Job Corps Health and Wellness Program Desk Guide Program Draft.pdf

Job Corps Health and Wellness Program

DESK REFERENCE GUIDE

Health and Wellness Director

Rough Draft

Desk Reference Guide: Job Corps Health and Wellness Director

Last Updated: June 2021 i

Table of Contents

Introduction

Job Corps Overview

Organization of Job Corps Career Development Services System National Health and Wellness and Disability Programs Center Health and Wellness Team Center Assessments

Part 1: Health Services (PRH 2.3)

Student Introduction to Health Services—PRH 2.3, R1 Health and Wellness Program—PRH 2.3, R2

Assessment Treatment Case Management Emergency Care Other Services Provided

Oral Health and Wellness Program—PRH 2.3, R3 Mental Health and Wellness Program—PRH 2.3, R4 Trainee Employee Assistance Program (TEAP)—PRH 2.3, R5 Tobacco Use Prevention Program (TUPP)—PRH 2.3, R6 Family Planning Program—PRH 2.3, R7

HIV/AIDS—PRH 2.3, R8

Healthy Eating and Active Lifestyles (HEALs)—PRH 2.3, R9 Health Aspects of Sports—PRH 2.3, R10 Basic Health Services Provided by Job Corps Centers—PRH 2: 2.3, R11 Health and Medical Costs Exceeding Basic Health Services Provided by Job Corps

Centers—PRH 2.3, R12 Professional Standards of Care—PRH 2.3, R13 Medication Management—PRH 2.3, R14 Waiver of Medical Care—PRH 2.3, R15 Health Care Guidelines—PRH 2.3, R16 Communicable Disease and Infection Control—PRH 2.3, R17 Inventory Records—PRH 2.3, R18 Continuous Quality Improvement—PRH 2.3, R19

Part 2: Other Program Management

PRH Chapter 2: Student Support Services Disabilities—PRH 2.4

PRH Chapter 3: Student Training Services Required Instruction for Health and Well-Being—PRH 3.4, R21

PRH Chapter 5: Management Services Standard Operating Plans and Procedures—PRH 5.1, R3 Reporting—PRH 5.1, R4 Monthly Meetings with Center Director—PRH 5.1, R35 Sexual Assault Prevention and Response—PRH 5.1, R39

FECA/OWCP—PRH 5.1, R40

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Health Services Staffing—PRH 5.2, R3 Significant Incidents—PRH 5.4 Medical Equipment and Supplies—PRH 5.6, R2 Minimum Staff Qualifications—PRH Exhibit 5-3 Required Staff Training—PRH Exhibit 5-4

PRH Chapter 6: Administrative Support Services Student Enrollments, Transfers and Separations—PRH 6.2 Medical Separations—PRH 6.2, R5 Death—PRH 6.4, R19 Authorizations (Consent for Treatment)—PRH 6.5, R5

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Introduction

This Desk Reference Guide (DRG) summarizes your responsibilities as a Job Corps Health and Wellness Director (HWD). Use this guide in conjunction with the Policy and Requirements Handbook (PRH), Job Corps directives, and other valuable information found on the Job Corps Health and Wellness website.

If you are new to Job Corps or just new to the job as the HWD, here are a few tips to get you oriented to your new position:

Contact the Nurse Specialist in your region to introduce yourself and receive an orientation to your new position. Your Nurse Specialist serves as a technical expert for the Regional Office and the centers in your region—contact your Nurse Specialist to answer your questions, help you understand policies, and provide you with up-to-date information that will assist you in your efforts to meet program requirements.

Review your center’s operating procedures (COPs) 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 protocols. Many center operators employ a Nurse Consultant at the corporate or agency level to orient new health staff and provide ongoing technical assistance.

Locate and familiarize yourself with the PRH (with special attention to section 2.3 Health Services), health and wellness Technical Assistance Guides (TAGs), and health-related Job Corps directives (i.e., Information Notices, PRH Change Notices, and Program Instructions).

Visit the Job Corps Health and Wellness website to review the latest information about the Job Corps Health and Wellness Program, including updates to this guide.

Policies and procedures for center Health and Wellness programs are defined and clarified in several documents:

Code of Federal Regulations (CFR), Section 670.525—The CFR states the operating requirements for Job Corps. The promotion and maintenance of student health and wellness is a desirable goal as well as a requirement under the CFR: “A Job Corps center operator must provide medical services, through provision and coordination of a wellness program which includes access to basic medical, dental, and mental health services for all students, from their date of enrollment until separation from the program.”

Policy and Requirements Handbook (PRH)—The PRH expands the CFR by establishing operating policy requirements for Job Corps centers. There are six PRH chapters. Chapter 2, section 2.3 Health Services, defines the required parameters and services of center Health and Wellness programs.

Technical Assistance Guides (TAGs)—TAGs contain guidelines and assistance for implementing the policies and requirements set forth in the PRH. As new requirements

HEALTH DIRECTORY

Contact information for Job Corps National Office staff, Health Specialists, and Health Support Contractor staff is located on the Staff Directory webpage.

