Surviving the Health and Wellness ROCA

1. Surviving the Health and Wellness ROCA Dallasedition Presented by Melissa Lorenzo, MPH Senior assessor, humanitas

2. Overview Background: What is Humanitas’ role? Pre-ROCA: Preparing for ROCA ROCA: On-site assessment activities Post-ROCA: Report release and Corrective Action Plan process ROCA Scores Tips for surviving your next ROCA

3. What is Humanitas’ Role? • Role of Health Support Contractor – • Works directly with the National Office • Provides support to all Regional Offices • Provides support to all centers by helping to develop and enhance center health and wellness services

4. Examples of Support Develop policy Provide education and training Provide technical assistance Review programs… ROCAs!

5. Humanitas’ Role on ROCAs Two health assessors conduct Health and Wellness Portion of the ROCA. Assessors will review all program components in 6.10 – 6.12 over the past 12 – 24 months Assessors on center 2-3 days Provide written report with findings

6. Who’s Who? Assessors: Lois Sacher, RN Pat Jackson, RN Cheryl Walker, APRN, MSN, MBA Gary Strokosch, MD Melissa Lorenzo, MPH

7. Who’s Who? • Region 1 – Boston Shannon Bentley, RN John Kulig, MD, MPH David Kraft, MD, MPH Maria Acevedo, PhD Kevin Avery, DMD, PhD Diane Tennies, PhD • Region 2 – Philadelphia Shannon Bentley, RN Teresa Lowery, MD, MPH Valerie Cherry, PhD Kevin Avery, DMD, PhD Diane Tennies, PhD • Region 3 – Atlanta Melissa Cusey, RN Teresa Lowery, MD, MPH Suzanne Martin, PsyD, MPH Kevin Avery, DMD, MPH Christy Hicks, MSW Region 4 – Dallas Shannon Bentley, RN Drew Alexander, MD Lydia Santiago, PhD Kevin Avery, DMD, MPH Christy Hicks, MSW Region 5 – Chicago Melissa Cusey, RN Gary Strokosch, MD Helena Mackenzie, PhD Pamela Alston, DDS, MPP Christy Hicks, MSW Region 6 - San Francisco Melissa Cusey, RN Sara Mackenzie, MD, MPH Vicki Boyd, PhD Pamela Alston, DDS, MPP Diane Tennies, PhD

8. Significance of ROCAs Helps identify problems on center level Influence policy Assess impact Shapes training

9. Pre-ROCA: Preparing for the Review • Center will receive Notice from Regional Office followed by an email from lead health assessor regarding the Health and Wellness Review • Email will include the dates the health assessors will be on center (2-3 days) • The following information is requested prior to the arrival of the assessors on center: • A schedule of when the subcontractors are on center • Pre-ROCA forms listed on the Job Corps Community Website

10. Pre-ROCA: Preparing for the Review Pre-ROCA Forms can be accessed on CITRIX > Job Corps Community Website > Health and Wellness > Documents > Pre-Arrival ROCA Tools

11. Pre-ROCA: Documents that will be reviewed • List of best practices (3-5) • Bloodborne Pathogen Plan • CLIA certification (if applicable) • Credentials for wellness staff • Certifications • Liability insurance • Licenses • Sub-contracts • Waivers, if applicable • HEALs Program Evaluation • Making the Grade • Health Care Guidelines (HCGs) • Health-related Standard Operating Procedures • Logs/Spreadsheets • CA-1/injury log • HIPAA disclosures • MSWR phone contact • Narcotics log • Refrigerator temperature monitoring • Sharps exposure • Spore testing log

12. Pre-ROCA: Documents that will be reviewed • Meeting minutes • HEALs meeting minutes • Monthly meeting with Center Director, Center Physician, CMHC • Quarterly SART meeting • Schedule of meeting times • SGA wellness committee • Wellness staff meetings • Memoranda of Understanding • MSWRs (past year) • Materials Safety Data Sheet (MSDS) • Personal authorizations • Quality assurance • Student Surveys • CQI studies • Reports/Surveys • Annual H&W Program Description • Assessments (most recent corporate and self review) • H&W quality assurance surveys/results • Health Services Utilization Report • Student Satisfaction Survey • Quarterly Alcohol Summary (past year) • SIRs (including nonmedical, past year) • Staff roster (all center staff, positions included) • Staff training hours (from HR including CPR/First Aid, Bloodborne Pathogens, HCGs) percent of total staff trained, and of those not trained who are essential staff

13. ROCA: On-Site Activities • Brief – In • Meet with HWM and Center Director • Student health records • Will be randomly selected • Documents listed above will be reviewed • Staff interviews • HWM, center physician(s), center dentist(s), CMHC, TEAP Specialist(s), family planning coordinator, SART coordinator/committee, HEALs coordinator/committee (recreation manager and food service manager), center nurses, dental hygienist, dental assistant, etc.

14. ROCA: On-Site Activities • Individual student interviews • Student Focus Group • Students will be randomly selected or health assessors will request for certain students to participate • Observation of select staff meetings • Brief – Out • Brief summary of findings from the ROCA • Center Director, HWM, Project Manager, ROCA Team Lead, corporate representatives

15. Post-ROCA: Reports • Timeline • Multi-tiered review process: Health Support Contractor > Lead Health Specialists > National Office • Released approximately 30 days after ROCA • Definitions • Weakness/Concern – refers to components that are non-compliant with the PRH. • Strengths – refers to Best Practices that go above and beyond PRH requirements. • Observations – suggestions that can improve quality of program.

16. Post-ROCA: Corrective Action Plan • Corrective Action Plan (CAP) process • Center must submit a CAP to the Regional Office 45 days after the ROCA report is released • CAP should address impact of ROCA • Regional health specialists, not assessors, who review and approve the CAP • If CAP is not received in 45 days, the National Office will be notified • General follow-up

17. Scoring Job Corps uses a Program Rating System (PRS) as a qualitative measure of performance for center/OA/CTS operations (PAG, pg 4, Aug 2008).

18. Scoring • PRS Rating Definitions: • Exceptional (8-9) – 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. • Very Good (6-7) – 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.

19. Scoring • PRS Rating Definitions cont’d: • Satisfactory (4-5) – Requirement 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. • Marginal (2-3) – Requirements and/or quality assurance 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. • Unsatisfactory (0-1) – 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.

20. ROCA Scores: Compliance Dallas: 4.6 versus National: 4.7

21. ROCA Scores: Quality Dallas: 5.0 versus National: 4.9

22. ROCA Scores: Overall Dallas: 4.8 versus National: 4.8

23. Tips for surviving your next ROCA Review Webinars: Preparing for the Health and Wellness ROCA and ROCA Common Concerns Review common concerns, particularly easy fixes, make sure they are done! Have pre-ROCA forms complete and available to assessors prior to ROCA List Best Practices! Participate on monthly conference calls Maintain a relationship with your nurse specialist! Document, document,DOCUMENT!

24. Questions? Contact information: Melissa Lorenzo, MPH Melissa.lorenzo@humanitas.coM