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 6.11 RELATED HEALTH PROGRAMS

 
 

 Purpose

 

P1. To provide prevention and intervention services and short-term treatment that will enhance student participation in the program and employability.

P2. To promote healthful choices that will have a positive impact on student physical and emotional well-being.

P3. To provide students with information and skills that will allow them to make appropriate choices regarding their health care needs, and to demonstrate acceptable workplace behavior that will enhance their opportunity for employment.

 

 Requirements

 

R1. Trainee Employee Assistance Program (TEAP) (See Exhibit 6-4, Job Corps Basic Health-Care Responsibilities)

Centers must provide basic TEAP services, as described below:

a. The general emphasis of TEAP must be on prevention, education, identification of substance use problems, relapse prevention, and helping students overcome barriers to employability.

b. Substance use prevention and education, to include:

1. Minimum of a one-hour presentation on substance use prevention for all new students during the Career Preparation Period. This presentation must explain (1) TEAP prevention, education, and intervention services, (2) Job Corps drug and alcohol testing requirements and procedures, and (3) the consequences of testing positive for drug or alcohol use while in Job Corps

2. Presentation(s) on managing substance misuse, abuse, and dependency symptoms and issues in the workplace for students during the Career Development and Transition Periods

3. At least three annual center-wide substance use prevention and education activities

4. Clinical consultation with Center Director, management staff, Center Mental Health Consultant, and Health and Wellness Manager regarding substance use prevention and education efforts for students and staff

5. Coordination with other departments/programs on center, to include, but not be limited to, residential, recreation, student government association, and Healthy Eating and Active Lifestyles (HEALs), to develop integrated prevention and education services

c. Assessment for identification of students at risk for substance use problems to include:

1. Review of Social Intake Form (SIF) or intake assessment of all students performed by counseling staff within one week of arrival

2. Formalized assessment measures (e.g., SASSI3 or SASSIA2), and clinical judgment to determine students’ level of risk for substance use

3. Collaboration with the Center Mental Health Consultant to determine when a MSWR or medical separation is appropriate and should be recommended for a student with substance use conditions (see R1, e5 below)

d. Intervention services for students identified at an elevated risk for substance use, to include:

1. Individual and group intervention services with a focus on behaviors that represent employability barriers

2. Collaboration with the Center Mental Health Consultant for students with co-occurring conditions of mental health issues and substance use

3. Referral to off-center substance abuse professionals or agencies for ongoing treatment and/or specialized services. Any student separating from Job Corps who has a substance use condition must be provided with a referral for support services in his or her home community

e. Drug and alcohol testing

1. Drug testing procedures:

(a) Students in the following categories must be tested for drug use:

(1) New and readmitted students must be tested within 48 hours of arrival on center.

(2) Students who tested positive on entrance must be retested between the 37th and 40th day after arrival on center.

(3) Students who are reasonably suspected of using drugs at any point after arrival on center must be tested; this testing must take place as soon as possible after staff suspects use. (NOTE: Reasonable suspicion is context specific, supported by specific and articulable facts, and may include (1) direct observation of drug use or behavioral signs or symptoms suggestive of drug use, or (2) specific reliable information that a student recently used drugs.)

(b) Biochemical testing is never permissible on a random basis, with the exception of designated licensed student drivers who are subject to 49 CFR Part 391 DOT Federal Motor Carriers Safety Administration. In addition, biochemical testing requested by work experience sites, union trades, or potential employers may only be performed by the requesting entity.

(c) If a student refuses to provide a specimen or has an unexcused absence from his or her follow-up drug test, he or she shall be presumed guilty of the Level I infraction Drugs: Use of drugs as evidenced by a positive drug test. Students who state they are unable to produce a specimen must be referred to the center physician or designee for follow up.

(d) Collection of urine for drug testing must be in accord with chain-of-custody principles and conducted by health and wellness staff or a staff member trained in urine collection procedures.

(e) The Job Corps nationally contracted laboratory must be used for all required drug testing. On-center urine drug testing is prohibited.

(f) Reinstated students cannot be subject to entry drug testing upon return to the center. Transfer students cannot be subject to drug testing upon arrival at receiving center. Both reinstated and transfer students shall be subject to testing for drugs upon suspicion of use only.

