10176 Corporate Square Dr. Suite 220 Creve Coeur, MO 63132

10176 Corporate Square Dr. Suite 220 Creve Coeur, MO 63132 (p)314-395-9375 (f)314-395-9381 Hours of Operation 8am-6pm New Hire Onboarding Welcome to BIS!

Agenda for the day! JOE DOUGLAS 9-9:30am -Collect the rest of paperwork & introductions LYNN BROOK 9:30-10:30am -First section of Orientation packet BERLY FORSYTHE -Policy & Procedure LUNCH -Food 10:30-12:30pm 12:30-1:30pm LYNN BROOK 1:30-2:00pm -Double check all paperwork & collect DARLA HOLLORAN -ISL Orientation 2:00-3:45pm JAMIE KLAMERT -Therap Training 3:45-4:15pm KYLE SWENDIG -WhenToWork Training 4:15-5:00pm HERE WE GO!

Intro The Mission Our mission is to help each individual we serve reach their highest potential in life by overcoming barriers and promoting independence, achievement, and inclusion. We utilize proven and positive behavior change strategies to reach this goal, while including all team members, friends, and family in the process. Defy Limits, Exceed Expectations

What are the three most popular services at BIS? Individualized Supported Living (ISL) Natural Home Personal Care Assistance Behavior Analysis via our BCBA, BCaBA Other Services Health and Wellness Classes – For Clients and Staff Yoga, Cooking, Fun with Fitness Social Skills Opportunities Person Centered Strategies Consultant (PCSC) Counseling and Support Groups Applied Behavior Analysis (ABA)

2004 NOW BIS was founded in 2004 We have experienced substantial growth since its beginning and have changed locations three times We currently hover around 150 PCA/Direct Care Staff and 215 total employees We are one of the largest providers of Behavior Therapy in the state of Missouri!

Kim Salls, BCBA BIS Directors Agency Director Lynn Brook Bachelor in Psychology from St. Louis University Masters in Applied Behavior Analysis from University of Nevada, Reno Received her BCBA in 2004 Started Behavior Intervention Services We now have approximately 160 employees & 200 clients Jessica Harrison, BCBA Director of Administrati on Started in ABA in 2004 Came to Behavior Intervention Services in 2006 as an ABA Implementer Promoted to Public Relations and Human Resources in 2008 Promoted to Director of Administration in 2011 Overseas office business, plans functions, & manages recruitment Asst. Agency Director Bachelor in Psychology & in Political Science from Johnson State College in Vermont Masters in Behavior Analysis from Southern Illinois University Received her BCBA in 2004 Specifically focused in Discrete Trial Training and severe challenging behavior Kimberly Forsythe HR Director Started as a full time PCA in 2006 Promoted to Staffing Coordinator and Human Resources in 2008 Been in the field of developmental disabilities since1993 & HR since 1996 Promoted to Human Resource Director in 2011 Melissa Hutson ISL Director BA in Education, Lindenwood University 1994 Classroom Special Education Teacher, 1994-2000 QDDP and Respite Coordinator, Residential Facility for Medically Fragile MRDD, 20082011 Intake Specialist & Placement Coordinator in host home model agency funded through DMH, 2011-2013

Sherrie Shannon BCBA, LBA Laura Western BCBA, LBA BOARD CERTIFIED BEHAVIOR ANALYSTS Beth Munkwitz BCBA, LBA Melissa Atis BCBA, LBA Kyler Hasl-Wright BCaBA Maija Graudins BCBA, LBA

Board Certified Behavior Analyst Requires a minimum of a Bachelors degree in a human services field and a masters in Applied Behavioral Analysis as well as Board Certification Makes initial contact with all potential clients Completes interviews with client and family and completes assessments to determine the needs of the client Develops a behavior plan to address all applicable behavioral needs Provides initial and ongoing training of all staff on client specific behavior plan

Therapy Support Staff BCBA – Board Certified Behavior Analyst BCaBA – Board Certified Assoc. Behavior Analyst . Lindsay Brefeld PCSC PCSC – Person Centered Strategies Consultant PCA Trainer – Gina Noble PCSC, PCA Trainer Personal Care Assistant Trainer Andrea Mazo BCaBA, PCSC Shannon Riemersma PCSC, PCA Trainer

