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​Center Physician Resources​

Introduction

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

If you are new to Job Corps, here are a few tips to get you oriented to your new position:

  • Contact the Medical Specialist in your region to introduce yourself and receive a brief orientation to your new position. Your Medical Specialist serves as a technical expert for the Regional Office and the centers in your region—contact your Medical Specialist to answer your questions, clarify Job Corps policies, and provide you with up-to-date information that will assist you in your efforts to meet program requirements. Contact information for Job Corps National Office staff, Health Specialists, and Health Support Contractor staff is available on the Directory webpage.
  • 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.
  • Locate and familiarize yourself with the ePRH (with special attention to sections 6.10 through 6.12), 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.”
  • Electronic Policy and Requirements Handbook (ePRH)—The ePRH expands the CFR by establishing operating policy requirements for Job Corps centers. There are six ePRH chapters. Chapter 6, sections 6.10 through 6.12, 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 ePRH. As new requirements are added to the ePRH, 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 ePRH and to disseminate information throughout Job Corps. Three types of directives are issued:

  • ePRH Change Notices—Contain new or revised policy with instructions to delete, replace, or add pages to the ePRH.
  • Program Instructions—Provide one-time instructions with a designated expiration date and usually require center response (e.g., updated SPAMIS medical separation codes).
  • 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 ePRH Chapter 6, 6.10 through 6.12 and will address other relevant sections of the ePRH.

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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
    • 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.

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 Health and Wellness Manager who is responsible for developing and implementing the policies and procedures that guide the delivery of health care and reasonable accommodation on center.
  • The Health Support and Accommodation Support Contractor—The Health Support and Accommodation Support Contractor works 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 ePRH.

Center Health and Wellness Team

The Health and Wellness Manager (HWM) is the administrative team leader for the Health and Wellness Program. All centers have the following staff as part of their Health and Wellness team:

  • Medical: Center Physician, Nurse Practitioner/Physician Assistant (NP/PA), HWM, nurses, clerical staff
  • 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, NP/PA, 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 ePRH Exhibit 6-5.1

As Center Physician, your role is that of a Medical Director for the Health and Wellness Center (HWC). You may also provide basic medical care along with the NP/PA. The HWM manages daily operations, while you guide 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. Center 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.

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

Center Assessments

Regional Office assessments 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 Program Compliance Assessment (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 the HWM 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 the Center Physician Pre-PCA Questionnaire that can be downloaded from the Job Corps Health and Wellness website.
This team uses the Job Corps Program Assessment Guide (PAG) and Health and Wellness PCA tools to conduct an overall assessment of your center's Health and Wellness Program. The PAG is located on the Job Corps Community website. The PAG and 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 ePRH. 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 may be consulted to assist with formulating CAPs as necessary.
PCAs provide an opportunity for you to highlight the strengths of the health and wellness program and for Regional Office staff to provide feedback about areas that could be changed or improved. As with each section of the ePRH, the Health and Wellness Program (Medical) is rated from 0-9 for the requirements listed in ePRH 6.10 (R1). In addition to the compliance rating, the assessors give a quality rating 0-9 collectively for all the programs in ePRH 6.10-6.12 and for each of the quality indicators in ePRH 6.10-6.12.
The table below describes ratings as outlined in the PAG:

Compliance/Quality Rating

0-1
Unsatisfactory

Critical requirements are missing or minimally evident. Quality indicators are not achieved. The program lacks procedures and controls necessary to ensure compliance, quality, and data integrity.

2-3
Marginal

Requirements and/or quality indicators are missing or minimally evident in applicable program areas. Quality assurance is minimal resulting in inconsistencies in accountability and integrity of program assets and data.

4-5
Satisfactory

Requirements and quality indicators are generally evident in applicable program areas with minor exceptions. A quality assurance plan is in place that demonstrates adequate controls to ensure integrity and accountability of program assets and data.

