP) specialist, as needed.

C 7.2: Evaluation of Applicant Folders and Disability Accommodations The CMHC is a critical part of the applicant review process, specifically, those applications that note any mental health problems, special education requirements, and/or contact with the judicial system. Request for accommodation from students with psychiatric disabilities must be evaluated on a case-by case basis. All requests for reasonable accommodation must be reviewed at the center level, unless the request is for accommodation for the admissions process. If the request for reasonable accommodation is determined to be complex, the Disability Coordinator is required to convene an Inter-Disciplinary Team (IDT) to review the process. If the accommodation concerns a mental issue, then the CMHC shall be a part of this team, and the team will be convened during the CMHC regularly scheduled hours on center.

If there is a reasonable belief, based on recent hospitalization, mental health treatment, or medication history, that the participant’s ability to perform in Job Corps will be impaired by the psychiatric condition with or without accommodations, the CMHC may recommend that the student be evaluated. The recommendation that a participant undergo an evaluation should not pose an undue hardship (to the center) regarding either time or cost. Centers should assist participants in accessing resources such as community health programs or the department of vocational rehabilitation for evaluation. Should the applicant refuse to seek an evaluation or provide the necessary information, the center IDT will complete the file review process and either accept the applicant for enrollment or will make recommendation for denial to the assigned Regional Office (RO) of the Department of Labor Job Corps.

A reasonable accommodation for a known psychiatric limitation must be provided unless it can be shown that the accommodation would pose undue hardship. The kind of accommodation provided should be determined on a case-by-case basis because individual participants will have varying needs. CMHCs may be able to suggest effective accommodations. Some examples include providing leave for disability-related treatment, installing partitions or other sound proofing barriers in the classroom to accommodate limitations in concentration, and providing a temporary job coach.

Medication monitoring by itself is not considered reasonable accommodation…There may be times a CMHC believes a student poses a direct threat and should not be admitted. A “direct threat” is defined as a significant risk of substantial harm to the health and safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation. The determination that an individual poses a direct threat must be based on an assessment of the participant’s current ability using recent medical knowledge and objective evidence. Centers must identify the specific behavior that would pose a direct threat. A student cannot be determined a direct threat just by virtue of having a history of psychiatric disability or mental health treatment.

The CMHC shall follow the specific guidelines in PRH Appendix 103 for direct threat assessment. Policy and Requirements Handbook (PRH) Appendix 103 concerning threat assessment follows:

Appendix 103, Policy and Requirements Handbook (PRH) is distinguished from the TAG for Mental Health and Wellness by the inclusion of “bold type.”

Appendix 103

Guidelines for Reviewing Applicant Files

1. Background Information

In cases in which the collection of background information raises concerns regarding the applicant’s behavior, the center will review the application and make a determination as to whether the applicant can reasonably be expected to participate successfully in group situations and activities. Where behavioral problems are related to mental or emotional disabilities, as defined in 29 CFR 37.4, see paragraph 2.b below regarding “direct threat”.

With regard to health issues the following standards apply:

b. A qualified individual with a disability must not be denied admission to the center for safety reason unless his or her disability is determined to pose a “direct threat.” This term is defined as a significant risk of substantial harm to the health and safety of the applicant or others that cannot be eliminated or reduced by reasonable accommodation or modification. The determination whether an individual poses a “direct threat” must be based on an individualized assessment of the applicant’s present ability to safely meet the essential requirements of the Job Corps program. This assessment must be based on a reasonable medical judgment that relies on the most current medical knowledge and/or on the best available objective, factual evidence—not on subjective perceptions, irrational fears, patronizing attitudes, or stereotypes. Relevant evidence may include input from the individual with the disability; the experience of the individual with a disability in previous situations similar to those he or she would encounter in the program; and opinions of medical doctors, rehabilitation counselors, or therapists who have expertise in the disability involved and/or direct knowledge of the individual applicant. In determining whether an applicant would pose a direct threat, the following factors must be considered.

(1) The imminence of potential harm

(2) The duration of the risk

(3) The nature and severity of the potential harm

(4) The likelihood that the potential harm will occur

To assist the CMHC and/or IDT in determining appropriate reasonable accommodations for a participant with a psychiatric history, resources such as the Job Accommodation Network (JAN), the department of vocational rehabilitation, or any other local relevant resource may be contacted. This contact shall be well documented.