ISL Leads Melissa Hutson ISL Director Crystal Frost, QDDP *Hazelwood ISL Darla Holloran Amy Gaultney, QDDP *Hedge ISL *Redbird ISL ISL Assistant Director co Jamie Klamert Kyle Swendig ISL Assistant Director ISL Staffing Coordinator m in g e ag ! Im oon s Karen Beck Racheal Jerashen, QDDP Wise ISL Dana Allen, QDDP Low ISL ISL Financials

Family Care Support Services Supervisor Brittan y Thorn Supervises FCAs Assigns FCAs to client caseloads Performs phone screenings and forwards Applicants to FCAs Kristin Robinson Family Care Advocate North County, Illinois, West County Kelly Crismon FCA Team Theresa Reedy South County, West County Jesse Bray Family Care Advocate Central and West County Family Care Advocate Family Care Advocate St. Charles County, North County, Central, South County Mirand a Pitonak Family Care Advocate St. Charles County, South County, Central Jessica Bartram Family Care Advocate Jefferson County, St. Charles County, Central Brittan y Zahn Family Care Advocate Central, South County, West County, Jefferson County

Family Care Advocates Meet with all Natural Home Families on their caseload to discuss services and to create a schedule within allotted funding Meet will all Natural Home PCAs to discuss client specific training and schedules Ensure all allotted funding is used appropriately Work 20 hours per week of direct care or supervision shifts within their caseload Available for emergency coverage when necessary Collect Daily Progress Notes from each household within their caseload and compile these notes into summaries for DMH Create time sheets for PCAs based on time in/time out on Daily Progress Notes Provide positive and constructive feedback to PCAs working within their caseload Work with PCAs and Families ongoing to ensure proper services are being rendered Help families receive additional resources for services when necessary

Office Support Team Lynn Broo k Director of Administratio n Matt Thielemie r Kim”Berl y” Forsythe Human Resources Director Joe Dougla s Coordinator of Client Services Debby Schaefer Human Resources Assistant Payroll Sarah Kelly Lisa Arne tt Receptionis t Financial Officer

Personal Care Assistant will be contacted by the FCA to discuss scheduling, initial training dates, and shadowing of current PCA staff are responsible for carrying out activities or programs set forth by the client-specific behavior plan, treatment plan, or individual support plan. Programs and activities differ depending on your clients ability level and living situation but may include living skills, personal hygiene, socialization etc. attend scheduled team meetings and required trainings to maintain current agency and state certifications are responsible for taking data per BIS and state guidelines, communicating with the family and team in a communication log, and reporting any incidents to supervisory staff (FCA or behavior support professional) will report directly to their client’s BT and FCA will be scheduled for hours based on the availability provided upon hire and client needs, and must provide two weeks’ notice for change in availability

Direct Care Staff will be contacted by the ISL Staffing Coordinator to discuss training shift. will be contacted by their supervising QDDP or BCBA for BSP and PCP training before initial worked shift. are responsible for carrying out activities or programs set forth by the client-specific Behavior Support Plan (BSP). will attend monthly team meetings as planned by the QDDP. will keep all clients within line of sight unless otherwise dictated in the client’s BSP. will maintain required trainings to satisfy current agency and state certifications. are responsible for taking data per BIS and state guidelines, communicating with team in the house communication log, and reporting any incidents to the QDDP. will be scheduled within the availability they provided upon hire and must provide two weeks notice to change that availability will report directly to Lead Staff and QDDP. will treat their clients with respect. will nominate their coworkers for Employee of the Week to recognize a job well done!

NH Tier 2 First Steps, ABA Implementer, or Tier 2 PCA - Natural Home must have a Bachelor's degree or 60 credit hours in a Human Services Field must attend Discreet Trial Training (DTT) will be responsible for working under the assigned ABA consultant to implement discreet trial programs as well as any other programming set forth by the consultant must Please pass an FBI fingerprint background check speak with Family Care Advocates about possible openings

From the Desk of Human Resources Policy and Procedures overview Kim “Berly” Forsythe

Where do I fit in? Direct Care Staff (DCS) Personal ABA Care Assistant (PCA) Implementer ISL Department Supervisory staff PCA/DCS/ ABA Implemente r Families and clients Office staff

Funding Sources How they effect YOU

New Hire Probationary Period Every employee’s first 90 days is considered a probationary period during which at any time BIS can retract it’s original offer of employment. After these 90 days an employee can remain at part time, working anywhere from 10-30 hours, or they may choose to pursue full time employment if positions are available.