6-7
Very good

Programs, procedures, and systems are consistently in place to ensure delivery of requirements and achievement of quality indicators. Some innovative approaches are employed to promote continuous improvement. A viable quality assurance plan ensures integrity and accountability of program assets and data.

8-9
Exceptional

Programs, procedures, and systems are well organized, clearly communicated, and administered to ensure quality delivery of all requirements and achievement of quality indicators. Innovative approaches result in program enhancements and improved outcomes. Through rigorous self-assessments and quality assurance, the operator safeguards program assets and maintains the integrity of program data.

In addition to PCAs and Corporate Office Center Assessments, the HWMs 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.

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Part 1: Health and Wellness Services (ePRH 6.10, R1)

Health and Wellness Program (Medical)—ePRH 6.10, R1

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 health services (ePRH Exhibit 6-4) 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. In providing care, Job Corps adheres to all current HIPAA regulations regarding consent and confidentiality for protected health information.

Assessment

Step 1: Folder review. Information about students arrives on center before you ever see the student. You 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 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 ePRH (see Laboratory Testing section).

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.

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, he/she 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 ePRH 6.10; R1(d).

    Refer to the Immunization Guide TAG for optional immunizations (e.g., influenza vaccine) that may be provided to students based on your recommendation, availability, and cost. Centers should utilize the Vaccines for Children (VFC) Program to provide immunizations for eligible students 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 students 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 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 8,000 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.
  • 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, ePRH 6.12, R7)
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
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 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.

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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Part 2: Medical Interface with other Wellness Disciplines
[Oral Health, Mental Health, Trainee Employee Assistance Program (TEAP)
and Related Health Programs (ePRH 6.10 and 6.11)]

Oral Health and Wellness Program—ePRH 6.10, R2

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).

The Oral Health and Wellness Program is led by the Center Dentist and supported by a Dental Hygienist and a Dental Assistant.

Mental Health and Wellness Program—ePRH 6.10, R3

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.
  • 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).
  • Works with you to coordinate care for students being treated with psychotropic medication. Centers may wish to consider regularly scheduled consultation with a community Psychiatrist or Advanced Practice Nurse with prescribing privileges.

Trainee Employee Assistance Program (TEAP)—ePRH 6.11, R1

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 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.

Health Aspects of Sports—ePRH 6.11, R2

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. As Center Physician, you must document sports clearance annually on the Job Corps Physical Examination Form.

Tobacco Use Prevention Program (TUPP)—ePRH 6.11, R.3

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:

  • All buildings and center-operated vehicles must be smoke free.
  • Tobacco products must not be sold on center.
  • If center operators choose to allow smoking and use of tobacco products, they must designate specific areas for tobacco use. It is required that these areas be at least 25 feet, or as required by state law, away from all building entrances.
  • Minor students' access to tobacco products should be restricted as required by state law.
  • Minors who use tobacco products shall 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—ePRH 6.11, R4

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(STIs), and pregnancy management. Both female and male students should be included in family planning education and services.

As Center Physician, you are 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:

  • Information on the options of continuing or terminating the pregnacy.
  • Prenatal services on center and/or in the community until separation, to include a comprehensive gestational record.
  • 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.

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.

Sample pregnancy log, pregnancy education forms, and the Health and Wellness Family Planning TAG are available for review/download.

HIV/AIDS—ePRH 6.11, R5

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.

All students, whether positive, negative, or indeterminate, receive post-test counseling. You (or your 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.

The PRH Exhibit 6-12, HIV Testing Information Sheet is available for review/download.

Sexual Assault Prevention and Response—ePRH 6.11, R6

Each center must establish a program for sexual assault prevention, counseling, treatment, and follow-up care. Centers are required to develop a sexual assault response team (SART) that involves center staff and outside resources.

Sexual assaults must be reported to local law enforcement authorities as required by state and local law.

For more information the Sexual Assault and Prevention TAG is available for review/download.

Healthy Eating and Active Lifestyles (HEALs)—ePRH 6.11, R7

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 program 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.

For more information review the HEALs Discipline-Specific Guidance section.