Rough Draft https://supportservices.jobcorps.gov/Health/Pages/default.aspx https://supportservices.jobcorps.gov/Health/Pages/default.aspx https://supportservices.jobcorps.gov/health/Pages/Directory.aspx https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Pages/default.aspx https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Pages/default.aspx https://supportservices.jobcorps.gov/health/Pages/Documents.aspx https://supportservices.jobcorps.gov/health/Pages/Documents.aspx https://supportservices.jobcorps.gov/health/Pages/default.aspx https://prh.jobcorps.gov/Pages/Home.aspx https://supportservices.jobcorps.gov/health/Pages/Directory.aspx

Last Updated: June 2021 Page 2 of 27 are added to the PRH, TAGs are updated or new TAGs are developed to assist in implementing policy.

The Job Corps directive and field communication system is used to update the PRH and to disseminate information throughout Job Corps. Three types of directives are issued:

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., dental equipment survey).

Information Notices—Provide one-time announcements with information that is of interest to centers (e.g., data summaries, flu vaccines, etc.).

Following an overview of Job Corps, this guide’s format will follow PRH 2.3 Health Services and will address other relevant sections of the PRH.

https://supportservices.jobcorps.gov/health/Pages/PRHNotices.aspx https://supportservices.jobcorps.gov/health/Pages/PINotices.aspx https://supportservices.jobcorps.gov/health/Pages/InfoNotices.aspx https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Pages/default.aspx

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Job Corps Overview

Job Corps is the nation’s largest residential educational and career technical training program for economically challenged young adults aged 16 to 24 (there is no upper age limit for individuals with disabilities who are otherwise eligible). Funded by Congress and administered by the U.S. Department of Labor (DOL), Job Corps has been training young adults since 1964.

Students are offered such services as basic education, occupational exploration, career technical training, work-based learning, social and employability skills training, health care, counseling, recreation, and post-program placement support.

The mission of Job Corps is to:

1. Provide students . . .

Career and technical training programs that are rigorous and relevant Competencies recognized for employment and advancement in high-growth industries Preparation for multiple jobs in a career path for life Support services to optimize success

2. Provide employers . . .

A ready pool of qualified employees Employees with industry-based skill standards and certifications Opportunities to customize training programs with their employment needs

3. Provide communities . . .

Partnership opportunities in all phases of the Job Corps operation Partnerships with education and local and regional workforce investment systems A solid business base for those communities in which Job Corps resides A viable resource for community service

4. Provide society . . .

Workers and citizens who will contribute to the Nation’s economic growth and success

Organization of Job Corps

Job Corps is a national program administered by DOL through the National Office of Job Corps and six Regional Offices. The National Office of Job Corps establishes policy and requirements and facilitates major program initiatives. Job Corps’ Regional Offices administer contracts and perform oversight activities.

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There are currently over 120 operational Job Corps centers throughout the United States and Puerto Rico. Each center is part of a region. The six regions include: Atlanta, Boston, Chicago, Dallas, Philadelphia, and San Francisco. Each region has approximately 20 centers within its jurisdiction.

If your center is managed by a company that won the bid for a contract to operate the center, it is referred to as a contract center. If your center is operated by the USDA Forest Service, you are working at a civilian conservation center (CCC). Both contract centers and CCCs work toward the same goals and objectives.

Each Regional Office has Program Managers (PMs) who work closely with the centers. Your PM is the DOL representative and liaison who works 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.

Career Development Services System

The Job Corps Career Development Services System (CDSS) is a comprehensive and integrated career management system for equipping all Job Corps students with the skills, competencies, knowledge, training, and transitional support required to facilitate entry into and sustain participation in a competitive labor market, the military or advanced education or training. The four CDSS periods within which health and wellness services and activities are conducted include:

Outreach and Admissions (OA) Period—OA staff members administer a health questionnaire, request immunizations records, explain to applicants the kinds of health and wellness services available at their center, and review requests for accommodations during the admissions process.

Career Preparation Period (CPP)—The CPP ensures that students are introduced to health and wellness services and are provided accommodations, if needed, to fully participate in program offerings.

Career Development Period (CDP)—The CDP ensures that career management teams coordinate with health services on health-related issues, and students perceive good health as being critical to achieving career goals.

Career Transition Period (CTP)—The CTP ensures that students understand health-related aspects of independent living, students with special needs have systems in place to support transition to and retention of employment, and post-center service providers know how to coordinate with Job Corps when needed to help graduates succeed.

National Health and Wellness and Disability Programs

The National Office, Health Support Contractor, and Accommodation Support Contractor guide the operation of center Health and Wellness and Disability Programs as follows:

The National Office—The Job Corps health and disability components are led by the National Office Health and Wellness Team Lead who is responsible for developing and

Last Updated: June 2021 Page 5 of 27 implementing the policies and procedures that guide the delivery of health care and reasonable accommodation on center.