Trainings Pre-Hire Requirements – Congratulations! - Unpaid Prerequisites CPR/First Aid – Two year certification if taken at BIS Mandt – Annual certification Orientation – Day 1 typically 9a-5p -Paid on first paycheck, minimum wage Agency Policy and Procedure Abuse and Neglect Seizure Training Blood borne Pathogens HIPAA ISL Policy and Procedure training Orientation – Day 2 typically 9a-5p- Paid on first paycheck at minimum wage Behavior Management #1 & #2 Orientation Wrap-Up Observe and Report Training Due to be completed within 30 days of hire date Class E license – all MO state drivers must obtain this license (out of state, valid licenses are exempt) Due to be completed within 60 days of hire date Behavior Management #3 & #4 - typically 9a-4:30p, paid at minimum wage Medication Administration Level 1 - 2-day course, 9a-5p each day, paid at minimum wage Not required for all employees Please make sure to turn in a timesheet for this class in order to be compensated! Mandatory For Tier 2 PCAs Only, But Open To All Discreet Trial Training (DTT) – typically 9a-5p, unpaid training

All BIS Employees are Mandated Reporters This will be covered more thoroughly in Abuse and Neglect Anyone holding any of these positions is considered by the state of Missouri to be a Mandated Reporter. As a Mandated Reporter it is your responsibility, in good faith, to report any allegation of abuse or neglect of a client to an immediate supervisor who will in turn report this allegation to the Department of Mental Health. As a Mandated Reporter, if you negligently or intentionally fail to report you could be found guilty of a misdemeanor and be liable for damages caused by your failure to report. As a Mandated Reporter, if you intentionally file a false report you could be liable in a civil suit for any damages suffered by the accused or the report facility No BIS employee will be retaliated against for submitting a good faith report.

If your last name begins with A-M, these items are Required each January of employment If your last name begins with N-Z, these items are Required every June of employment Abuse & Neglect (A & N) Abuse & Neglect training (A & N) Blood Borne pathogens (BBP) Blood Borne Pathogens (BBP) Confidentiality agreement Confidentiality agreement HIPAA test HIPAA test Observe, Record and Report test (ORR) Observe, Record and Report test (ORR) Seizure training acknowledgement Seizure training acknowledgement

How do I request time off? (RTO requests) Make sure you are not scheduled for any shifts for the day you wish to take off Log into the W2W system Click on “Request Time Off (Full or Partial day) Choose either full day or Partial Day or Repeating Days off Comment as necessary Receive approved or rejected based on previous stipulations/requirements If you know of any days that you need off currently (within the next 4 months), please enter them into W2W as soon as you receive your log in information!

Full-Time Employee Benefits Must work at least 37-40 hours per week Accrued paid vacation accrued after one year of fulltime employment After one year of full-time employment, 5 days of vacation are available After two years of full-time employment, 10 days of vacation are available Retirement Plan (available to all employees) which matches up to 3% of employee contribution after 90 days from full time start date Vision and dental insurance 30 days after full time start date at a premium of 4.00 per pay period or 8 per month. Healthcare benefits 90 days after full time start date at a premium of 60 per pay period or 120 per month

Holidays in the ISL Time and a Half for hours worked on the following Holidays: New Year’s Day Easter Thanksgiving Christmas

Holidays in the Natural Home New Year’s Day Easter Thanksgiving Christmas Memorial Day Independence Day Labor Day Natural Home Communicate PCAs are not with your paid above their clients ahead of hourly rate to time and relay work on the your plans! listed Holidays

Professionali Relationship with Families sm Sexual Harassment Rate of pay Med Administration Client’s Siblings / own Smoking Cell phone use Dress code Drug and alcohol use Confidentiality/HIPAA children Name Badge Client Transportation Seatbelt Class E Insurance Agitated State NO TEXTING/TALKING on Respect Line of Sight Arms length Supporting a client vs. the appearance of Sleep phone WHILE DRIVING

Any BIS employee found to be in violation of these or any policies/ procedures will be subject to disciplinary action up to and including termination. Progressive Disciplinary Action: Verbal Verbal Feedback Feedback Written Written Feedback Feedback Action Action plan/suspension plan/suspension (Final (Final notice notice for for improvement) improvement) Termination Termination –– Training Training repayment repayment policy policy enforced enforced Recovery Recovery of of any any agency/client agency/client items items HIPAA HIPAA and and confidentiality confidentiality agreements agreements invoked invoked

BIS Grievance Procedure Express grievance verbally to your immediate supervisor. If resolution has not been reached within one week then Put the grievance in writing and submit it again to your immediate supervisor. If issue is not resolved with in a reasonable amount of time then . Contact the office to request a hearing with a Behavior Intervention Services BCBA. All parties will state their case and the BCBA will provide a resolution.