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Part 3: Health Administration (ePRH 6.12)

Staffing—ePRH 6.12, R1

Center management has a responsibility to employ or subcontract with qualified health care providers. The number of hours required to staff a Job Corps Health and Wellness Center HWC is determined by the center's contracted student enrollment capacity; these requirements are included in ePRH Exhibit 6-5.

Authorizations (Consent for Treatment)—ePRH 6.12, R2

The Job Corps Health Questionnaire (ETA 6-53), which authorizes basic/routine health care, is placed in the SHR. If the student is a minor, the form should have been signed by the student's parent/legal guardian.

Written consent/authorization from the student (if age > 18 years) or parent/legal guardian (if age 16 or 17 years) for any care or services beyond basic/routine health care authorized on initial ETA 6-53 should also be placed in SHR.

Basic Health Services Provided by Job Corps Centers—ePRH 6.12, R3

Center operators are responsible for providing and paying for basic health care as detailed in ePRH Exhibit 6-4.

Providers may not bill third party payors, including Medicaid, for basic health services covered by the provider's subcontract.

Health and Medical Costs Exceeding Basic Health Services Provided by Job Corps—ePRH 6.12, R4

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 (attachments: 13-09a, 13-09b, 13-09c, 13-09d, 13-09e, 13-09f, 13-09g, 13-09h, 13-09i) 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 or 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—ePRH 6.12, R5

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.

Documentation of current medical licensure, DEA registration, and malpractice insurance should be kept on file 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.

Controlled Substances—ePRH 6.12, R6

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 (attachment IN 08-17a) dated September 17, 2008 for more requirements and tips.

Waiver of Medical Care—ePRH 6.12, R7

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. Such a waiver shall be clearly documented by the center physician/NP/PA in the student’s health record and include an explanation as to why the decision was made.” If a student refuses any of these services, you may waive the examination, test, and/or immunization if it is felt there is sufficient justification. The waiver and an explanation of why it was granted must be documented and signed by the student and you and placed in the SHR.

FECA/OWCP—ePRH 6.12, R8

Job Corps students are considered federal employees for purposes of the Office of Workers Compensation Program (OWCP). If students sustain injuries (1) resulting from training-related activities, or (2) incurred outside of the training day, in the dormitory, during recreational activities, or while on off-center sponsored trips, they are eligible to file a claim with OWCP.

When a student reports an injury or illness that occurred in the performance of duty, the staff member responsible for reporting will complete the online ECOMP form (CA-1) and print a copy for the SHR. If the student is medically separated due to the injury or illness, the form must be submitted to OWCP within 10 working days of the injury, after approval from the National Office.

Health Care Guidelines—ePRH 6.12, R9

Health Care Guidelines (HCGs) provide information concerning accepted practices for common health problems and situations in Job Corps. There are several reasons why it is important that each center has specific written instructions to be used throughout Job Corps. They are designed to:

  • Help ensure the safety and comfort of students.
  • Provide evidence-based scientific rationale to support decisions regarding treatment of students.
  • Decrease the possibility of medicolegal concerns for center staff.
  • Provide information and training on current health care practices for the staff.
  • Save time for the consulting medical personnel to address other problems requiring their special attention.
  • Facilitate the orientation of new health and non-health staff.
  • Provide non-health staff with direction for action, especially when a member of the health services staff is not available or not on center.

All HCGs shall be approved and signed annually by you, the CMHC, or Center Dentist, as appropriate, and shall be kept in the HWC.

Annually, each center shall submit a memorandum to the Regional Office indicating which, if any, HCGs have been modified. Copies of any personal authorizations for health staff and HCGs that have changed shall be sent to the Regional Office for approval. Personal authorizations for non-health staff shall be retained on center.

The Health Care Guidelines and Written Instructions TAG includes Health Staff Treatment Guidelines, Non-Health Staff Symptomatic Management Guidelines, and Prototype Staff Authorizations.