The Health Support and Accommodation Support Contractors—The Health Support and Accommodation Support Contractors work with the National Office, all Regional Offices, and all centers to develop and enhance center health and wellness and disability services. For example, the contractor assists the National Office in developing policy, training center staff on new health and wellness and disability initiatives, developing resource materials, collecting and analyzing health and disability program data, pilot testing new health and wellness and disability initiatives, and managing a national network of subject-area experts. Functioning under the auspices of the Health Support and Accommodation Support Contractor, a team of Health/Disability staff is assigned to each Regional Office. Every Regional Office has a Nurse Specialist, Medical Specialist, Mental Health Specialist, Oral Health Specialist, TEAP Specialist, and Regional Disability Coordinator. Health and Disability staff provide technical assistance to center Health and Wellness/Disability staff members and conduct center assessments for quality and compliance with the PRH.

Center Health and Wellness Team

The Health and Wellness Director (HWD) is the administrative team leader for the Health and Wellness Program.

Effective June 15, 2021, each center is required to have a full-time HWD (40 hours/week. The HWD must be a RN. Additionally, each center is also required to staff 50 hours/100 students/week of nursing hours. The first 40 nursing hours staffed must be by a RN; the rest of the nursing hours may be filled by licensed practical/vocational nurses (see table below for example breakdown). Satellite centers must staff a RN. Staff nurses play a vital role in implementing the Health and Wellness Program and are often given primary responsibility for particular tasks, such as the Family Planning Program or Healthy Eating and Active Lifestyles (HEALs) Program.

Example Nursing Staffing Based on PRH Change Notice 20-05

Position Contracted OBS

100 students 200 students 300 students 400 students 500 students

See PRH Exhibit 5-6 for 501+ students

HWD 40 40 40 40 40

Registered Nurse Staff Nurse

40 40 40 40 40

Additional Nursing Hours (can be

LPN/LVN)

10 60 110 160 210

All centers have the following staff as part of their Health and Wellness team:

Medical: Center Physician, Nurse Practitioner/Physician Assistant (NP/PA), HWD, staff registered nurse (RN) nurse, other nurses, clerical staff

Rough Draft https://supportservices.jobcorps.gov/health/Pages/FamilyPlanning.aspx https://supportservices.jobcorps.gov/HEAL/Pages/default.aspx https://supportservices.jobcorps.gov/HEAL/Pages/default.aspx https://supportservices.jobcorps.gov/health/Pages/PRHNotices.aspx https://prh.jobcorps.gov/Exhibits/Exhibit%205-6%20Center%20Health%20Services%20Staffing%20Requirements.pdf

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Mental Health: Center Mental Health Consultant (CMHC) Oral Health: Center Dentist, Dental Assistant, Dental Hygienist Trainee Employee Assistance Program (TEAP): TEAP Specialist Disability: Disability Coordinator (DC)

The Center Physician, CMHC, TEAP Specialist, and oral health positions are usually filled by independent subcontractors rather than by center employees. Required staffing levels have been established for each position based on the center’s contracted student enrollment capacity and are included in Exhibit 5-6 Center Health Services Staffing Requirements.

The Center Physician’s role is that of a Medical Director for the Health and Wellness Center (HWC) and medical care provider. The HWD manages daily operations, while the Center Physician guides the Health and Wellness Program and assumes responsibility for the quality of care rendered. The Center Dentist, CMHC, and TEAP Specialist do likewise for their respective areas.

The Center Director (CD) has the final administrative decision-making authority on all matters concerning students and staff.

Center Assessments

Program Compliance Assessments (PCAs) are much like the accreditation reviews that occur at health facilities nationwide. Every 1 to 2 years, Health Support and Accommodation Support Contractor personnel visit each center as part of a PCA team. You can expect to have student health records (SHRs), appointment books, and other records audited during this assessment.

When the PCA is announced, an assessor will contact you to set up an interview appointment with various members of the HWC staff. In preparation for the health and wellness assessment, you will also be requested to complete various Pre-PCA Questionnaires that can be downloaded from the Job Corps Health and Wellness website.

This team uses the PRH and Health and Wellness PCA tools to conduct an overall assessment of your center's Health and Wellness Program. The PCA tools are designed to highlight the strengths of your program and identify any program components and aspects that are out of compliance with the PRH. The PCA team will make recommendations to correct the noncompliant areas. After the PCA report is released, the center administration will develop and submit corrective action plans (CAPs) to the National and Regional Offices. You will be consulted to assist with formulating CAPs.

An unannounced Regional Office Targeted Assessment (ROTA) may also occur at any time to assess program compliance, follow up on a complaint, or other inquiry.

In addition to PCAs, ROTAs, and Corporate Office Center Assessments, the HWDs typically conduct their own internal record audits and program assessments on an ongoing basis. If you are familiar with the program requirements and the assessment criteria, it will be easier to maintain a continuous level of quality and a consistent level of compliance.

https://prh.jobcorps.gov/Exhibits/Exhibit%205-6%20Center%20Health%20Services%20Staffing%20Requirements.pdf https://supportservices.jobcorps.gov/health/Pages/PreparingForPCA.aspx

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Part 1: Health Services (PRH 2.3)

Student Introduction to Health Services—PRH 2.3, R1

Students learn about the center’s Health and Wellness Program through orientation sessions and the student handbook. Orientation, which occurs soon after students arrive on center, is designed to:

Prepare students for required medical examinations and tests Inform students about available health and wellness services Begin building motivation for preventive care Elicit questions and concerns Help new students feel comfortable and at ease using health and wellness services

The ultimate goal is to foster wellness as an employability skill and to move students from a school-based model of health care to a work-based model of health care with reliance upon self-management during the workday.