Community Event Report Forms (CERF) & Medical Event Report Forms (MERF) What is considered a “Community Event” for one client may be a daily occurrence for another. Please make sure to speak with your clients Behavior Analyst or PCA Trainer to better understand your particular clients and when a CERF may be necessary. Forms will be located in your clients home in the data binder All CERFs must be turned in within 24 hours of the event All CERFS must be legible and precise If you are uncertain as to whether an CERF should be completed, please call your Supervisor for clarification

CLIENTS DEPEND ON US!! If you are going to miss a shift with a client in the natural home setting you must .

Attendance and Punctuality Policy Call in/shift coverage To maintain a safe and productive work environment, BIS expects employees to be reliable and to be punctual in reporting for scheduled work. Absenteeism and tardiness place a burden on other employees and on BIS and will not be tolerated. In the rare instances when employees cannot avoid being late to work or are unable to work as scheduled, they should notify their supervisor as soon as possible in advance of the anticipated tardiness or absence and their start time should reflect the late start time as discussed in the Time Keeping and Mileage Log policy (401). Changes to the scheduled start and/or end time of any publish schedule must be submitted to the Staffing Coordinator of that client within 24 hours of the changes so that it may be reflected in the employee's published schedule. Unreported and undocumented changes to a published schedule will result in disciplinary action. Failure to follow the agency's call off/shift coverage policies will subject the employee to disciplinary action. Employees that call off to a scheduled shift during the hours of Friday at 3pm to Monday at 8am will receive a first and final disciplinary action (DAF). Employees that call off to a second shift during the hours of Friday at 3pm to Monday at 8am during a six month period will be terminated. Employees that have three call offs of any nature during a six-month period (unless excused by a physician's note) will be terminated. Employees that are late to three scheduled shifts in a 6 month period will receive a first and final disciplinary action (DAF). Employees that are late to an additional shift in a 6 month period and have already received a first and final warning regarding tardiness will be subject to termination. Poor attendance and excessive tardiness are disruptive. Either may lead to disciplinary action, up to and including termination of employment.

Natural Home: Call all team members Call the office and the BT Call the family With as much advanced notice as possible to see if anyone can cover your shift Contact the team’s Family Care Advocate and immediate supervisor regarding whom you have contacted and what, if any, resolution has been made If coverage was found, let the family & FCA know who will be working that shift so that changes can be entered into W2W. If coverage was not found, a discussion must take place with the family regarding make up hours before the end of the service month. Changes should be reported to the Family Care Advocate.

Timesheets, W2W, DPN’s and Pay: Please clock in and out on the master timesheet located in the client binder in each home. Do not clock in before your scheduled shift time and do not clock out on the sheet until you leave your shift. Time in and out must match your client’s Daily Progress Note (DPN) as well as your W2W shift assigned to you. Any deviations or problems with any forms may result in a lack of pay for the shift. DPN’s (in home only) are used as your weekly timesheets. 2 ways to receive pay: Via mail or direct deposit – individual issues will be handled on a case by case basis. Time must be reported in 15 min increments – do not clock into shift before your scheduled time! DO NOT FALSIFY A TIME SHEET or a DPN – Medicaid/Insurance Fraud Mileage logs are to be turned in at the same time as your timesheets

Mileage logs and guidelines To claim mileage with a Natural Home client, you must do the following: *Have a shift that is at least 3.5 hours long *Travel a minimum of 20 miles with that client within that shift *Complete mileage logs with starting and ending mileage and destinations *Mileage logs must be turned in *Failure to turn in according to pay cycle. Please mileage logs on time, refer to Pay Cycle doc for will result in nondates** payment. *receive 4 per shift as a mileage stipend

Workers Compensation All employees will sign a copy of the Workers Compensation policy stating that they understand it’s contents If you are injured during billable time with a client you must call your immediate supervisor to start the Workers Comp process. You will be asked a series of questions and a treatment determination will be made All Workers Compensation claims will begin with a drug test This test must be completed within 24 hours of the incident. Workers Compensation will not cover an injury if the drug test is outside of these parameters We ask that all employees visit a Walgreen’s Take Care clinic instead of visiting an Urgent Care facility if at all possible All paperwork acquired must be presented to BIS for submission to the Insurance company An injured employee will not be permitted to return to active duty until a letter from a health care professional has been received permitting the individual to return to work

HR Wrap-Up Questions?

