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 6.10 STUDENT HEALTH SERVICES

 
 

 Purpose

 

P1. To assist students in attaining and maintaining optimal health by providing basic on-center health services to include promotion, prevention, assessment, intervention, treatment, and follow-up.

P2. To educate students on how to maintain a healthy lifestyle, which will contribute to their ability to retain employment.

 

 Requirements

 

R1. Health and Wellness Program (See Exhibit 6-4, Job Corps Basic Health-Care Responsibilities)

Centers must provide basic medical services to students. (NOTE: For a description of basic services, refer to Exhibit 6-4, Job Corps Basic Health-Care Responsibilities.) The Health and Wellness Program must include the following components:

a. A cursory health evaluation, laboratory testing, and a medical history within 48 hours of arrival on center. (NOTE: Reinstated and transfer students are exempt from the cursory health evaluation/physical examinations.​) The medical history must be documented on the Job Corps Health History Form. The cursory health evaluation and medical history must be conducted by a qualified health professional designated by the Center Physician.

b. A complete entrance physical examination[3] and a review of the medical history within 14 days. (NOTE: Near and distant vision screening, color vision screening, and hearing screening shall be part of the entrance physical examination.​) The cursory evaluation, with the exception of the required entrance laboratory testing, may be omitted if the physical examination is conducted within 72 hours of a student’s arrival on center. The physical examination must be provided by a qualified health professional and documented on the Job Corps Physical Examination Form. (NOTE: As determined by the center physician who authorizes the activity by a written personal authorization.​)

1. When indicated, the center must furnish one pair of glasses that meet American National Standards Institute (ANSI) standards.

2. Contact lenses must be provided if clinically indicated. Students who lose or damage glasses provided by Job Corps must replace them at their own expense.

3. Students identified as having chronic health problems during the cursory or entrance physical must be monitored as directed by the Center Physician or other appropriate center health-care provider.

c. Laboratory tests within the time frames shown below:

Entrance Laboratory Testing Requirements

Required Time Frame

HIV Antibody Test

Within 48 hours after arrival

(see waiver condition, Section 6.12, R7)

Syphilis Serology

Optional. (NOTE: 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

(Males Only)

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

(Females Only)

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 younger than 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)

 

d. 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 staff on entry to determine currency of immunizations. Centers must immunize students for the following as directed by the Office of Job Corps:

1. Immunizations or boosters if the following immunization series are incomplete or if current immunization records cannot be produced:

(a) Tetanus and diphtheria toxoid (Td) or Tetanus-diphtheria-acellular pertussis (Tdap)

(b) Inactivated polio vaccine (IPV) for students younger than 18 years

(c) Measles, mumps, and rubella vaccine

2. Hepatitis B vaccine series

At a minimum, Hepatitis B vaccine must be provided to health personnel and health occupations training students. Vaccination consent/declination must be documented in the staff member’s personnel file or student health record. Vaccination of health occupations training students must begin six weeks prior to on-site clinical work experience.

Refer to the Immunizations and Communicable Disease Control Technical Assistance Guide (TAG) for optional immunizations (e.g., influenza vaccine) that may be recommended but not required by the center physician, based upon availability.

Centers should utilize the Vaccines for Children program to provide immunizations for eligible students according to the latest Centers for Disease Control and Prevention (CDC) guidelines.

e. A tuberculosis skin test (Mantoux) is required of all new students who do not have documented proof of a previous negative Mantoux test taken within the last 12 months. Annual tuberculin testing should be done for students in health occupations and for students at increased risk of infection. In addition, students in health occupations must receive a Mantoux test prior to clinical work experience in accordance with state or local health department requirements.

Results of tuberculin skin testing should be interpreted without regard to a prior history of BCG vaccination.

Refer to Treatment Guidelines in the Health-Care Guidelines TAG, for management of students with a positive Mantoux test.

f. A daily walk-in clinic outside of the training hours for students to receive routine health care.

g. An inpatient unit (during office hours) for minor conditions, such as respiratory infections or flu symptoms.

h. 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 must be used to manage common acute and chronic conditions.

i. Access to prescription medications.

j. An off-center specialist referral system.

k. A 24-hour emergency-care system, to include on-center CPR and first aid and written referral plan or agreement for off-center medical, oral health, mental health, substance use, and inpatient care.

l. Explain and have the student sign, on the first visit to health services, the notice describing how medical information about students may be used and disclosed, and how students can get access to this information (see Exhibit 6-10, Notice of Medical Information Use Disclosure, and Access​).