Health and Wellness Program—PRH 2.3, R2

The Health and Wellness Program is in place to assist students in attaining and maintaining optimal health.

Job Corps centers are required to provide basic medical services (Exhibit 2-4 Basic Health Care Responsibilities) to all students and accommodations for students with disabilities.

Center health care delivery consists of assessment, treatment, emergency care, and case management.

These components are outlined below.

Assessment

Step 1: Folder review. Information about students arrives on center before you ever see the student. You and the clinician can get a head start on assessing the student by reviewing all medical information, including the Job Corps Health Questionnaire (ETA 6-53), the Reasonable Accommodation Request Form, and any other health information in the sealed envelope that comes to the center with the applicant folder prior to the student’s arrival.

Step 2: Cursory health evaluation. Within a student’s first 48 hours on center, nursing staff should complete a cursory health evaluation that includes a health history, vital signs (e.g., weight, height, blood pressure), and laboratory testing as outlined in the PRH (see Laboratory Testing section).

HIPAA, PHI?

First things first . . . the Health Insurance Portability and Accountability Act (HIPAA) of 1996 gives patients certain rights with respect to their health information. Job Corps, as a covered entity under HIPAA, must comply with HIPAA requirements (i.e., explain and have the student sign the Notice on the first visit to health services).

In addition, Health and Wellness staff must keep a log of Protected Health Information (PHI) disclosures.

The Notice, PHI Disclosure Log, and Program Instruction 02-19 are located on the HIPAA webpage.

Rough Draft https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Program%20Requirements/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Program%20Requirements/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://supportservices.jobcorps.gov/health/Pages/HIPAA.aspx

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The health history should be documented on the Job Corps Health History Form. This form includes alert questions designed to help Health and Wellness staff members quickly screen for emergent physical-, mental-, and oral-health issues, and serious substance abuse problems.

Vital signs should be documented on the Job Corps Physical Examination Form. Vision and hearing screening can be completed during the cursory health evaluation or during the entrance physical examination (Step 3).

The cursory health evaluation can be omitted if the entrance physical examination is completed within 72 hours of a student’s arrival.

The Job Corps Health Questionnaire (ETA 6-53), Job Corps Health History Form and instructions, and the Job Corps Physical Examination Form are located on the Frequently Requested Documents page.

Step 3: Entrance physical examination. The entrance physical examination must be completed within 14 days of a student’s arrival on center. This examination includes:

Complete physical examination—The physical examination and review of the health history must be conducted by a qualified health professional (i.e., Center Physician, NP/PA). If the examination is not completed by the Center Physician, they shall authorize the NP/PA to conduct the examination by a written personal authorization. The Job Corps Health History and Job Corps Physical Examination forms must be signed by the qualified health professional who conducted the examination.

Immunizations—All applicants are required to provide Admissions Counselors with current immunization records at the time of application. Records will be reviewed by center Health and Wellness staff on entry to determine currency of immunizations.

Immunizations or boosters should be given to students if immunization records cannot be produced or if immunization series are incomplete. A list of required immunizations can be found in PRH 2.3, R2 (d).

Refer to the Immunizations TAG for optional immunizations (e.g., influenza vaccine) that may be provided to students based on Center Physician recommendation, availability, and cost. Centers should utilize the Vaccines for Children (VFC) Program to provide immunizations for eligible students, ages 16 through 18 years, according to the latest Centers for Disease Control and Prevention (CDC) guidelines.

All immunizations should be documented on the Job Corps Immunization Record Form.

Tuberculin Skin Testing—A tuberculin test is required for all students who do not have proof of a negative test within the past 12 months. Date of testing and results must be documented on the Job Corps PPD Testing Form. Tuberculin testing should be repeated annually for students in health occupations training and for students at increased risk of infection. Refer to the Health Care Guidelines and Written Instructions TAG for management of a student with a positive PPD test.

Vision Screening—Job Corps requires that each new student be screened for near, distant, and color vision during the cursory or entrance physical examination. Visual acuity should be tested using the Snellen, Jaeger, or similar tests. Students with refractive errors of 20/40 or worse on the Snellen chart or J/3 or worse on the Jaeger or

Rough Draft https://supportservices.jobcorps.gov/health/Pages/Documents.aspx https://supportservices.jobcorps.gov/health/Pages/Documents.aspx https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Pages/default.aspx https://supportservices.jobcorps.gov/health/Pages/Immunization.aspx https://www.cdc.gov/vaccines/programs/vfc/index.html https://supportservices.jobcorps.gov/health/Pages/Immunization.aspx https://supportservices.jobcorps.gov/health/Pages/Immunization.aspx https://supportservices.jobcorps.gov/health/Pages/HCGuidelines.aspx

Last Updated: June 2021 Page 9 of 27 similar chart should be referred to an Optometrist or Ophthalmologist. Color vision should be tested using the Ishihara or similar test. Make referrals as appropriate.

