Job Corps Center Physician Orientation July 2022

Job Corps Center Physician Orientation July 2022

Overview What is Job Corps? Multidisciplinary Role center health staffing of the center physician Policy and Requirements Handbook (PRH) Provision of basic health services Introduction to your medical health specialists Pearls of wisdom

What is Job Corps? 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 National Office of Job Corps establishes policy and requirements and facilitates major program initiatives. Job Corps’ Regional Offices administer contracts and perform oversight activities. There are currently 121 operational Job Corps centers throughout all 50 United States and Puerto Rico. Each center is part of a region. The six regions include: Atlanta, Boston, Chicago, Dallas, Philadelphia, and San Francisco.

Career Development Services System 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.

Health and Wellness website Welcome to the Job Corps Health and Wellness Program Website. This site is designed for Job Corps health and wellness staff — use it to connect with your peers, get the latest information on new initiatives and training events, learn about the health program, and link to related resources. https:// supportservices.jobcorps.gov

Health and Wellness website Health & Wellness: Home Job Corps Policy and Requireme nts Handbook COVID-19 Policy & Procedures Wellness Staff Desk Reference Guides Applicant File Review Administration & Health To pics Crisis and Emergency Resp onse Data Submission & Annual Reports Health & Wellness Director Center Physician Center Mental Health Consu ltant Frequently Requested Form s & Documents CMHC Training Bundles Center Dentist Health Care Guidelines/Wri tten Instructions TEAP Specialist Health Education Curriculu m

Health and Wellness website New Items: PIN 21-12 Talking Points for Ad missions Counselors and Cente rs and PIN 21-12 Frequently Asked Qu estions Webinar: Vaping and eCigarettes — June 28, 2022 Center Dentist Desk Reference Guide (PDF format) — July 2022 W ebinar: Cultural Competence and Humil ity — June 22, 2022 PI 21-12 Consolidation of Job C orps’ COVID-19 Policies and Ali gnment with Centers for Disea se Control and Prevention (CD C) Guidance for Institutions of Higher Education (IHE) Attachment A: Student COVID-19 Vaccine Cer tification, Authorizations, and Acknowledgements and Testin g Consent — June 15, 2022 Job Corps Draft Plan Template Job Corps COVID-19 Protocols by Community Level and Vacci nation Status Job Aid

The Policy and Requirements Handbook (PRH) The Policy and Requirements Handbook contains the rules by which all centers operate: Chapter 2 (2.3 R1-R19) Chapter 5 (5.1, R3, R4; 5.2 R3, R5; 5.4 R2; 5.6 R2) Chapter 6 (6.2 R2 and R5)

Center Physician’s Role in Student Health and Wellness Serve as medical director for the center’s health program Collaborate with nursing, mental health, oral health and substance misuse professionals on center Review the health history and perform a comprehensive physical examination within 14 days of entry Review and modify or approve health care guidelines and personal authorizations annually Facilitate access to prescription medications and CDC recommended ageappropriate immunizations Participate in monthly monitoring of students with chronic illness and taking daily medication Participate in applicant file review involving medical conditions Meet monthly with the center director and health staff

Multidisciplinary center health staffing Nursing – RN, LPN/LVN Medicine – MD, DO, NP, PA Mental Health – PhD, LICSW Oral Health – DDS, DMD, RDH, RDA Trainee Employee Assistance Program (TEAP) – CSAC, LADC substance misuse – often also serves as TUPP Coordinator TUPP – Tobacco Use Prevention Program

Minimum staffing requirements by center size Hours per 100 students per week Position Physician 4 Health and Wellness Director (RN) 40 Staff Nurse 50 Dentist 3 Dental Assistant 4 Dental Hygienist 3 Center Mental Health Consultant TEAP Specialist 15 TUPP Coordinator Clerical support 8 varies 20

Basic health care – Medical – Exhibit 2-4 Assessment and diagnosis of illness and injury, to include: Cursory medical evaluation by a qualified health professional; must be completed within 48 hours after the student’s entry. Entrance physical examination by a qualified health professional within 14 days after entry using Job Corps approved history and physical forms. Required entry laboratory studies Immunizations, to include boosters for incomplete immunization series, and hepatitis B vaccine for health occupations training students. Tuberculin skin test (Mantoux). Vision and hearing screening. Daily walk-in clinic and appointment system for above and for episodic illness or injury assessment by center physician and/or nurse. Inpatient unit visits for minor conditions, such as respiratory infections, or flu symptoms