If the accommodations considered are believed to require a fundamental alteration of the program or would be unduly costly to provide, the center is charged with taking any other action that would not result in such a hardship or alternation, but that would permit the applicant to meet the essential eligibility requirements, or participate in the programs or activities. Applicant must not be denied admission based solely on the need to provide reasonable accommodation or modification. The applicant must be given the opportunity to enroll in the program without accommodation unless that accommodation is necessary to prevent safety risk. In this instance, the center director would contact the assigned Forest Service Job Corps Assistant Director (AD) and the assigned DOL Regional Office for assistance.

After all of these steps have been completed and IDT recommends a denial, the folder is forwarded to the assigned regional office for review. Only the regional office can make the final determination of student’s denial.

C 7.3: Prevention

Many clinical direct services provided by the CMHS will be in response to programs perceived by staff members. However, there are methods by which the CMHC can facilitate students’ successes in Job Corps and prevent mental health problems. Incoming students ’mental health problems may be identified by the following:

· Review of the self-reported medical history that is completed during the cursory health evaluation

· Review of the social intake performed by career counselors.

In addition, as part of the EAP model, consider providing pamphlets and brochures to students about mental health and wellness. Develop groups with a focus on how to deal with stressors in the job setting.

One way to prevent a problem from escalating to a serious crisis is to plan for early intervention. Toward this end, the CMHC should review existing mental health care guidelines and tailor them to center-specific needs. Each center has specific procedures for the operation of most aspects of the health and wellness center. The CMHC would be responsible for drafting the procedures for emergency psychiatric situations such as suicide attempts, psychotic episodes, urgent referrals, and danger to others. As part of these procedures, there should be a process for 24-hour on-call coverage. The CMHC should review the mental health guidelines annually and provide training for center staff regarding their use.

C: 7.4: Interview, Evaluation, and Diagnosis

The CMHC should review the referral material and the health record prior to the evaluation review. The background and interview provide the CMHC with information regarding the physical and emotional status of the student. Once the interview/evaluation is complete, the results are entered in the student’s health record along with a working diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Test Revision (DSM-IV-TR) for diagnostic categories (use of Axis 1 and Axis II is sufficient).

If the CMHC determines that the student requires care beyond those services available in Job Corps, he/she should provide a documented recommendation for separation with/without reinstatement to the center director through the health services manager. The decision to retain or separate the student rests with the center director. Note: Most mental health referrals do not result in medical separations.

If the student is retained, the CMSC develops a written management plan and discusses elements of the plan with the appropriate staff.

C 7.5: Psychological Testing Referrals

Most students referred to a CMHC are suffering temporary situational or developmental problems that interfere with their social or educational adjustment. Psychological testing is costly and time consuming, but it may be necessary in very, selected cases to complete the evaluation or to determine the disposition. Use of psychological test batteries to establish diagnosis and clinical treatment plan is discouraged.

C 7.6: Management Plans

After evaluation of the student’s mental health problems, the CMHC should make a confidential entry in the health record and prepare a management plan. The management plan should be tied to Job Corps program elements and specific staff members. A career counselor is the ideal case manager for an individual with academic or social problems. The case manager is responsible for following up on the management plan designed by the CMHC. The CMHC and case manager work together to provide a bridge between the student’s needs and staff skills. For example, if the plan calls for group recreational activities, the career counselor and CMHC discuss the aspect of the management plan with the recreation staff. Out of the discussion, the recreation staff gains understanding of what the student needs, and the CMHC gains awareness of what is available. Sometimes, only one intervention by the CMHC will be necessary, and the counselor/case manager continues the follow through process. In other cases, visits to the CMHC by the student may be an actual part of the management plan (e.g. brief therapy).

The management plan should be designed to improve the student’s mental health and to strengthen his/her performance in the vocational and educational program. The management plan should identify the barriers to employment and what support activities or groups the student will be referred to. Sample formats can be found on the Job Corps website at http://jchealth.jobcorps.gov/health-topics/mh/mh-docs.

The CMHC should document the clinical impression and the management plan, including specific staff involvement in the student’s health record. (In general, a management plan should be concise, no longer than one page.)

Counseling staff, and in some cases, selected health and/or academic/vocational instructors, are usually responsible for some aspects of the management plan. The case manager monitors non-health staff involvement in the plan and may work with a teacher to monitor the student on performance goals. The CMHC may also require that the case manager involve the student’s parent/guardian in some aspects of the plan. The student should also be involved in a conversation about his/her management plan; expectations for behavior should be clearly outlined in writing.