When indicated, the center shall furnish one pair of glasses that meet American National Standards Institute (ANSI) standards. Contact lenses shall be provided if clinically indicated. Students who lose or damage glasses provided by Job Corps shall replace them at their own expense.

Hearing Screening—Job Corps requires that each new student be screened for hearing loss during the cursory or entrance physical examination. In order to meet the Occupational Safety and Health Administration (OSHA) standard, the test is administered by a qualified health professional using an audiometer that can be calibrated and meets the following requirements. Audiometric tests should be pure tone, air conduction, hearing threshold examinations, with test frequencies including as a minimum 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz. Students who enroll in career technical training generally known to provide excessive noise based on the training curriculum (e.g., carpentry, welding, forestry, or other construction related trades) should be retested prior to separation to ensure that hearing loss has not occurred while enrolled in Job Corps. Results of all audiometric tests must be recorded in the SHR.

The OSHA standards and related information, including the Hearing Conservation Program, can be found on the OSHA website.

See Program Instruction 08-20: Frequently Asked Questions Regarding the Hearing Conservation Program Required in Accordance with 29 CFR 1910.95 (and attachments 08-20a, 08-20b) for additional guidance.

Laboratory Testing—The nationally contracted laboratory must be used for HIV, Chlamydia, and urine drug testing; all other laboratory testing may be sent to the nationally contracted laboratory or to a laboratory of the center’s choice.

Entrance Laboratory Testing Requirements Required Time Frame

HIV Antibody Test Within 48 hours after arrival (see waiver condition, Section 2.3, R15)

Syphilis Serology

Optional

(The center physician may choose to continue screening for syphilis on entry if there is a significant prevalence in the center population)

Hemoglobin or Hematocrit Within 48 hours after arrival

Sickle Cell Screening (must be offered to all at-risk students) Within 48 hours after arrival

Urinalysis (dipstick) for Glucose/Protein Within 48 hours after arrival

Drug Screen (urine) Within 48 hours after arrival

Rough Draft http://www.osha.gov/ https://supportservices.jobcorps.gov/Program%20Instruction%20Notices/pi_08_20.pdf https://supportservices.jobcorps.gov/Program%20Instruction%20Notices/pi_08_20.pdf https://supportservices.jobcorps.gov/Program%20Instruction%20Notices/pi_08_20a.pdf https://supportservices.jobcorps.gov/Program%20Instruction%20Notices/pi_08_20b.pdf

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Entrance Laboratory Testing Requirements Males Only Required Time Frame

Urinalysis (dipstick) for leukocyte esterase (gonorrhea screen) Within 48 hours after arrival

Chlamydia Testing (urine) Within 48 hours after arrival

Gonorrhea Testing if leukocyte esterase screen is positive (urine) Within 48 hours after arrival

Entrance Laboratory Testing Requirements Females Only Required Time Frame

Pregnancy Test (urine) Within 48 hours after arrival

Pap Smear

Females age >21 years (unless documented Pap smear results within 24 months before arrival on center)

Within 14 days after arrival

Students under age 21 years only require pelvic/speculum exam for clinical indications such as pelvic pain, vaginitis, menstrual disorders, pregnancy, etc.

Chlamydia Testing (endocervical or urine) All females; perform on urine if age < 21 years

Within 48 hours after arrival (or at time of pelvic exam if age > 21 years)

Gonorrhea Testing (endocervical or urine) All females; perform on urine if age < 21 years

Within 48 hours after arrival (or at time of pelvic exam if age > 21 years)

Treatment

Job Corps has a TAG on treatment—the Health Care Guidelines and Written Instructions TAG contains Personal Authorizations, the Job Corps List of Preferred Medications, information to handle emergencies, Symptomatic Management Guidelines for Non-Health Staff, and Treatment Guidelines for Health Staff.

Case Management

Chronic diseases can have a major impact on the employability of Job Corps students. Chronic Care Management Plans (CCMPs) are tools that provide a systematic approach to treating and managing chronic conditions. Each CCMP includes a student fact sheet; a disease-specific questionnaire sent to the applicant’s health care provider during the application process by the Admissions Counselor; a summary of specific interventions; and a flow sheet for periodic treatment plan monitoring.

Rough Draft https://supportservices.jobcorps.gov/health/Pages/HCGuidelines.aspx

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Once a CCMP has been created, a center nurse most often assumes the role of case manager and works with other center staff to coordinate care. Non-health staff should be included, as appropriate, in the student's care plan.

CCMPs are available for asthma, diabetes, HIV infection, hypertension, obesity, seizure disorder, sickle cell disease, sleep apnea, and tobacco cessation.

Emergency Care

Emergency care is defined as immediate care provided in a life-threatening situation. A 24-hour emergency care system must be provided.

Emergency care may be provided by health or non-health staff. All center staff should be certified in first aid and CPR.

Centers must have a written referral plan or agreement for emergent or urgent off-center medical, oral health, mental health, substance abuse, and inpatient care.

