RFP-19R0002_Atch-8_WCGS_Draft_SOP.docx

19R0002, WCGS RFP Atch 8 – Draft SOP This is a living document, which is subject to change. Upon contract award, the contractor shall coordinate with the COR to ensure compliance with the latest version.

USSOCOM WARRIOR CARE PROGRAM (CARE COALITION) RECOVERY CARE CENTER STANDARD OPERATING PROCEDURE

AUGUST 2017

RECOVERY CARE CENTER (RCC)

Chief of Recovery Care Center The Chief of RCC supervises Liaisons (LNOs), Recovery Care Support Specialist (RCSS), Advocacy, Operational Case Coordinators (OCC’s), Quality Assurance Manager (QAM), and RCC Training Coordinator. The RCC Director reports directly to the Care Coalition Director.

Deputy Chief of Recovery Care Center The Deputy Chief of RCC, provides immediate support to the Chief of RCC and acts on his behalf in his absence. The Deputy Chief of RCC supervises all Advocacy related issues. He is responsible for the Training, Quality Assurance Programs, and Operational Case Coordinators of the RCC Section. He interfaces with all ancillary sections of the WCP Program to ensure synchronization of activities are delineated and executed in order to meet the intent of the DoDI 1300.24.

USSOCOM Warrior Care Program – NCOIC of the RCC The RCC NCOIC directly supervises the Recovery Care Center staff. The RCC NCOIC mentors, provides technical advice, administrative guidance and instructions regarding programs, objectives, policies, procedures, mission analysis, course of action, problem solving and coordination of administrative activities. The RCC NCOIC identifies training development needs, establishes training plans, and provides formal and informal training as required. ?the RCC NCOIC initiates various requests for personnel actions such as promotions, reassignments, training performance based awards, disciplinary, etc.. The RCC NCOIC enforces established performance standards and evaluate subordinates. The RCC NCOIC plans and assigned non-routine work, sets priorities, and schedules the completion of special projects; cross assigns and levels workload based on priorities, existing projects, and selective consideration of the difficulty of assignments and capabilities of employees. The RCC NCOIC enforces timeliness quality, procedural, policy and regulatory requirements. The RCC NCOIC reports to the Chief of the RCC.

USSOCOM Warrior Care Program – RCC and Liaison Duties RCC/LNOs provide services and enhance access to military services. They deliver non-medical medical care, with the following objectives:

· Decrease barriers to medical and support services

· Increase awareness of treatment options through focused expertise

· Build/strengthen relationships between SOF WII, support agency, and LNO

· Foster SOF WII self-sufficiency through specific advocacy and services

· Provide advocacy as well as Government and non-Government support services

· The team is made up of seasoned professionals; they include retired E-9 and O-6s with extensive SOF and NCCM experience. The Advocate and LNO collective government and non-government connections are available to support the SOF WIIs and their families as well as the unit, community, military, and our nation. These relationships allow the CC to provide the needed support to the SOF WIIs and their families related to Government benefits, pay, the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB), Veterans Affairs (VA), and transition.

After a case is identified, the Advocates and LNOs complete an interview and record the information into our Secure Internet Protocol Router Network (SIPRNet) Casualty Tracker (i.e., “SIPR Tracker”) with the assistance of the operations specialist. The elements of this interview assessment are the crucial step in the process of determining the appropriate services and resources to which the Advocate will refer the SOF WII in order to assist in meeting their Goals and supporting their subsequent transition and path to independence.

The interview is the basis of our Recovery Care Plan (RCP). The RCP is used to gather the needed SOF WII and family data related to eight major Domains; Career, Daily Living, Family, Finances, Health, Legal, Military and Spirituality.

Working closely with the DoD, VA, and non-governmental organizations, the Advocate team has primary responsibility for the overarching view of Goals related to benefits (government and non-government), pay, services, resources, entitlements, medical/physical evaluation boards, VA disability, and all transitional assistance available to the SOF WIIs and their families, from notification through recovery, rehabilitation, then either to transition or back into active duty or to civilian life.

By keeping participants well informed of available pay, services, and benefits; our Advocates are be able to help the SOF WII make informed long-term healthcare and career-related decisions. We are experienced with the primary tools needed for coordinating the care of the SOF WIIs and their families—the SIPR Tracker and the RCP. Our Advocates are experienced with applying the seven processes of the RCP: intake, assessment, goal setting, review, rehabilitation, pre-transition, and post-transition.