ISL ISL Policy & Procedures With Assistant ISL Director Darla Holloran Assistant ISL Director Jamie Klamert ISL Staffing Coordinator Kyle Swendig

What is an ISL? -Individualized Supported Living -Requires staff to be committed, reliable, and enthusiastic about the Dire Care staff Position -Residential living with around the clock support staff -able to provide safe environment for our consumers -provide 24 hours behavior intervention -promotes independence and a quality lifestyle for individuals -There are specific policy and procedures of Direct Care Support Staff within the ISL Department.

Medication Administration Must be Med Certified to pass any medication to a consumer (this includes creams and treatments) Must complete DMH Med Level 1 Certification Class before passing meds Must have Supervised Medication Administration Sign-off Signed before passing meds at any ISL Label and Storage of medications Controlled Substances must be double locked! All staff (med certified or not) must count controlled substances every shift If you are not med certified: It is Direct Care Staff’s responsibility to ensure that a consumer receives their medication Always check the MAR when entering the ISL. This will inform you what time the consumer takes their medication You must notify your QDDP that you will need someone to pass meds for

Medication Administration Continued Medication Errors The importance of the “Triple Check” Reporting a Medication Error: 1) Inform the QDDP immediately 2) Leave medication in the bubble pack 3) Fill out specific Med Error ERF

Restraints & Outs MANDT Last Time Cannot be used as a punishment Resort Must Keeping you and your client safe be the choice of the consumer Time out No Break Yes

Consumer Rights Treatment of Client: Do not say “NO!”—The use of positive talk Consumer Rights Consumer Rights/ Limitations HIPPA Role of Parents/Guardians Rights of Parents/guardians ERF and State Documentation language: The importance of positive language on state documents Eliminating the words “must” “have” “don’t” “can’t” “no” “stop” from your vocabulary

What’s Wrong with this Report?! Please find your Report Worksheet! At 5:50pm I prompted SP that she needed to take one bite of food in the next five minutes or she would not have her snack tonight. I prompted SP every minute explaining how many minutes she had left to take one bite. SP refused to take any bites. After the five minutes were over I explained to SP that we would sit at the table until it was time to take her bath and go to bed. SP continued to sit and look. SP began to rest her head on her hand as if she was going to sleep. At 7:00pm, her room mate began to eat her dinner, Subway. SP began pointing to her roommate's plate saying she was hungry. I gave SP her meds and prompted her to eat her food. SP responded by scratching staff, ripping her shirt and punching her body. She was prompted to have nice hands. At 7:15 SP threw her spoon at roommate and was removed to her bedroom where she sat with nice hands. At 7:30, SP chose her clothes for the next day, her night clothes and began her bath routine. She required help washing her hair and verbal prompts to wash her body. SP independently dressed herself, brushed her teeth and went to bed at 8:30pm. Overall SP had an okay day with the exception of several target behaviors and refusals.

Consumer Funds Each consumer within an ISL receives funding Chaperone Funds These funds are for staff to use from the state. Some consumers may receive when doing activities in the additional funding from additional sources At the community start and end of each shift, you will be responsible These funds are tracked on a for checking and recording consumer funds financial tracking sheet in the ISL Personal Funds The set monthly amount for each Each consumer receives a set allowance from the consumer is 30. state each month. These funds can ONLY be used with These funds are used for activities in the Personal Funds community, as well as, personalized items (i.e. Must have a personal fund receipt hair products, soap, OTC medications, hygiene to match chaperone receipt products) These funds are tracked on a financial tracking Household funds All consumers receive a set 30 sheet in the ISL monthly allowance for household Set monthly amount varies per consumer items Pocket Money Includes all cleaning products This funding comes from parents, guardians, Paper towels, toilet paper, hand family members soap, laundry detergent Can be spent on activities in the community, These funds are tracked by the personal items, food, whatever the client might QDDP want or need Must use these items sparingly Amount varies per consumer These funds are tracked on a financial tracking Once the house hold is out of money, THAT’s IT! sheet in the ISL MUST KEEP ALL RECEIPTS NO MATTER WHAT FUND IS USED!!