Student Introduction to Health Services—ePRH 6.12, R10

Students learn about the center's Health and Wellness Program through orientation sessions and the student handbook. You are encouraged to participate in orientation, which occurs soon after students arrive on center, and 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 work day.

Medical Separations—ePRH 6.12, R11

Medical separations occur when students have significant health problems that preclude participation in career training, are too complex to manage on center, or are unusually costly.

Medical separations are initiated by Health and Wellness staff.

There are two options for medical separation:

  1. Medical separation: : A decision to medically separate should be made if a medical assessment and functional evaluation indicate that a student's medical, dental, mental health, or substance use condition is unable to be ameliorated within 180 days.

    Any student receiving a medical separation is eligible to reapply to Job Corps one year following the date of his/her separation.

  2. Medical separation with reinstatement rights (MSWR): A decision to MSWR may be used if the health care provider estimates that the student's condition will be resolved and the student will be able to return to the center within 180 days.

    For MSWRs, students are contacted monthly by the HWM to assess progress and plan their return to Job Corps within the 180 days allowed. Center staff may submit a request to the Regional Office to extend an MSWR beyond 180 days for extenuating circumstances. The request should be accompanied by supporting documentation from the student's health-care provider verifying that extension of leave is medically necessary. Requests will be reviewed on a case-by-case basis.

Health and Wellness staff must approve a student's transportation plan for medical separation.

For both types of separation, a detailed health assessment, conducted by the appropriate provider, must be performed prior to every medical separation and documented in the SHR. The Center Director must approve all medical separations.

Death—ePRH 6.12, R12

In the event of a student's death, the Center Director must notify multiple parties, arrange for the remains to be sent home, and forward student records to the National Office. A significant incident report (SIR) must be submitted. Many of these activities may be delegated to Health and Wellness staff.

Communicable Disease and Infection Control—ePRH 6.12, R13

The HWM should establish infection control policies and procedures, train staff, and monitor compliance. Center staff must always use universal precautions in the care of students, especially when there is a potential for exposure to blood or body fluids. Universal precautions include barrier protection (e.g., gloves, masks, gowns), hand washing, procedures for cleaning and disposing of sharp instruments, sterilization, and disinfection.

Follow infection control measures as mandated by state and federal law. Report cases of disease to state and local health departments in accordance with state and local laws. The Bloodborne Pathogen Plan should be reviewed and updated annually.

The Immunizations Guide TAG is available for review/download.

Equipment and Supplies—ePRH 6.12, R14

Health and Wellness staff members are responsible for controlling access, inventory, and storage of medical and dental supplies and equipment. Most commonly used medications and supplies should be limited to no more than a three-month inventory.

Centers shall purchase equipment and supplies from government supply service centers (GSA, HHS, VA), whenever possible. The Job Corps List of Preferred Medications is based on the HHS Supply Service Center Medical Supply Catalog. While not considered an exclusive formulary, this list includes cost-effective choices for commonly prescribed medications.

The Job Corps List of Preferred Medications and the Job Corps Suggested Equipment and Supplies are available for review/download.

Continuous Quality Improvement—ePRH 6.12, R15

Quality improvement activities should focus on improving performance as well as compliance with the standards of care. These activities are essential to managing and improving the care provided to the students by the HWC. Consider the following when establishing a continuous quality improvement system on your center:

  • Seek feedback from students through surveys.
  • Utilize the Student Government Association's Health and Wellness Committee to develop a quality management system that works for your center.
  • Establish ongoing processes to assess effectiveness of current treatment protocols.

The Health & Wellness Student Satisfaction Survey and the Quality Assurance Health Record Audit Form are available for review/download.

Monthly Meetings with Center Director—ePRH 6.12, R16

As Center Physician, you and the CMHC are required to meet monthly with the Center Director to discuss clinical and organizational issues. During these meetings, trends in student health needs can be recognized and addressed, changes or modification to the HCGs for staff can be discussed and approved, and health-related policies can be reviewed. Meeting minutes should include documentation of attendees and items discussed.

