Policy & Directives

Job Corps Policy

• ePRH Chapter 5: Management, Exhibit 5-2 Plan and Report Submission Requirements
• ePRH Chapter 6: Administrative Support, 6.12 Health Administration, R9 Health Care Guidelines

Job Corps Directives

Information Notices

• IN 13-51 Updated Chronic Care Management Plans
  Release Date: April 10, 2014
• IN 08-02: Mental Health Chronic Care Management Plans
  Attachments: 08-02a, 08-02b, 08-02c, 08-02d, 08-02e, 08-02f, 08-02g, 08-02h, 08-02i, 08-02j, 08-02k
  Release Date: July 16, 2008

Introduction

Since most Job Corps centers only have the services of a health care provider¹ for a few hours each week, many health and non-health staff are called upon to assess medical, dental, and mental health problems, and even to provide treatment in the health care provider's absence. Thus, authorizations, health care guidelines, which include treatment guidelines for health staff and symptomatic management guidelines for non-health staff, chronic care management plans, and medication lists were introduced to help staff perform various health-related functions via specific written instructions. Modifications may be needed to meet individual state medical and nursing board regulations.

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 non-health staff with direction for action, especially when a member of the health services staff is not available or not on center.
• Avoid unnecessary emergency transport and visits to the emergency department.

1. All health care guidelines shall be approved and signed annually by the center physician, center mental health consultant (CMHC), and center dentist, as appropriate.
2. Current signed and dated health care guidelines shall be kept in the Health and Wellness Center (HWC).
3. Annually, each center shall 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 shall be sent to the regional office for approval. (Refer to ePRH-5: Exhibit 5-2, Plan and Report Submission Requirements, for reporting deadlines.)

This TAG provides the following administrative tools:

1. Treatment and Symptomatic Management Guidelines are directives that outline different points to consider and steps to take when the health or non-health staff is presented with a student's health problem. These guidelines specify the treatments to be administered or offered by a staff member. These guidelines also outline the steps to determine whether to refer a student to the center physician, off-site health professional, or emergency service.
2. Authorizations are directives that outline the limits of the health care activities that specific members of the staff are expected to perform in particular situations.
3. Chronic Care Management Plans are tools that have been developed to provide a systematic approach for the treatment of chronic diseases.
4. Medication Protocols include both prescription and non-prescription medications used to treat common medical, mental health, and oral health conditions in a cost-effective manner.

Health Care Guidelines

Health care guidelines are written directives that must be followed, especially when the health care provider is not present. This ensures that the health care provider knows and approves of how the staff will handle a problem. Health care guidelines should include the following:

• A signature and date when the guidelines were last reviewed; review treatment guidelines at least once a year at the time of contract anniversary for contract centers and at the beginning of the program year for civilian conservation centers, as well as when there is a health care provider change, to keep current.
• A signature or initial by all responsible persons (e.g., center physician, center dentist, CMHC, HWM) as appropriate.
• Clear and concise directions describing how and who is to handle the problem.

The health care provider and HWM, as appropriate, may adopt as written or modify any or all of the guidelines in this basic set.

After tailoring the guidelines to the center's specific needs, assemble one review package to send to the regional office for approval each year at the time of contract renewal for contract centers and at the beginning of the program year for civilian conservation centers. A review package should consist of a cover memo including:

• A listing of the health care guidelines that have been changed and copies of the modified guideline(s) attached for review. (Guidelines without change need not be sent for annual review.)
• The personal authorizations for new health staff members. If new health staff have been hired or a major change in authorizations has occurred, attach the modified (or new) authorization for review. Authorizations for new health staff should be completed and forwarded for review within 15 days after employment. Authorizations for non-health staff members do not have to be submitted, but should be kept on center readily available for use and review.

Contract centers should send this entire package to the Regional Office for review annually. Civilian conservation centers will send the review package through agency channels. The regional nurse specialist will review and recommend approval or modifications.

Treatment Guidelines for Health Staff are designed specifically to prescribe the most current and cost-effective medical and behavioral treatments for commonly encountered medical, dental, and psychological diagnoses seen in the Job Corps student population.

The health care provider should provide a diagnosis before the applicable treatment guideline is implemented. The person implementing a treatment guideline must have an authorization to do so.

Before administering any recommended medication, the student should be asked if he/she is allergic to that medication. If possible, also check the student's health record for similar information. If the student is allergic, refer to the alternate treatment in the treatment guideline or consult the center physician for guidance.

Medications administered as a single dose or prescribed over time must be carefully documented in the student's health record (dose, route of administration, frequency of administration, and duration of therapy). All medication orders should be signed by the center physician or advanced practice clinician (NP/PA).

In addition, any necessary follow-up plan should be detailed in the health record.

Such notes should be legibly signed by the administering person and may refer to the specific treatment protocol being used.