Delegating management plan components does not relieve the CMHC of the responsibility of the clinical outcome. The case manager should keep in contact with CMHC regarding the student’s progress, and CMHC should assess the effects of the care provided by the health and wellness staff. The plan may need adjustment and revision as the student’s needs and prognosis change.

C 7.8 Brief Interventions

Some students may benefits from brief therapy. The CMHC should conduct on-center sessions (approximately five) conducted. The CMHC shall document in the management plan if more sessions are needed.

The CMHC may not provide long-term psychiatric treatment to a student when this treatment would require significant expenditure of program funds and staff time. The CMHC may make a referral to an off-center psychiatrist. The CMHC should maintain contact with the off-center provider to monitor the student’s compliance and progress and to ensure that a copy of the provider’s notes is entered in the student’s health record. One exception to providing long-term treatment might involve monthly supportive psychotherapy of individuals requiring long-term medication management.

Job Corps does not have the staff to provide extensive treatment for students with serious psychological and/or emotional problems. Clinical services are limited to those who are physically and emotionally able to participate in normal Job Corps duties without extensive medical and mental health treatment. While successive or intermittent interviews between a student and the CMHC may be scheduled, students whose treatment plans require extensive psychotherapy should be referred to a local provider in the community to which they return if they are separated because the accommodation for mental health is deemed unreasonable. Students requiring periodic (e.g. monthly brief visits) for medication management may be exceptions, if otherwise progressing in the program.

C 7.8: Support to the Trainee Employee Assistance Program (TEAP) Specialist

The services of a TEAP specialist are provided on center to address the problems of alcohol and drug use among students. The CMHC should provide the TEAP specialist with clinical support by performing the following:

· Participating in the intervention and management planning process

· Providing direct support for co-occurring and difficult cases

· Authorizing medical separations with/without reinstatement for alcohol and drug related diagnoses

Time should be allowed each week for the CMHC and TEAP specialist to discuss cases. These meetings should be documented in the health record and initiated by both professionals.

C 7.9: Staff Development

Staff development activities are essential to establishing an effective mental health and wellness program as required by the Policy and Requirements Handbook (PRH). Planning for the provision of these services should be based on student and staff needs. The center director should meet regularly with the CMHC to discuss the status of the program, the staff contribution, and current student problems.

C 7.10: Organizational Development

The CMHC serves as principal technical advisor to the center director and senior staff on managing organizational development. Organizational analyses may be conducted by examining patterns for delegation of authority and responsibility, observing the planning cycle and implementation of operational plans, analyzing interactive management styles, and assisting in developing needs assessments. These observations, their possible meanings, and various alternative models can be shared with the center management team with a view toward improving organizational effectiveness.

C 7.11: Technical Assistance

Staff development is enhanced when the CMHC works with staff in groups on “applied” topics. For example, through case conferences, the CMHC and a teacher may work on how to motivate beginning reading students; or the CMHC and residential living staff may discuss potential mental health problems encountered in the dorms. These technical assistance sessions can count toward fulfilling the requirement for general skills training; they provide on-the-job staff development using real cases as vehicles.

C 7.12 Skills Development

The CMHC contributes to staff training requirements through the staff development modules. These modules, contained in the Mental Health and Wellness Program: Staff Development Supplement, are a basic set of sessions. The basic presentation outline, overhead text, and handouts are provided for each module. Other modules can be added according to need. Delivery of these modules can be performed by the CMHC, but staff training experiences should not be limited to the CMHC’s presentations.

C 7.13: Case Management

Considering the at-risk population and limited time on center, the CMHC will need an integrated case management system approach. This will involve interaction with the TEAP specialist, counseling, residential life, and physician, regarding student behavior, compliance, medication, side effects and treatment progress. Case management notes should appear in the health record, so there is documentation of follow-up care, even without face-to face interaction with the student. If case management notes do not appear in the health record, it can only be concluded that follow-up care did not occur.

C 7.14: Psychotropic Medications

Some students will be on psychotropic medications. Since center staff members are working as a treatment team, part of the CMHC’s responsibility is to help monitor how well the medications are working as well as noting side effects. The CMHC will need to be in contact with the health and wellness manager and the center physician to report side effects, medication effectiveness and compliance. On many centers, the CMHC will work with the physician to help choose an appropriate medication and treatment plan. It is important the CMHC is up to date on most of the more commonly used psychotropic medications. Complicated psychotropic medication management may require the services of an off-center psychiatrist consultant.

C 7.15: Community Linkages and Resources

The CMHC’s clinical position is one of prevention, assessment, and triage. The practice of referring out to the community is a large part of this position, and therefore community linkages are keys to implementing an effective mental health and wellness program. CMHC responsibilities would include some case management for those referred out, including documentation of treatment compliance and progress.