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Part 4: Additional Requirements

Although the majority of your responsibilities are found in ePRH-6, sections 6.10 through 6.12, several other areas of the ePRH may require your attention.

Wellness Education—ePRH 3.17, R1

During the Career Development Period (CDP), students receive instruction on a variety of health topics including emotional and social well-being, depression, STIs, and nutrition and fitness. You are encouraged to participate in student health education as an occasional guest instructor as time permits.

Standard/Center Operating Procedures—ePRH 5.1, R3

A standard/center operating procedure (SOP/COP) is an established procedure to be followed in carrying out a given operation or in a given situation. All SOPs/COPs should be center specific and individualized. It is recommended that your center have a SOP/COP for each health- and wellness-related ePRH component and additional procedures for specific center policies (e.g., filling a first aid kit, dispensing medicine). Requirements for SOPs/COPs vary among centers and center operators.

SOPs/COPs should:

  • Reflect current ePRH information and be updated anytime there is a change in policy or practice.
  • Include a reference to the corresponding ePRH component.
  • Provide a detailed, step-by-step approach to complying with the ePRH requirement or performing the center practice.
  • Reference center-specific forms, if applicable.

Management and Reporting of Significant Incidents—ePRH 5.5

A Significant Incident Report (SIR) is a detailed report submitted by center staff documenting Job Corps-related significant incidents (e.g., serious injury, assault, death). The purpose of these reports is to ensure proper and effective management of serious incidents involving students, staff, or facilities.

All Job Corps centers are required to submit a SIR within 24 hours of the center being made aware of the incident (6 hours in the case of student or reportable staff death). SIRs must be submitted within this timeframe even if all information has not yet been gathered or a resolution has not yet been determined.

Minimum Staff Qualifications—ePRH Exhibit 5-3

All Health and Wellness staff must meet minimum education and licensure qualifications, which can be found in epRH Exhibit 5-3, Minimum Staff Qualifications.

Required Staff Training—ePRH Exhibit 5-4

All Job Corps employees are required to complete trainings when they begin employment. Some trainings, such as HIPAA, CPR/first aid, and bloodborne pathogens, etc., must be repeated annually.

In addition to required training, all Job Corps employees are required to complete an additional 5 hours of adolescent growth and development training. This requirement may be met by attending Job Corps trainings and webinars or through training by outside professional organizations.

For additional information review ePRH Exhibit 5-4, Required Staff Training.

Student Enrollments, Transfers and Separations—ePRH 6.4

If a student transfers from one center to another and has received medical services, including mental health, oral health, and TEAP, the transferring center will provide a legible or typed summary note on the student's current status, medication, and treatment compliance at least 2 weeks prior to the student's arrival. The SHR must arrive at the time of student arrival.

Disability Program—ePRH 6.14

Because it is a federally funded training program, Job Corps is required to ensure its program and facilities are accessible and provide reasonable accommodation to individuals with disabilities to prevent discrimination on the basis of disability. Each center should have Disability Coordinators who ensure the center is providing services to students with disabilities as required by the ePRH and Workforce Innovation and Opportunity Act (WIOA) regulations.

Guidelines for providing reasonable accommodation are outlined in ePRH Appendix 605 and on the Job Corps Disability website.

For additional information visit the Job Corps Disability and/or the Learning Disabilities website.

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1 Four hours/100 students/week is the minimum required level of physician coverage for centers with a capacity of 2,000 or fewer students. Centers with a capacity greater than 2,000 students are not required to have more than 80 hours of physician coverage. Up to 2 hours/100 students/week of required physician hours can be assumed by a Physician Assistant (PA) or Nurse Practitioner (NP) to provide routine medical services within the licensee’s scope of practice and supervision requirements. The terms of supervision, where applicable, must be outlined in a collaborative agreement and contracts for the Center Physician and the NP/PA. The Center Physician/PA/NP may not serve as both the Center Physician/PA/NP and the Health and Wellness Manager.
Regional Office waivers may be requested based upon NP/PA availability or variations in the state’s nurse practice act regarding NP supervision.