Basic health care – Medical – Exhibit 2-4 Treatment, as highlighted below, will be provided when necessary. Thirdparty payer information will be given to providers when off-center care is required. Primary emergency care for illness and injury, including first aid and CPR, and secondary care within capabilities, e.g., injection of epinephrine, and immediate transfer to hospital emergency room for specialized diagnosis and treatment, if needed. Treatment of urgent and other conditions not needing specialized care and that are within the capabilities of qualified health professionals on staff. Management of chronic health conditions as directed by qualified health professionals. Referral to off-center physicians for detailed specialized assessment. Access to prescription medications. If a student sustains an on-the-job injury that requires extensive or specialized treatment, he or she will be medically separated as a Medical Separation with Reinstatement Rights (MSWR) and a referral will be sent to the Office of Workers’ Compensation Programs (OWCP).

Vision and Hearing Screening Conduct vision screening (near, distance and color vision). For students with 20/40 refractive deficiencies refer to optometrist. When indicated, the center must furnish one pair of glasses that meet American National Standards Institute (ANSI) standards. Using audiometer conduct hearing screening at the following Hertz levels (Hz) 500, 1000, 1500, 2000, 3000, 4000, 6000. Document results on the Job Corps Physical Examination Form.

Entrance Laboratory Testing completed in first 48 hours HIV (see 2.3 R15 regarding waivers) Hemoglobin or Hematocrit Urinalysis (dipstick for glucose and protein) Urine Drug Screen (UDS) (cannot be waived) Chlamydia and Gonorrhea* Pregnancy for females Sickle cell – offered to all at risk students Syphilis serology (optional)

Tuberculin Skin Test (TST) A tuberculosis skin test (Mantoux) is required of all new students who do not have documentation of a previous negative Mantoux test taken within the last 12 months. Students in health occupations must receive a Mantoux test prior to clinical work experience in accordance with state or local health department requirements. Annual tuberculin testing is no longer indicated for students in health occupations. A Quantiferon (IGRA) blood test can be obtained as an alternative to skin testing and is preferred for students with a prior history of BCG vaccination. Results of tuberculin skin testing should be interpreted without regard to a prior history of BCG vaccination. Refer to Treatment Guidelines in the Health Care Guidelines for management of students with a positive Mantoux test and negative chest x-ray.

Medical History and Physical Examination A complete entrance physical examination and review/annotation of the medical history should be completed within 14 days of a student’s arrival. The physical examination must be provided by a qualified health professional and documented on the Job Corps Physical Examination Form. Conduct the exam with patient gowning and a chaperone. Exam should include: breast exam for all students testicular and hernia exam for male students discuss birth control options and safer sex Female students 21 and older no longer require a pelvic exam and Pap smear as new American Cancer Society guidelines defer screening to age 25.

Immunizations All applicants are required to provide Admissions Counselors with current immunization records at the time of application. Immunizations or boosters indicated if the following immunization series are incomplete or if current immunization records cannot be produced: Tetanus and diphtheria toxoid (Td) or Tetanus-diphtheria-acellular pertussis (Tdap) Inactivated polio vaccine (IPV) for students younger than 18 years of age Measles, mumps, and rubella vaccine Hepatitis B vaccine series At a minimum, Hepatitis B vaccine must be provided to health personnel and health occupations training students. Vaccination of health occupations training students must begin six weeks prior to on-site clinical work experience. Centers should utilize the Vaccines for Children program to provide immunizations for eligible students according to the latest Centers for Disease Control and Prevention (CDC) guidelines.

Chronic Care Management Students identified as having chronic health problems during the cursory or entrance physical exam must be monitored as directed by the Center Physician or other appropriate center health care providers. Evidence of chronic care management should be documented in the SHR. This can be done by using the CCMPs located in the Health and Wellness website: https://supportservices.jobcorps.gov/health/Pages/HCG uidelines.aspx#ccmps or by writing a note clearly titled “Care Management” or “Case Management Note” on the SF-600 or progress note.

Applicant file review As center physician you may be asked to participate in a Health Care Needs Assessment (HCNA) to review medical records and speak with a Job Corps applicant who has medical issues that may limit participation. Denial of enrollment for medical diagnoses is much less common than denial for mental health concerns. Many students are afforded reasonable accommodations to address their medical needs and succeed in completion. Denial should be based upon the inability to meaningfully participate in the Job Corps program despite accommodations. Students with chronic illness often do better on center than at home given the structure of three meals a day, adequate sleep and case management by the center health staff.

