Policies and procedures for center Health and Wellness programs are defined and clarified in several documents:
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:
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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The mission of Job Corps is to:
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.
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:
The National Office, Health Support Contractor, and Accommodation Support Contractor guide the operation of center Health and Wellness and Disability Programs as follows:
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:
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.
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.
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.
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.
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.
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.
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.
The Job Corps Health Questionnaire (ETA 6-53), Job Corps Health History Form and instructions, and the Job Corps Physical Examination Form are located here on the Document webpage.
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:
The Job Corps Immunization Record Form, Hepatitis B Vaccine Series Consent/Declination Form, PPD Testing Form, and the Immunizations and Communicable Disease Control TAG are located on the Immunization webpage.
(The center physician may choose to continue screening for syphilis on entry if there is a significant prevalence in the center population.)
Within 48 hours after arrival
Females age >21 years (unless documented Pap smear results within 24 months before arrival on center)
Within 14 days after arrival
All females; perform on urine if age < 21 years.
Within 48 hours after arrival (or at time of pelvic exam if age > 21 years).
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.
Emergency care is defined as immediate care provided in a life-threatening situation . A 24-hour emergency care system must be provided.
Other Services Provided
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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.
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:
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:
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.
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.
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:
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.
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.
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.
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.
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.
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.
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.
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.
If a Job Corps student experiences a medical emergency or unanticipated serious illness requiring off-center treatment:
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.
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.
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 (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:
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.
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:
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 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:
Any student receiving a medical separation is eligible to reapply to Job Corps one year following the date of his/her separation.
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.
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.
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.
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.
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:
The Health & Wellness Student Satisfaction Survey and the Quality Assurance Health Record Audit Form are available for review/download.
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.
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.
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.
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.
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.
All Health and Wellness staff must meet minimum education and licensure qualifications, which can be found in epRH Exhibit 5-3, Minimum Staff Qualifications.
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.
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.
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.