Symptomatic Management Guidelines

The symptomatic management guidelines for non-health staff are intended to assist non-health staff during hours when no health staff are present on center. They provide guidance on how to handle common symptoms without expecting the non-health staff to make a definitive diagnosis.

Symptomatic management guidelines also suggest parameters to follow about when to refer the student urgently to the on-call health staff or, if they are not reachable, to a local emergency response team or emergency center. At the direction of the on-call health staff, a stabilized student may also be referred to the next open time at the HWC. If the student's condition deteriorates prior to that time, this decision can always be changed.

Whatever action(s) is taken/not taken should be documented in writing and forwarded to the HWC the following day for inclusion in the student's health record (date, times, symptoms, over the counter medications given, person(s) contacted, and outcome).

If the student is transported off center for care, appropriate center staff should be notified promptly (health staff, center physician, CMHC, and/or center dentist). Consider notifying a family contact with the student's permission. If it is a serious event, also notify the center director.

The following list constitutes a basic set of symptomatic management guidelines for a center's non-health staff.

Non-health staff should not attempt to follow Treatment Guidelines unless a signed and dated authorization exists for the non-health staff member.

New non-health staff members must receive training in the use of symptomatic management guidelines within their first 90 days of employment and annually. New health and wellness staff members must receive training in the use of treatment guidelines within their first 90 days of employment. See ePRH Exhibit 5-4.

Authorizations

Authorizations are directives that outline the limits of the health care activities that specific members of the staff are expected to perform in particular situations.

Health and Wellness Staff

The health care providers will specify which tasks each ​health s​​taff member is authorized to perform. All health staff members will have personal authorizations on file in the HWC and in his or her personnel record.​

Non-Health Staff

The health care providers will specify which tasks each non-health staff member is authorized to perform after proper training.  A copy of each non-health staff member's personal authorization must be filed in his/her personnel record.

• Personal Authorization for Center Nursing Staff
• Personal Authorization for Advanced Practice Clinicians
• Personal Authorization for Non-Health Staff
• Personal Authorization for Center Dental Staff

Chronic Care Management Plans (CCMPs)

Chronic diseases have a major impact on the employability as well as morbidity and mortality of Job Corps students. ePRH-6: 6.10, R1(b3) states "Students identified as having chronic health problems during the cursory or entrance physical shall be monitored as directed by the center physician or other appropriate center health care provider." Chronic care management plans are tools that have been developed to provide a systematic approach for the treatment of chronic diseases. Chronic care management plans have been developed for the most common chronic diseases and disorders found in the Job Corps student population.

Medication Protocols

Medications should be stored and dispensed in accordance with federal and state practice acts/laws.  The appropriate Treatment Guidelines for Health Staff should be followed.  It is the responsibility of the center physician and HWM to determine the security, accessibility, appropriate storage, and adequacy of medication supplies.

The non-prescription medications list contains a recommended list of medications that each center should make available to the non-health staff in residential areas so that symptomatic management guidelines can be instituted until the affected student receives treatment in the HWC.

Medications should be purchased through a government supply center, such as the Health and Human Services Supply Service Center (HHS SSC), whenever possible.

Forms & Documents

General

• Job Corps List of Non-Prescription Medications — August 2019
• Personal Authorization for Center Nursing Staff — January 2020
• Personal Authorization for Advanced Practice Clinicians — January 2020
• Personal Authorization for Non-Health Staff — January 2020
• Personal Authorization for Center Dental Staff — January 2020
• Review Package - Sample Memo to Regional Nurse Specialist

Technical Assistance Guide 

• ​Health Care Guidelines and Written Instructions TAG​​
  Release Date: September 2015

Training Slides

• Chronic Illness Case Studies
  Handout: Case Studies Scenarios
  Shannon Bentley, RN, Nurse Specialist, Humanitas, Inc.; Melissa Cusey, RN, Nurse Specialist, Humanitas, Inc.; Drew Alexander, MD, Medical Specialist, Humanitas, Inc.; Suzanne Martin, PsyD, Mental Health Specialist, Humanitas, Inc.; Christy Hicks, MSW, TEAP Health Specialist, Humanitas, Inc.; Pamela Alston, DDS, MPP, Lead Oral Health Specialist, Humanitas, Inc.

Webinar

• Health Care Guidelines: Successfully Implementing Treatment Guidelines and Symptomatic Management Guidelines
  Date: July 13, 2016
  Purpose: This presentation will provide an overview of health care guidelines (HCGs), including treatment guidelines (TGs) and symptomatic management guidelines (SMGs). Oneonta Job Corps’ health and wellness manager will provide an overview of a staff training program for implementing SMGs.
• Getting the Most Out of Chronic Care Management Plans
  Date: April 23, 2010
  Purpose: This presentation provides an overview of the chronic care management plan (CCMP) process to include initiating and updating CCMPs, highlight the importance of the CCMP in chronic disease education, and teach wellness staff to use a CCMP to aid students in maintaining or improving their health.