Consumer Funds Continued Buying consumers gifts Any additional purchase made outside of the provided consumer funding, must be approved by the QDDP for each consumer This is to prevent perceived gift/purchase entitlement of the consumer Set-up expectations that all staff should buy them something Staff cannot bribe clients If you do/stop that then I will buy you “Be a good girl today, and I will take you to McDonald’s”

Behavioral Crisis Procedure In the event that a behavioral crisis or injury to staff occurs at the time of a shift change or while on shift that places the safety of our consumers and/or staff at risk, it is expected that staff is not to leave the ISL prior to the following procedure: the QDDP and/or Behavior Analyst for the team has been contacted The Event Report Form has been filled out and faxed to the BIS office the staff relieving you on shift has arrived the situation has deescalated a supervisor (QDDP, BT, ISL director) gives permission to leave Failing to remain with the consumer before these steps have been taken will constitute consumer neglect and job abandonment, and employment with BIS will be terminated. The situation will also be submitted to the state for investigation.

Time off requests will not be approved for the any of the afore mentioned holidays DCS members will be given at least one month’s notice of their time slots for holidays If a DCS member wants a holiday off you must follow proper protocol of finding coverage and informing the QDDP and ISL Staffing Coordinator of any changes For any improper Call-off that does not follow the policy guidelines will result in disciplinary action ISL Holiday Guidelines Please turn to pg. 3 of the ISL Policy and Procedure packet Holidays in the ISL: New Year’s Day, Easter Sunday, Thanksgiving, Christmas Day These holidays are paid at Time and a half Holiday staff is required since we cannot leave consumers unstaffed Holiday shifts are broken down into 3 or 4 hour shifts for the following dates: New Year’s Day, Easter, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Eve, Christmas Day Each member on the team will be required to work a small portion of each holiday First infraction Second infraction Third Infraction

Individualized Support Plan What is the person centered approach? According to DMH, person centered planning is a process directed by the individual, with assistance as need from a represented. This process allows the individual to access supports that will allow him/her to achieve personally defined outcomes and the training, supports, therapies, treatments, and other services to become part of the plan. All consumer’s within the ISL will have an ISP or PCP. Each staff member is required to receive PCP training (and BSP training if applicable) before working their first shift with any consumer It is important to remember that the Individualized Support Plan is the document that drives all that we do with our consumers. ALL STAFF MUST FOLLOW THE PCP AT ALL TIMES

Individualized Support Plan What information is in the ISP? The individual’s demographic information Contributors to the plan Who is important to the individual What is important to the individual What do you need to know to appropriately support the individual What supports are needed for health, if any? What support are needed for safety, if any? Requirements of family of minor child or guardian How the person communicates (i.e. verbal vs. non-verbal) Issues to be resolved/ concerns Action plans toward meeting outcomes Legal Issues Some homes require locks on doors, cabinets, refrigerators Any restriction put in place in the home must be approved by the Human Right Committee

Missouri Quality Outcomes 1) People belong to their community 2) People have a variety of personal relationships 3) People have valued roles in their family and in their community 4) People are connected with their past 5) People’s communication is understood and receives a response 6) People are provided behavioral supports in positive ways 7) Prepare are provided with support in a manner that creates positive image 8) People express their own persona identity 9) People have control of their daily lives 10)People have the opportunity to advocate for themselves, for others, and for causes they believe in 11)People’s plans reflect how they want to live their lives, the supports they wants, and how they want them to be provided 12)People live with dignity 13)People feel safe and experience emotional well being 14)People are supported to attain physical wellness 15)People are actively supported throughout the process of making major lifestyle changes

Paperwork in ISL We are going to touch on a few of the aspects of daily paperwork. There may be more or less depending on the consumers you work with. You will learn more about client-specific paperwork during your training shift with the Lead Staff. It seems like a lot at first, but once you get used to it, it’s a breeze!

Daily Progress Notes (DPN) DPNs track the progress of consumers toward their PCP goals and Missouri Quality Outcomes These DPNs must have your accurate time in/time out, date, printed name, signature DPNs must be fully filled out—do not leave anything blank! Circle or write in N/A if that particular task was not completed DPNs are different for each consumer

Daily Progress Notes (DPN) What information is included on a DPN? Progress made towards outcomes Any doctor’s appointments attended Any medications that have been given Any new medical information specific to the consumer (i.e. illness, new medication order, etc.) Any visitors to the home Any pertinent phone conversations Any unusual incidents Behavior Incidents The emergence of any new behavior concerns Emergency Situations Community Outings Any new skills that have been mastered

Behavior Data Sheets Behavior Data Sheets collect information that is needed for Behavior Therapy. Not all ISL consumers have Behavior Data Sheets separate from DPNs, but they are just as important! These sheets help you and the Behavior Analyst track the behavioral progress that the consumer is making and help justify their need for services.