Staff and student orientation programs should include instruction on emergency care procedures.

If a student is transported off center for care, appropriate center health staff should be notified promptly per center policy.

Other Services Provided

A daily walk-in clinic outside of the training hours for students to receive routine health care.

An inpatient unit (during office hours) for minor conditions, such as respiratory infections or flu symptoms.

An appointment system for follow-up during the training day for treatment of chronic, urgent, and other conditions within the capabilities of center health professionals.

Treatment Guidelines for Health Staff shall be used to manage common acute and chronic conditions.

Access to prescription medications.

An off-center specialist referral system.

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Oral Health and Wellness Program—PRH 2.3, R3

The general emphasis of the Oral Health and Wellness Program shall be on early detection, diagnosis of oral health problems, basic oral health care, dental hygiene, and prevention/education (e.g., oral hygiene instructions, caries risk assessments, the relationship between oral health and employability, oral health and wellness plans).

A dental readiness inspection shall be completed within 14 days after arrival by the Center Dentist or designee as determined by the Center Dentist who authorizes the activity by a written personal authorization. It is recommended that this inspection be conducted by center oral health staff unless oral health services are provided off center, in which case it is recommended that a nurse complete the dental readiness inspection. If the person conducting the dental readiness inspection is not a dentist, the Center Dentist should provide training to designated staff on how to conduct this inspection.

The results of the dental readiness inspection should be documented on the Job Corps Physical Examination Form.

An elective oral examination, including bitewing x-rays, priority classification, and treatment plan, shall be completed and recorded on the Job Corps Oral Examination Form by the Center Dentist upon student request as a follow up to the dental readiness inspection. The x-ray images should be securely stored as part of the SHR.

Refer to PRH 2.3, R3 Oral Health and Wellness Program, Exhibit 2-4 Job Corps Basic Health Care Responsibilities, and the Center Dentist DRG for complete details of required oral health and wellness services.

Mental Health and Wellness Program—PRH 2.3, R4

The general emphasis of the Mental Health and Wellness Program shall be on the early identification and diagnosis of mental health problems, basic mental health care, and mental health promotion, prevention, and education designed to help students overcome barriers to employability.

The Center Mental Health Consultant:

Provides assessments and recommendations for Job Corps applicants.

Coordinates a mental health promotion and education component for Job Corps staff and students.

HWD responsibilities include:

• Provide daily management and oversight

• Conduct dental readiness inspections if prior instruction and approval has been given by Center Dentist

• Assist with off-center referrals for students

• Ensure that Center Dentist has access to the full SHR

• Ensure oral health and wellness staff complete and file all required forms and provide documentation in the SHR

• Provide emergency oral health care as per Treatment Guidelines for Health Staff https://supportservices.jobcorps.gov/health/Pages/OralHealth.aspx#forms https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Pages/default.aspx https://prh.jobcorps.gov/Exhibits/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://prh.jobcorps.gov/Exhibits/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://supportservices.jobcorps.gov/health/Pages/DRG-DDS.aspx

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Utilizes an employee assistance program approach that includes short-term counseling, referral to center support groups, and crisis intervention services for students with mental health conditions.

Makes recommendations for care management plans and accommodations for students with chronic mental health conditions.

Assists students with chronic mental health conditions. Services may be documented on Mental Health Chronic Care Management Plans (MHCCMPs).

Refer to PRH 2.3, R4. Mental-Health and Wellness Program, Exhibit 2-4 Job Corps Basic Health Care Responsibilities, and the CMHC DRG for complete details of required mental health and wellness services.

Trainee Employee Assistance Program (TEAP)—PRH 2.3, R5

The general emphasis of TEAP shall be on prevention, education, identification of substance use problems, intervention services, relapse prevention, and helping students overcome barriers to employability.

The TEAP Specialist:

Ensures orientation of new students to the center's TEAP program as a center-wide alcohol and drug prevention and education effort with a focus on preventing barriers to employability.

Provides center-wide substance prevention and education services that encourage healthy lifestyle choices.

Conducts assessment of students to identify substance use problems and develops intervention services as needed.

Coordinates relapse prevention services.

Assures adherence to Job Corps’ Zero Tolerance (ZT) policy for substance abuse among students.

Coordinates all aspects of the biochemical testing program—from scheduling students for drug testing to training staff in the use of alcohol testing devices.

Ensures that the integrity of the biochemical testing program is maintained.

Submits quarterly alcohol reports to the National Office.