Advocates review the RCP prior to contacting a SOF WII or when a SOF WII is in crisis. The Advocates collaborate closely with the SOF WII Chain of Command, Care Coalition Leadership, Chief Advocate, and Site Coordinator to ensure complete collaboration to discuss the SOF WII’s medical and transition status and review the RCP and Goals. Our Advocates will maintain contact (follow-up) as frequently as requested by the SOF WIIs or their families—from daily to annually, based on the Goals and needs of the particular SOF WII and their family.

As the SOF WIIs more clearly formulate their goals for the future and move forward in their RCP to independence, the Advocates will continue to provide support with the lifetime management phase of their recovery. Advocates will execute proactive management throughout all phases of the SOF WII’s RCP. Over the course of supporting the SOF WIIs and their families, our Advocates use our issue resolution process to determine the actions needed from internal SMEs, Care Coalition personnel, or external resources. As part of this process, our Advocates create open item(s) within the SIPR Tracker, record the specific issue faced by the SOF WII, and identify the internal or external SME with whom the Advocate is coordinating to resolve the issue.

The advocacy Frequency of Contact (FOC) metric is one of the most visible measurements of effectiveness and requires the Advocates to recognize how often they need to contact the SOF WII and their family (ranging from daily to annually) based on variations in the timelines associated with the phases of recovery, rehabilitation, reintegration, or transition. The common denominator will always be the Goal setting and actions required to assist with achieving the goals.

Liaison Duties for In-patient and Out-patient SOF WII at a Military Treatment Facility (CONUS or OCONUS), Department of Veterans Affairs Medical Center or Civilian Medical Treatment Facility:

1. Meets ambulance/bus at designated patient drop-off location as required by MTF, region, or SM status. OR Attempt to be present within two hours after SM arrival. For CONUS away from current duty location but within your designated region, contact the Recovery Care Center Chief for travel authorization.

2. Visits SM and family members daily, weekly or monthly depending on clinical need and enters encounter in the USSOCOM Warrior Care Program Casualty Tracker

3. Monitors SM's clinical treatment plan, Goals, and coordinates multidisciplinary team meetings.

4. Communicates with the clinical staff on SM/Family member Goals and assists with issue resolution.

5. Maintains working relationship with the Services Personnel Centers, Casualty Affairs office, and unit medical staff. Additionally, assist Unit Escorts as needed. Ensure roles and responsibilities are understood in relation to Warrior Care Program Operations.

RCC Responsibilities.

The RCC will serve as the LC for all SOF WII Service members in an outpatient status. The RCC has the primary responsibility for the oversight and assistance for the Recovering Service Member (RSM) and family care management, throughout the continuum of care from recovery through rehabilitation to reintegration while remaining on Active duty. The primary tool used for coordinating the RSM's/family's care is the Comprehensive Recovery Plan (CRP) by identifying Goals and developing Courses of Actions. The Case Manager will work with the medical case managers and non-medical care managers involved with RSMs/families for the development and oversight of the CRP.

The RCC shall:

(1) Complete USSOCOM WCP-CC training prior to assuming the duties of their positions and attend the next scheduled DoD training opportunity. RCCs may begin duty upon completion of the initial WCP-CC specific training.

(2) Have primary responsibility for development of the ICP, in conjunction with the CMT, Goal development, and assist the commander in overseeing and coordinating the services and resources identified in the ICP.

(3) Ensure the SOF WII Service member, and family member or designated caregiver when applicable, participates in the development and modification and Goal Review of the ICP through each phase of their recovery. The RCC will identify the Goal for and facilitate the proper Domains; Career, Daily Living, Family, Finances, Health, Legal, Military and Spirituality.

(4) Serve as the primary point of contact for SOF WII Service members and their families or designated caregivers for coordination of care, benefits, and services related to the ICP. The RCC will identify potential conflicts in the ICP, and facilitate resolution within the CMT.

(5) Communicate with the SOF WII Service member, family and designated caregiver on an ongoing basis (in person, when possible), and provide them with contact information for members of the CMT.

(6) Provide a copy of the ICP to the SOF WII Service member, family member or designated caregiver upon completion and whenever goals are completed or new goals are identified. Review and update the ICP in person (when possible) with the SOF WII Service member, family member or designated caregiver as frequently as necessary based on their needs and during transition through the phases of recovery in the WII Service member’s care (change in location or familial, marital, financial, job, medical, or retirement status).

(7) Ensure, in coordination with the appropriate military component concerned, that the SOF WII Service member and family or designated caregiver have access to all medical and non-medical services throughout the recovery phases.

(8) Minimize delays and gaps in treatment and services and seek alternative care based on diagnosis or agreements with specialty treatment centers (Moffitt, MD Anderson, Laurel Ridge etc...)