Applicant file review – Case vignettes Applicant #1 Jason is a 19 year-old male with type 2 diabetes (hgb A1c 14.0), obesity (BMI 41) and hypertension (BP 155/96) who reports taking his metformin and lisinopril “most days,” but checks his blood glucose and administers insulin only when he “needs it.” No recent hospitalizations or urgent care visits for diabetes. Applicant #2 Jasmine is a 19 year-old female with type 2 diabetes (hgb A1c 10.0), overweight (BMI 29) and normal blood pressure (118/72) who was diagnosed one year ago and had three subsequent urgent care visits for hyperglycemia ( 468). She lives at home, takes metformin daily and her mother checks her blood glucose and administers her insulin daily. Question: Accept Applicant #1, #2, both or neither? Note that all proposed center denials are reviewed by a regional health specialist prior to a final decision by the regional office.

R13. Professional Standards of Care All center health staff and providers must follow accepted professional standards of care and are subject to prevailing state laws, including but not limited to: Maintaining a copy of the current provider’s license, Drug Enforcement Agency (DEA) registration, and proof of professional liability insurance, if applicable, in the center health facility. Documenting all prescribed medications and treatment in the student health record (SHR). Documenting all laboratory procedures ordered and recording the results in student health record. Following current standards of care when providing health services and treating illnesses and injuries.

R14. Medication Management 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 specified in Appendix 203. Center physicians may prescribe psychotropic medications consistent with their experience and training.

R15. Waiver of Medical Care The Center Physician/Nurse Practitioner (NP)/Physician Assistant (PA) may waive any portion of the medical examination and laboratory testing except for the entrance drug testing if in his or her opinion there is sufficient justification or if a student refuses. The Center Physician/NP/PA may grant waivers of immunization requirements for valid medical and/or religious reasons.

R16. Health Care Guidelines All health care guidelines must be approved and signed annually by the Center Physician, Center Mental Health Consultant, or Center Dentist, as appropriate. Current signed and dated health care guidelines must be kept in the Health and Wellness Center. Annually, each center must submit a memorandum to the Regional Office indicating which health care guidelines have been modified. Copies of any individual health staff authorizations and health care guidelines that have changed must be sent to the Regional Office for approval. (Refer to Exhibit 5-2, Plan and Report Submission Requirements, for reporting deadlines.) https://supportservices.jobcorps.gov/health/Pages/HCGuidelines.aspx

R19. Continuous Quality Improvement (CQI) Center health staff must seek feedback from students, employ mechanisms to document quality of care provided, and document quality improvement activities. Assessors assess these components: Feedback - surveys, focus groups, etc. Mechanisms - regular chart audits and other frequent means to ensure follow up and referrals, etc. Quality Improvement (CQI) - active measures to ensure a solution to an observed problem in the last year such as conducting studies, survey results, comments/complaints.

CQI continued Identify the problem or issue and document the improvements or changes made over time. Examples: Students not showing up for appointments modifying the pass system Broken appointment rates before and after Students showing up randomly without appointments staff education in health care utilization Daily walk-in visits before and after Flu vaccine uptake offering outside of HWC and seeing if increase occurs Compare prior year percentage vs. current year High pregnancy or STI rate increased student education to decrease rates Rates before and after education 27

Standard Operating Procedures PRH 5.1 R3 & Exhibit 5-1 Center contractors, agencies, and OA/CTS contractors must: Establish Standard Operating Procedures (SOPs), as shown in Exhibit 5-1 (Standard Operating Procedures) and submit them to the Regional Office for approval within 90 days of contract award. Updates and revisions shall be submitted as changes occur. For agency-operated centers, provide up-to-date SOPs, as shown in Exhibit 5-1, with annual plans and amendments to SOPs submitted to the Department of Labor (DOL) Regional Office for approval by June 1st for the upcoming program year. Required Wellness SOPs/COPs: Over the Counter Medications Prescribed Non-Controlled Medications Prescribed Controlled Medications Wellness Staffing 28

Staffing SOP Each center is required to submit a Staffing SOP (see CN 16-02 and Exhibit 5-1). The Staffing SOPs should address state practice acts. Coverage for LPN/LVN when the supervising RN or HWD is on vacation or ill. Recruitment plan for when a center employee (e.g. nurse) or subcontracted staff position is vacant. Coverage for short- and long-term absences of any subcontracted health staff (Physician/NP/PA, Dentist, RDH, Dental Assistant, CMHC, TEAP)