HWD responsibilities include:

• Provide daily management and oversight

• Delegate biochemical testing and prevention activities to staff and ensure adequate training for staff involved in urine collection procedures

• Manage all aspects of the biochemical testing program and ensure the integrity of the program is maintained

• Facilitate referrals to the CMHC, TEAP Specialist, and outside resources

• Ensure training of designated non-health staff in the use of alcohol testing devices

HWD responsibilities include:

• Provide daily management and oversight

• Review and triage of applicant files with mental health histories

• Collaborate with CMHC in developing mental health promotion and education activities

• Collaborate with CMHC and Center Physician in the monitoring of students on psychotropic medications

• Assisting CMHC with off-center referrals for students requiring mental health services in the community

• Ensure that 24-hour emergency mental health and wellness services are available

Rough Draft https://supportservices.jobcorps.gov/health/Pages/HCGuidelines.aspx https://supportservices.jobcorps.gov/health/Pages/HCGuidelines.aspx https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Pages/default.aspx https://prh.jobcorps.gov/Student%20Support%20Services/2.3%20Health%20Services/Pages/default.aspx https://prh.jobcorps.gov/Exhibits/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://prh.jobcorps.gov/Exhibits/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://supportservices.jobcorps.gov/health/Pages/DRG-CMHC.aspx

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Refer to PRH 2.3, R5. Trainee Employee Assistance Program (TEAP), Exhibit 2-4 Job Corps Basic Health Care Responsibilities, and the TEAP Specialist DRG for complete details of required TEAP services.

Tobacco Use Prevention Program (TUPP)—PRH 2.3, R6

Centers must implement a program to prevent the onset of tobacco use and to promote tobacco-free environments and individuals. To support this program, a TUPP Coordinator shall be appointed (he or she need not be a health services staff member). Centers must establish a smoke-free, tobacco-free environment for the majority of the center. Centers are encouraged to maintain an entirely tobacco-free environment, especially during the training day.

TUPP requirements:

Educational materials and activities that support delay and/or cessation of tobacco use A smoke-free, tobacco-free environment that prohibits the use of all tobacco products in center buildings and center-operated vehicles Designated outdoor smoking areas located a minimum of 25 feet, or as required by state law, away from the building entrance Prohibition of the sale of tobacco products on center Adherence to federal and state laws regarding the use of tobacco products by minors Minors who use tobacco products must be referred to the TUPP All services provided should be documented in the SHR

TUPP tips:

Case management for tobacco cessation should be offered to all students who use tobacco products.

Designated smoking areas should be located away from central locations thereby discouraging non-smokers from congregating with smokers and have proper receptacles.

Staff should not smoke in the presence of students.

Family Planning Program—PRH 2.3, R7

Health and Wellness staff members provide reproductive health services with the assistance of mental health and other staff, as needed. These services cover sexuality, family planning, sexually transmitted infections, and pregnancy management.

Both female and male students should be included in family planning education and services.

HWD responsibilities include:

• Collaborate with Center Director to appoint a TUPP Coordinator

HWD responsibilities include:

• Appoint a program coordinator, usually a member of the nursing staff https://prh.jobcorps.gov/Exhibits/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://prh.jobcorps.gov/Exhibits/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://supportservices.jobcorps.gov/health/Pages/DRG-TEAP.aspx

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The Center Physician/PA/NP is encouraged to offer all currently available methods of contraception for students – either provided on center or by referral off center.

Students who are pregnant and/or experiencing pregnancy-related medical conditions shall be afforded the same access to medical services, leave and medical separation as any other student experiencing a medical condition, unless otherwise provided by law.

Once a center learns that a student is pregnant, pregnancy-related services shall include:

Prenatal services on center and/or in the community until separation. This includes a comprehensive gestational record in the SHR.

The Center Physician, in conjunction with an obstetrical provider and the student, will agree upon a care-management and separation plan that takes into account the health and safety of the pregnant student before and after childbirth.

The center shall identify available community health/social resources and services and will make arrangements for transportation for the purpose of obtaining such resources and services. In lieu of the center providing transportation, the center may approve a student’s request to be transported by a friend, partner or family member.

The center shall not pay for an abortion unless the pregnancy is the result of rape or incest or unless a physician has certified that the student suffers from a physical disorder, injury, illness, or condition that places her in danger of death unless an abortion is performed.

A student who is experiencing a pregnancy-related medical condition may be placed on paid administrative leave.

Pregnancy-related services shall include information on the options of continuing or terminating the pregnancy.

If required by applicable state laws in which the center is located, the center shall notify the student’s parent/guardian of her pregnancy if she is a minor, and if required by applicable state law, inform the student of this requirement prior to the disclosure.

See the Family Planning TAG (including family planning forms) for additional guidance.

https://supportservices.jobcorps.gov/health/Pages/FamilyPlanning.aspx

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HIV/AIDS—PRH 2.3, R8

All students receive HIV/AIDS education, testing on entry and when clinically indicated, follow up, and counseling. HIV-positive students receive case management on center but are often treated by off-center infectious disease specialists.

Pre-test counseling must be recorded on Form 2-02 HIV Testing Information Sheet.

All students, whether positive, negative, or indeterminate, receive post-test counseling. The Center Physician, or his/her designee, and the CMHC are required to notify HIV-positive students of their test results and should identify local resources that provide comprehensive care for students with HIV infection.

HIV positive students should receive counseling on partner notification and notifying intravenous drug contacts. HIV positive test results should be reported to the state and/or local health department.

Healthy Eating and Active Lifestyles (HEALs)—PRH 2.3, R9

Sound nutrition and physical activity, along with other healthy behaviors, form the basis for wellness. Centers are required to establish a Healthy Eating and Active Lifestyles (HEALs) Committee to oversee and coordinate this program, incorporate student preferences into program planning, provide individualized weight management programming and/or counseling, incorporate motivational interviewing and goal setting into counseling, and periodically assess the program.