(9) Facilitate and monitor the execution of services for the SOF WII Service member across the phases of recovery as documented in the ICP Goals, to include services available from the DoD, the VA, DOL, and the Social Security Administration.

(10) Coordinate the transfer of an updated ICP, when a SOF WII Service member transfers from one level of care and/or location to another, by person-to-person communication between transferring and receiving LCs. The current LC will provide the next identified LC with a summary of the course of care to date, and a current copy of the ICP and related tools. The transferring LC will be responsible for requesting any authorizations required to release the WII Service member’s health information, providing the WII Service member and family or designated caregiver with information about the receiving LC, inform them of any changes to the ICP, document the hand-off in the WII Service member’s health record and ICP as appropriate, and provide contact information to the SOF WII Service member and family or designated caregiver. The receiving LC should acknowledge and document transfer of responsibility in the SOF WII Service member’s database records and ICP as applies, review the ICP, and meet with the SOF WII Service member, family member, or designated caregiver as soon as feasible.

(11) Close out or suspend the ICP when the SOF WII Service member has met all goals, returned to duty or declines further support. The RCC will retain all documents according to applicable WCP-CC policies.

The RCC is further responsible for:

(1) Ensure the SOF WII Service member understands his or her medical conditions and treatments and is pleased with the appropriate coordinated health care.

(2) Assist the SOF WII Service member and family or designated caregiver in understanding the WII Service member’s medical status during care, recovery, and transition.

(3) Assist the SOF WII Service member in receiving well-coordinated prescribed medical care during all phases of the continuum of care.

(4) Work within all DoD programs, policies, systems and procedures to ensure SOF WII Service member and family or designated caregiver receives needed non-medical support such as assistance with resolving financial, administrative, personnel, and logistical problems.

(5) Provide feedback on the effectiveness of the ICP in meeting the SOF WII Service member’s personal goals.

(6) Assist the SOF WII Service member with finding the resources to maintain or improve his or her welfare and quality of life.

(7) Maintain record of all actions (Goals) taken with SOF WII in the WCP-CC Casualty management database.

(8) Maintain 85% contact rate (with a stretch goal of 90%) on all active ICP SOF WII cases assigned to the RCC.

Operational Case Coordinators (OCC’s):

The Operational Case Coordinator is responsible for evaluating and understanding nursing diagnoses to assist Recovering Service Members (RSMs) in efforts to optimize their level of function and self-care.

Other duties of the OCC’s will include:

· Reviews newly assigned CAT 2 & 3 tracked cases.

· Provides a full range of professional health nursing principles, practices, and procedures in non-clinical settings in order to analyze the full scope of problems associated with providing appropriate, cost effective care to Department of Defense (DoD) beneficiaries.

· Collects, organizes, records, and communicates data relevant to primary health assessments including a detailed medical history in order to develop time sensitive plans which delineate the expected process of continuum of care for selected case managed RSMs.

· Establishes priorities for RSMs and evaluates progress toward the stated goals in order to provide coordinated, efficient, and effective care within the structured Recovery Care Plan.

· Maintains minimum 80%contact rate with RSMs within 3 days of being referred by an advocate, LNO, and/or Care Coalition leadership.

· Contributes and collaborates with QA providing daily, weekly, monthly, and adhoc reports by reviewing all Cat2 and 3 records. Provide immediate feedback via email to RCC assigned to records with short comings in documentation as well as Goal and Needs Assessments practices.

· All other duties as assigned by the Chief of RCC or designated representative.

Quality Assurance Manager (QAM):

Maintains and improves Quality Assurance (QA) for the Care Coalition Wounded Warriors, family members and caregivers by through and with compliance, monitoring, and training. Quality assurance program consists of three aspects: management audits, peer reviews, and performance metrics that we will gather, analyze, and address proper utilization. Quality control checks may also be conducted through on-site visits, teleconferencing, spot checks, and in-house created reports and spreadsheets.

· Understand and maintain the level of quality (i.e., continuity, timeliness, and accuracy) to the “actions and milestones” identified and inputted by the Advocate into the CRP—particularly for Advocates who are geographically dispersed. QAM will mitigate quality by conducting on-the-spot and routine audits of CRPs. The QAM will also use the data collected by the tool as an indicator of training success, policy implementation, advocate performance, and quality of support provided to SOF WII. Management will use the data collected to make adjustments to training and to inform policy development for the Care Coalition.

Other duties of the QAM will include:

· Ensures the development, implementation and oversight of the Comprehensive Recovery Plan (CRP).

· Assess and identify family needs as it relates to the CRP and ensure those needs are met.