FECA/OWCP/ECOMP PRH 5.1 R40 Students are considered federal employees for purposes of the Office of Workers’ Compensation Programs (OWCP). OWCP benefits do not begin to accrue until the day following a student’s separation from the program. Use the Employees' Compensation Operations & Management Portal (ECOMP) to report the work-related injury or illness. Complete CA-61 (Notice of Separation of Student) with National Office of Job Corps approval The center must complete the appropriate ECOMP form(s) whenever a student is injured, develops an occupationally related illness, or dies while in the performance of duty. Complete CA-1 (Federal Employee’s Notice of Traumatic Injury) and file in the SHR If the student dies while in Job Corps – Contact the Nurse Specialist for guidance and Heather Edmonds for completion of CA-6; SIR should be completed - see PRH 5.5.

Medical Separations PRH 6.2 R5 Centers must ensure that: Medical/Mental Health separations are initiated by health services staff. Students are medically separated when they are determined to have a pre-existing or acquired health condition that significantly interferes with or precludes further training in Job Corps, or the health problem is complicated to manage, or the necessary treatment will be unusually costly. If the Center Physician estimates that the student will be able to return to the center within 180 days, a Medical Separation With Reinstatement Rights (MSWR) will be given. Health and social service referrals are provided for all separated students. For MSWR, students are contacted monthly by the Health and Wellness Director to assess progress and plan their return to Job Corps within the 180 days allowed. Health and Wellness staff approve a student’s transportation plan for medical separation. Center staff must submit a request to the Regional Office to extend an MSWR beyond 180 days for extenuating circumstances.

Medical Equipment and Supplies PRH 5.6 R2 The center must: Provide necessary equipment and supplies for routine and emergency delivery of basic medical, dental, and mental health services. All such equipment must comply with federal and state requirements. Purchase major dental equipment according to the current dental equipment list published periodically by the Office of Job Corps. Purchase from government supply service centers (General Services Administration [GSA], Health and Human Services [HHS], Veteran Administration [VA]), whenever possible.

Introducing your regional medical specialists John Kulig MD MPH - Boston Lead Medical Specialist Region 1 Boston & Region 2 Philadelphia Medical Specialist Gary Strokosch MD – Chicago Region 3 Atlanta & Region 5 Chicago Medical Specialist Drew Alexander MD – Dallas Region 4 Dallas Medical Specialist Sara Mackenzie MD – Seattle Region 6 San Francisco Medical Specialist

Pearls of wisdom from your medical specialists Job Corps Health Specialists are employed by Humanitas, holder of the national contract for support of the Job Corps Health & Wellness Program, Office of Job Corps, Employment and Training Administration, United States Department of Labor. We are not government employees, and our role is advisory, limited to making recommendations, not policy decisions. Job Corps Health Specialists are available for clinical consultation to discuss a student, but final decision making is the responsibility of the licensed center clinician. Job Corps Health Specialists’ role in the employment of center health staff is limited to review of professional credentials. We do not address personnel issues such as schedules, salaries, and subcontracts that should be discussed with the Health & Wellness Director and/or the Center Director.

More pearls Job Corps students are entitled to the same standard of care that you provide in your private office practice. Because Job Corps students have been medically underserved, their time in the program may be the only opportunity to discover and address unmet health needs. Funding for costly referrals, procedures and prescription medications beyond basic health care may require innovative approaches to obtain third party payment from health insurance, pharmacy assistance programs, and discounted fees negotiated for specialty care, procedures and supplies. Consider use of local urgent care facilities as an alternative to hospital emergency departments.

And even a few more pearls Monthly meetings in person with the center director are encouraged to “keep on the same page” and maintain a consistent approach to student health care on center. Consider developing a collegial relationship with someone in your local health department to assist with reporting requirements, latent tuberculosis and immunizations. Job Corps does not yet have an electronic medical record, electronic prescribing, or storage space for digital dental radiographs! Job Corps policies addressing reproductive health care for students are currently under review by Department of Labor attorneys given the recent Supreme Court decision overturning Roe v Wade.

Contacting your regional medical specialists John Kulig MD MPH – Boston & Philadelphia Gary Strokosch MD – Atlanta & Chicago Drew Alexander MD – Dallas Sara Mackenzie MD MPH – Seattle Note: Use @jobcorps.org address for all HIPAA applicable messages