Job Corps’ HEALs website provides: an evidence-based curriculum to educate students;

guidance for food service, recreation, Health and Wellness staff, as well as information for instructors and residential living staff; web-based trainings and workshops; tips to integrate healthy living into the center culture; and strategies to evaluate the program.

HWD/nurse responsibilities include:

• Inform new students about HIV testing during new student orientation

• Conduct and document pre- and post-test counseling

• Submit specimens for HIV testing to the nationally contracted laboratory

• Participate in the case management team working with HIV-positive students

• Assist in coordinating off-center referrals for HIV positive students

HWD/nurse responsibilities include:

• Serve on HEALs Committee

• Collaborate with various departments

• Record students’ BMI and waist circumference in CIS

• Oversee the weight management program

Rough Draft https://prh.jobcorps.gov/Forms/Form%202-02%20HIV%20Testing%20Information%20Sheet.pdf https://prh.jobcorps.gov/Forms/Form%202-02%20HIV%20Testing%20Information%20Sheet.pdf https://supportservices.jobcorps.gov/HEAL/Pages/default.aspx

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Health Aspects of Sports—PRH 2.3, R10

Job Corps students’ participation in sports and athletics can lead to improved physical/mental health and well-being. A well-planned program can only be achieved when factors such as adequate nutrition, general health and safety, environmental conditions, training, protective equipment, first aid and treatment of injuries are understood and implemented, when necessary, by center staff. The Center Physician must document sports clearance annually on the Job Corps Physical Examination Form.

Basic Health Services Provided by Job Corps Centers—PRH 2.3, R11

Center operators are responsible for providing and paying for basic health care as detailed in Exhibit 2-4 Job Corps Basic Health Care Responsibilities. Job Corps shall not pay for any health-related costs incurred by a student while on leave or pass unless previously authorized by the Center Director upon recommendation of a center health professional.

Health and Medical Costs Exceeding Basic Health Services Provided by Job Corps Centers—PRH 2.3, R12

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.

Program Instruction 13-09 Implementation of the Affordable Care Act and Health Insurance Marketplace in Job Corps outlines resources for Health and Wellness staff, including a script to review health insurance options with students, a fact sheet for students, an acknowledgement form, and an exit script for students leaving Job Corps.

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 medical separation with reinstatement rights (MSWR) is appropriate.

Request third-party payment only for services beyond those basic services stipulated in the center operator’s prime contract.

Professional Standards of Care—PRH 2.3, R13

The medical practice standards for Job Corps HWCs are comparable to those for other health facilities found in communities nationwide. All Health and Wellness staff in the Job Corps setting should follow accepted professional standards of care and are subject to state laws.

HWD responsibilities include:

• Ensure students participating in organized contact or rigorous sports are scheduled for an annual physical examination

• Communicate sports clearances and restrictions with Recreation Supervisor https://supportservices.jobcorps.gov/Program%20Instruction%20Notices/pi_12_32a.pdf https://supportservices.jobcorps.gov/Program%20Instruction%20Notices/pi_12_32a.pdf https://prh.jobcorps.gov/Exhibits/Exhibit%202-4%20Job%20Corps%20Basic%20Health%20Care%20Responsibilities.pdf https://supportservices.jobcorps.gov/health/Pages/ACA.aspx https://supportservices.jobcorps.gov/health/Pages/ACA.aspx

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Documentation of current credentials, licenses, DEA registration, and liability insurance (if applicable) for all health care providers must be available for review in the HWC.

As part of professional standards of care, all Health and Wellness staff must document all prescribed medications, treatment, laboratory tests ordered and results in the SHR. All staff must follow current standards of care when providing health services and treating illnesses and injuries.

Medication Management—PRH 2.3, R14

Centers must comply with all state and federal regulations regarding prescribed non-controlled medications, prescribed controlled substances, and over-the-counter medications. Centers must follow medication management guidelines as specified in Appendix 203 Medication Management Guidelines. Centers are required to outline their medication policies and procedures in three Standard Operating Procedures (SOPs) per Exhibit 5-1 Standard Operating Procedures.

Schedule II controlled substances on center should be limited to individual prescriptions for specific students. It is vital to follow appropriate procedures when storing controlled substances on center. Among other procedures, all controlled substances must be double locked and counted by two staff members at least weekly. Review the Information Notice 08-17 Protocol for Purchasing, Storing, Administering and Disposing of Controlled Substances in the Health and Wellness Center (and attachment) dated September 17, 2008 for more requirements and tips.

Waiver of Medical Care—PRH 2.3, R15

The Center Physician (CP)/Nurse Practitioner (NP)/Physician Assistant (PA) may waive any portion of the medical examination and laboratory testing except for the entrance drug testing and TB screening if in his or her opinion there is sufficient justification or if a student refuses.

The CP/NP/PA may grant waivers of immunization requirements for valid medical and/or religious reasons.

Any waiver granted by the CP/NP/PA must be clearly…