Intake, Sleep, and BM Logs These logs are very simple to complete, but it is important to keep track of Intake (what the consumer eats/drinks), sleep (times that the consumer is sleeping), and BM (times that the consumer has a Bowel Movement) to maintain communication in the house and to monitor the consumer’s health. These Medical Data sheets must be completed every shift If any consumer has not had a BM in 3 days you MUST notify the QDDP immediately Some consumers require their blood pressure, weight, fluid intake, or temperature to be recorded everyday, these are important medical records that must be kept up with accurately to ensure the quality of our consumer’s health

Monthly Nursing Reviews The Community RN looks for signs and trends that may be medically, behaviorally, and mentally intertwined and affecting the clients behavior or well-being Intake, Sleep, and BM logs are also reviewed by the BIS Community RN who does monthly visits to each ISL with every individual consumer Many people don’t realize that physical and physiological symptoms can all effect our behavior, the monthly RN visit are essential to maintaining our consumers health and over all wellbeing It’s important for staff to familiarize themselves with why medical data is being taken and who to notify if abnormal observations are made Always notify the QDDP if there are any abnormal medical changes or medication concerns The QDDP contacts the Nurse for further instructions

Timesheets Behavior Intervention Services, LLC ISL time sheets are due every other Monday after the Sunday overnight (9am) All time sheets will be faxed to the Office at (314) 395-9381 from the ISL by whomever works Sunday overnights One time sheet per HOME Only use 15-minute increments when signing in and out Time sheet times MUST match Daily Progress Notes (DPN) Do NOT falsify the time sheet. This is Medicaid fraud! Sign in and out ACCURATELY! Mileage logs are turned in with time sheets. ANY questions regarding time sheets may be directed to Staffing Coordinator or Financial Officer Debby! (Time sheets are completely different in Natural Home settings— please get clarification before working any Natural Home shifts.) Direct Care Staff Time Sheet Log ISL Name (Clients’ name(s)): Please keep track of your hours worked on this log. Hours not logged will not be paid. Pay Cycle Dates: Date PCA Name Mileage for this shift: On Call Client’s Initials: Time In Time Out Hours Worked TIMESHEETS ARE FAXED TO THE BIS OFFICE EVERY TWO WEEKS AFTER THE SUNDAY OVERNIGHT. SEND THEM TO FAX # 314-395-9381. FAXED IN BY: ON: (Staff Name) (Date)

Mileage Logs o Every ISL consumer is allotted a budget for a certain number of miles for the DCS staff to receive reimbursement. o Mileage logs can be found in ISL o The amount of miles allotted to each consumer varies o Mileage is paid out at .45 cents per mile. If over miles, payout is recalculated to stay within budget. o E.g. Consumer budget 400 miles/month equaling 180. o If 450 miles that month, new payout .40 cents/mile to stay within 180 budget. o Mileage Logs are turned in bi-weekly with timesheets and will be paid out according to the dates on the Pay Cycle Document o Mileage Logs must be filled out legibly, accurately, and completely o Each consumer requires different mileage logs; DO NOT combine STAFF ARE NOT ALLOWED TO USE THEIR PHONE AT ANY TIME WHEN TRANSPORTING CONSUMERS!

Lead Supervisors QDDPs Direct Supervisor when in the ISL Provide Verbal feedback Can be contacted about general household questions or concerns Conduct in-home training and training shifts Report to QDDP at least twice week Collaborate and work side by side with the QDDP during staffing and behavioral difficulties Supervise all DCS staff within the ISL Manage 2-3 ISLs Provide additional staff training and written feedback Must be contacted any time a med error occurs, injury to consumer, behavioral crisis, or an ERF/med error occurs Must be contacted for approval before using any PRN medication Provides communication between day programs, schools, case managers, family/guardians, and DCS staff