R2. Oral Health and Wellness Program (See Exhibit 6-4, Job Corps Basic Health-Care Responsibilities)

Centers must provide basic dental services, as described below:

a. The general emphasis of the Oral Health and Wellness Program must 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).

b. A dental readiness inspection must be completed within 14 days after arrival by the center dentist or designee as determined by the center dentist who authorizes the activity by a written personal authorization. The dental readiness inspection must be documented in the appropriate section on the Job Corps Physical Examination Form.

c. An elective oral examination, including bitewing X-rays, priority classification, and treatment plan, must be completed and recorded on the Job Corps approved oral examination form by the center dentist upon student request as a follow up to the dental readiness inspection. The X-ray images should be securely stored as part of the student’s health record.

d. Dental procedures to treat oral disease and correct oral health conditions that may represent employability barriers, to include: restorations, extraction of pathological teeth, root canal therapy on anterior/other strategic teeth, replacement of missing upper anterior teeth with a removable prosthesis, and dental hygiene treatment for periodontal disease.

e. Written referral plan or agreement with community facilities for emergent or urgent conditions treatable beyond the expertise of a general dentist.

f. Job Corps shall not pay for student orthodontics. Applicants with orthodontic appliances must furnish:

1. Proof of orthodontic care visits during previous three months consistent with orthodontic treatment plan.

2. Proof that a treatment plan is in place for continued care.

3. A signed agreement that the cost of continued treatment and transportation related to treatment will be borne by the student, parent, or legal guardian.

4. A signed agreement by the applicant (parent/guardian of a minor) that he or she will remain compliant with orthodontic care and schedule all orthodontic appointments such that he or she will not exceed authorized leave limits for elective dental treatment.

R3. Mental-Health and Wellness Program (See Exhibit 6-4, Job Corps Basic Health-Care Responsibilities)

Centers must provide basic mental-health services as described below:

a. The general emphasis of the Mental-Health and Wellness Program must 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 program uses an employee assistance program approach that includes short-term counseling with an employability focus, referral to center support groups, and crisis intervention.

b. Assessment and possible diagnosis, to include:

1. Assessments and recommendations for Job Corps applicants;

2. Review of Social Intake Form (SIF) or intake assessment performed by counseling staff of students who indicate mental-health history, current mental-health problems, or who request to see the Center Mental-Health Consultant within one week of arrival;

3. Mental-health assessments and recommendations for referred students. Students who are assessed as a safety risk to self or others must be continuously supervised, until their case is resolved. Disposition should occur as soon as possible;

4. Determination when a MSWR or medical separation is appropriate and recommended for students with mental health conditions and/or substance use co-occurring conditions.

c. Mental health promotion and education, to include:

1. Minimum of a one-hour presentation on mental-health promotion for all new students during the Career Preparation Period with an emphasis on employability:

(a) Presentations must explain the Mental-Health and Wellness Program, what services are available, and how to make a self-referral.

(b) Students will learn basic skills in identifying and responding to a mental-health crisis.

2. At least one annual center-wide mental-health promotion and education activity

3. Clinical consultation with the Center Director, management staff, and Health and Wellness Manager regarding mental health-related promotion and education efforts for students and staff

4. Coordination with other departments/programs on center, including, but not limited, to residential, recreation, student government association, and HEALs, to develop integrated promotion and education services

d. Treatment, to include:

1. Short-term counseling with mental-health checks as needed. The focus of these sessions should be on retention and behaviors that represent employability barriers;

2. Collaboration with TEAP specialist for short-term counseling of students with co-occurring conditions of mental-health issues and substance use;

3. Collaboration with center physician and Health-and-Wellness staff on psychotropic medication monitoring of stable students, with the advice of consulting psychiatrist, if appropriate;

4. Collaboration with counseling staff in developing and/or leading psycho- educational skill-building groups to promote wellness (e.g., relaxation training, anger management, mood regulation, assertiveness skills, handling relationships, sleep hygiene, etc.);

5. Information exchange through regular case conferences between the Center Mental Health Consultant, counselors, and other appropriate staff based on individual student needs;

6. Crisis intervention, as needed. In the event of a mental health emergency, the Center Mental-Health Consultant or the Center Physician must conduct a mental health evaluation as soon as possible, and when necessary, refer the student for psychiatric care. If the Center Physician or Center Mental-Health Consultant is not available, the student must be referred immediately to the emergency room of the nearest medical facility. If there is a life-threatening situation, 911 or the emergency response team should be called;

7. Referral to off-center mental-health professionals or agencies for ongoing treatment and/or specialized services; 

8. A written referral/feedback system must be established and documented in the student-health record.

 

 Exhibits

 
  
Exhibit 6-4 Job Corps Basic Health Care Responsibilities
Exhibit 6-10 Notice of Medical Information Use, Disclosure, and Access