The following are a few examples of community resources that may be appropriate linkages and referral sources:

· Community educational groups for stress and depression management

· Emergency psychiatric facilities

· Planned Parenthood for students who are pregnant or dealing with issues of sexually transmitted diseases.

· Graduate school programs that could provide student interns to provide entry-level mental health services on-center. For additional information on mental health intern program, see http://jchealth.jobcorps.gov/health-topics/mh/mh-pp.

· Specialized off-center referrals can provide treatment for people of different ethnicity or life styles (gay and lesbian) and at the same time support diversity

· Department of vocational rehabilitation can be a helpful referral for testing to assess present levels of ability and to help in planning an appropriate individual reasonable accommodation plan

· Psychiatry consults through a memorandum of understanding with a board-certified psychiatrist to have students evaluated and perhaps maintained on more complex psychotropic medications; the center physician is usually capable of prescribing the more common anti-depressant and stimulant medications.

C 7.16 Charting

The wellness model is a multi-disciplinary treatment team approach. It is important that the CMHC’s assessment, treatment, and case management notes are legible and part of the student’s health record. When writing notes you should consider, “If it isn’t charted, it didn’t happen.”

Center Mental Health Consultants should follow center procedures for health and wellness documentation. Mental health notes should be brief, clear, legible, and consistent. All entries should be signed and dated in ink by the person making the entry. The problem-oriented record system (SOAP notes) is recommended format for all health entries:

· S=Subjective-What symptoms are described by the student?

· O=Objective-What signs are detected upon physical examination?

· A=Assessment-What is medical diagnosis?

· P=Plan-What interventions, treatment, or referrals will be performed, recommended, or prescribed?

Health records are confidential, chronological accounts of medical information for each student. These records include the health history and physical examination, laboratory testing results, reports of episodic health care, oral and mental health care, and health counseling sessions.

Well-documented records increase the health and wellness staff’s ability to promote and maintain the health of each student. Because health records indicate the quality and quantity of health care delivered, they are also important tools for internal and external reviews and are legal documents that may be examined by a court of law. In summary, documentation of health care is essential for the following:

· Maintaining accurate chronological record of health care in progress notes

· Enhancing communication among health care providers

· Monitoring health care performance

· Meeting legal requirements

· Standardizing care

· Achieving cost benefits

· Following through on treatment plans

· Documenting student non-compliance with care C 7.18: Intake Notes

Intake notes should indicate, at a minimal level, reason for referral, presentation of problem, history of presenting problem, mental status exam, diagnostic impression, and a clear management plan. The management plan will be multidisciplinary and describe various modes of treatment, including groups, TEAP counseling, medication evaluation, as well as off-center referrals. The management plan should identify barriers to employment and interventions designed to minimize those barriers.

If the student’s health record is subpoenaed from the center of if a CMHC receives a subpoena to appear in court for a Job Corps-related issue, the center director, the National Office of Forest Service Job Corps, and the DOL Regional Office (RO) solicitor should be notified at once.

C 7.19: Confidentiality of Records/HIPPA Regulations In discharging their responsibilities, CMHCs are regulated and influenced by state psychology laws, professional ethical standards, legal considerations, and Job Corps policy. Ethical standards and legal requirements must be followed to ensure protection of a student’s privacy and to avoid unauthorized and inappropriate disclosure of confidential health information. Health Insurance Portability and Accountability Act (HIPPA) regulations mandate strict attention to these issues (April 2003).

Mental health practice within the Job Corps environment often presents problems for determining what, how much, and to whom information should be disclosed. The basic guidelines for disclosure follow:

· All privileged or confidential information should only be accessible beyond consultant (physician, nurse, dentist, CMHC) and health and wellness staff to center staff persons who have a need to know in accordance with HIPPA policies. HIPPA documentation can be found on the Job Corps health and wellness website at http://jchealth.jobcorps.gov/health-topic/hippa-docs.

· Health and wellness staff should inform students why the medical information is being shared with other staff. If the Protected Health Information (PHI) to be shared is not covered in the Authorization, or is not for treatment, payment or Health Care Operations (HCO), obtain an Authorization for release of PHI from the student or parent/legal guardian if a minor.

· Release of counseling or psychotherapy records require a specific consent.

· Medical information can be released in accordance with the Notice and Authorization. All requests from outside of Job Corps for medical information should be received in writing and include all the elements of a valid authorization.