WHO DO YOU CALL? Exercise . You notice you’re running low on paper towels You’re giving your consumer a bath when you notice a bruise on their lower back While out in the community you consumer requests to buy a soda, but you forgot their personal funds You’re realize you’re going to be 15 minutes late picking up your consumer from their day program When filling out Ernie’s BM log you realize that a 0 has been put for the last 4 days You are working an overnight one night and you discover you’re out of floor cleaner You’re taking Joey’s blood pressure and receive a reading of 80/40; the parameters for Joey’s blood pressure are: Systolic: if this number is greater than 200 or less than 90 Diastolic: if this number is over 100 or less than 50 On your first shift from 3pm-11pm, you go to the MAR and see that Charlie has 5pm meds, you are the only staff member in the house and you are not med certified You have a question about how to fill out the Daily Progress Note You’re in the community with your consumer when suddenly they begin having a behavioral crisis and are refusing to leave, the store manager has already asked you one time to leave the store While out for a walk Sally trips and scraps her knee. The cut requires minor First Aid including her PRN Neosporin Jimmy wants to go out to eat, but his PCP states that he can only go out to eat once a week, you notice that his chart does not indicate whether or not he’s been out to eat for the week

Timesheets need to match DPNs Scheduling of Clients Will be scheduled for hours based on the availability provided upon hire, and must provide two weeks notice for change in availability Any ongoing change to a schedule, be it for personal reasons or at the request of a parent/guardian, must be reported and approved by the staffing coordinator and the BT or QDDP It is the responsibility of all employees to update their preferences on When2Work Anytime there is a shift addition/change that is outside of your normal schedule will be followed up by an email from the ISL staffing coordinator All employees (especially DCS) should be checking WhenToWork at least twice per week. Hours are specific to the individual needs of clients or their parents or guardians Unassigned shifts are assigned to staff using inverse seniority Flexible scheduling available if requests are made in a timely fashion & needs are met for families All schedules will be posted on the When to Work websites. Requests for time off will also be made and approved or denied using this system

Anyone working in an ISL must. Call all other team members Call Staffing Coordinator Contact With as much advanced notice as possible to see if anyone can cover your shift With as much advanced notice as possible to make them aware of who will be working the shift Contact your QDDP, Lead Staff member, and Staffing Coordinator so that an appropriate Floater DCS may be contacted

THERAP is an Online Software System for Providers Supporting People with Developmental Disabilities for Effective and Efficient Documentation, Reporting and Communication. Currently every DCS and ISL staff member is responsible for medication administration, T-logs (daily summaries), and some health tracking on THERAP every shift. Each ISL has a laptop and a jetpack (wireless internet provider) which is kept in the locked med closet Laptops are not allowed out around consumers Laptops are to be used for work related repurposes ONLY Sites like YouTube, Pandora, and Netflix are strictly prohibited Lead Supervisor, QDDP, and ISL Assistant Director track data usage and web history for each laptop within the ISL

www.therapservices.net How to Log in Sign-off on the THERAP MAR Create a T-log summary Create a T-note Check and create S-comms (messaging system)

Reward Programs Employee of the Week and Month Family Feedback Bonus Applicant Referral Bonus

Perks for All Employees!!! (After 30 days employment) Discounted Phone Legal Shield Supplemental Reinforcement Service Programs Prepaid LawyerInsurance Verizon Wireless Services AFLAC Employee of the Club Fitness 8% discount on Credit Week Short Term 10/month monthly Monitoring Disability, Employee of the Cancer Month Identity Theft Minimum of 8 services Screening, Bring your checkprotection Employee of the visits per Wellness Plans, stub to the Year 15.95- 22.24 month etc. nearest Verizon per month Applicant Concierge SIMPLE IRA store! Referral Bonus Wellness is retirement plan 25 at 90 days also available Available to all Family Feedback to all employees Bonus whom have employees! 10 and 1 per earned 5000 quarter BIS will match up to 3% of contribution Corporate Wellness

Scheduling System Individual user id and password 24/7 access to schedules, team member contact info, intranet email system Request Time Off (RTO) abilities Scheduling preferences Urgent text alerts Employee Bulletin Board Trade Board BIS Agency Website Upcoming events and trainings BIS Buzz Employee Nominations Staff-only section to access Annual forms/trainings due: January for A-M June for N-Z

Like us on Facebook! https://www.facebook.com/behaviorinterventionservices Facebook is a great place to find out: Upcoming events Client function updates EoW and EoM winners About your co-workers and other members of the agency

Any Questions? Please complete all new hire packet forms with signatures and dates Please turn in any additional items that are needed for your file Verify your next training date and time of that class Turn in all items to your moderator for HR