· Consults and collaborates with Multidisciplinary Teams (MDT) during initial treatment phase and continuing throughout the continuum of care.

· Oversees, coordinates, and monitors the medical and non-medical services across the continuum of care as documented in the CRP.

· Ensures that the Recovering Service Member (RSM) and family have access to all medical and non-medical care management services including, but not limited to medical care, rehabilitation, education, employment-related programs, and disability benefits.

· Reviews the CRP and makes modifications in conjunction with the MDT’s supporting RSM and family.

· Oversees the CRP, anticipating future challenges during phases of recovery, rehabilitation, and reintegration.

· Identifies gaps in non-medical services, intervenes as necessary to expedite outcomes and assists with coordination of resources to develop and improve outcomes for enhanced delivery of non-medical services.

· Facilitates an efficient, effective and smooth rehabilitation and transition back to active duty or civilian life as a veteran through coordination with appropriate personnel (Military Service Coordinators/VA Liaisons).

· Coordinates local and state resources where the RSM and family will reside.

· Collects, maintains, and analyzes data for planning and reporting purposes in accordance with governing program guidance.

· Will comply with standardized training requirements for Recovery Care Coordinators.

RCC Training Coordinator:

· Coordinates and conducts initial and Annual USSOCOM Specific Training for all RCC’s, and newly assigned personnel. Training includes TBI, PTSD, Suicide Prevention, Resilience, and Sexual Assault Prevention and Response. Additionally training will include SOCOM specific database and SOPs.

· Ensures Training certificates and attendance rosters are provided to the WCP office in a Quarterly bases.

· Schedules newly assigned RCC’s to attend the Warrior Care Policy Training.

· Primary coordinator of the care Coalition Annual Training Conference.

· Ensures coordination between Contract companies Lead and CC staff for coordination of initial training dates and that access was granted prior to arriving for training.

· Provides training updates to the CC leadership on a Weekly base or as needed.

· Identifies trends that require training oversight for RCC’s.

· Provides individual training as part of an MTT to RCC locations on a quarterly bases.

Recovery Care Support Specialist (RCSS) The RCSS is responsible for recovery care support, Advocate and Liaison support, and the tracking of WII RSMs OCONUS to CONUS. The RCSS executes daily data entry into the USSOCOM master casualty database and tracks all SOF WII from the RSM’s point of injury onward. RCSS ensures effective communication to and from the components and Theater Special Operations Commands (TSOC) regarding the status of each SOF Enterprise WII RSM.

· Review daily OCONUS and CONUS casualty reports. Update existing cases and create new cases for wounded, ill and injured SOF in the Care Coalition database

· Forward information for all new incidents to the appropriate CONUS Regional Site Coordinators for case assignment

· Responsible for tracking and reporting itineraries for RSMs transferring from OCONUS to CONUS for continued medical care

· Regular communication with Care Coalition Liaisons regarding new WII

· Compose the daily LRMC Report to advise CONUS Advocates of RSM’s injuries, current location and itinerary for scheduled movement to CONUS MTFs

· Brief Care Coalition Leadership on any issues for newly WII needing immediate attention

· Train all newly hired LNOs and Advocates on casualty tracker use

· Update, maintain and quality checks for data in the Care Coalition Casualty Tracker database

· Read daily updates in the low side casualty tracker before each transfer of information. Create Care Coalition Tasks, update Checklists and all other information in fields not located in the low side casualty tracker

· POC for remote Advocates with IT and equipment issues

· Serve as POC for remote Advocates and LNOs without access to high side casualty tracker. Relate information not available in the low side tracker

· Enter updates in the high side casualty tracker for Advocates who are TDY

· When needed, assist remote Advocates with high side access by creating new cases in the casualty tracker

· Update the Daily Military Personnel Status Report for the Chief of Advocacy

· Summarize OCONUS evacuation totals and CONUS IPs and OPs at major MTFs for Chief of PPO

· Submit daily Advocate contact percentage rates for all 9Line and Akimeka Advocates to 9Line LLC President

· Ensure RSMs meet eligibility criteria for SOWF (Special Operations Warrior Foundation) and/or GBF (Green Beret Foundation) stipends. Once eligibility requirements are confirmed RCSS’ forward information to the SOWF and GBF organizations for stipend distribution.

· Advise Advocates and LNOs of patient movement OCONUS to CONUS and CONUS to CONUS using TRAC2ES (TRANSCOM Regulating and Command & Control Evacuation System).

· Regularly monitor the NIPR and SIPR organizational inbox (SOCOM Tracker Casualty Support) for requests for assistance from Advocates and LNOs.

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