2. Alcohol testing procedures:

(a) Students who are reasonably suspected of being intoxicated or consuming alcohol on center or under center supervision must be tested; this testing must take place immediately after staff suspects use. (NOTE: Reasonable suspicion is context specific, supported by specific and articulable facts, and may include (1) direct observation of alcohol use or behavioral signs or symptoms suggestive of alcohol use, or (2) specific reliable information that a student recently used alcohol.​)

(b) Centers must use devices that measure alcohol in the breath or saliva (e.g., breathalyzers or alcohol test strips/tubes/swabs). Alcohol testing must only be administered by a staff member trained in the use of these testing devices. All testing must be documented and the results submitted to the health and wellness center.

(c) If a student refuses to submit to a breathalyzer or provide a sample for alcohol testing, the student shall be presumed guilty of the Level I infraction Alcohol: Possession, consumption, or distribution while on center or under center supervision.

3. Students testing positive for drug or alcohol use:

(a) New students and readmitted students not previously separated for drug use (ZT separation code 5.2a); possession, use or distribution of drugs on center or under center supervision (ZT separation code 5.2b); possession, consumption, or distribution of alcohol while on center or under center supervision (ZT separation code 5.1b); or abuse of alcohol (ZT separation code 5.1b) who test positive on entry must receive intervention services and a follow-up drug test. The results of the follow-up drug test must be received on center prior to the end of the intervention period.

To remain in the program, students who test positive on entry must have a negative drug-test result at the end of the intervention period.

If an intervention period takes place during a center vacation period (i.e., winter break), the intervention period is suspended and resumes the day the student is scheduled to return to the center (e.g., if a student is on day #30 of his or her intervention period at the time of the center vacation, the day count will be suspended at 30 days, and resume as day #31 the day he or she is due back on center). If a student does not report to the center on the day he or she is expected to return, the intervention period still resumes and the student is labeled an Unauthorized Absence.

Students who are an Unauthorized Absence on the day of their scheduled follow-up drug test shall be presumed guilty of the Level I infraction Drugs: Use of drugs as evidenced by a positive drug test.

(b) Readmitted students previously separated for drug use (ZT separation code 05.2a) that test positive on entry or any time during their second enrollment at Job Corps must be separated immediately without an intervention period. Such students shall not be allowed to reapply to Job Corps.

(c) Students who test positive for drug use by an off-center facility must be retested on center using the Job Corps nationally contracted laboratory as soon as possible, to include:

(1) Work-based learning students who tested positive on a drug test administered by experience sites, union trades, or potential employers;

(2) Students who tested positive on a drug test administered at a referral health facility (e.g., hospital emergency department, urgent care facility).

This retest by the Job Corps nationally contracted laboratory must be classified as a suspicion-of-drug-use test. For students who test positive for drug use on this retest, centers must follow the same procedures outlined in (c) above.

(d) Student drivers who test positive for drug use under 49 CFR Part 391 DOT Federal Motor Carriers Safety Administration must follow the same procedures outlined in (c) above for positive suspicion tests. In addition, during the intervention period, student drivers who fall under DOT regulations are not permitted to drive.

(e) Students who test positive for alcohol use on suspicion must be referred to the TEAP specialist for assistance and the center’s student conduct system for disciplinary action.

4. Student notification of drug or alcohol test results

(a) Students who test positive for drug use must be informed of their results by the TEAP specialist, Center Physician, or designee within 24 hours of receipt of positive result, or as soon as possible, given staff and student availability. Minor student’s parent/guardian must be notified of positive test results as required by applicable state laws for the state in which the center is located.

(b) Alcohol test results must be provided to the student by the person administering the test.

(c) Drug and alcohol test results must be shared only with center personnel who have a need to know for purposes of discipline, counseling, administration, and delivery of services (in accordance with 42 CFR, Part 2).

(d) If a student questions the validity of a confirmed positive drug test, he or she must be referred to the Center Physician or designee for counseling.

5. Medical Separations with Reinstatement Rights (MSWR) for substance use conditions:

(a) Students may be given a MSWR for a diagnosed substance use condition, allowing the student to return to Job Corps to complete his or her training within 180 days. To return to Job Corps, proof of treatment completion from a qualified provider must be received.

(b) A MSWR for substance use conditions can only be given if the following conditions are met:

(1) The TEAP specialist and Center Director agree that the student has a diagnosed substance use condition.

(2) There is a documented assessment of the student’s diagnosed substance use condition by the TEAP specialist in collaboration with the center mental health consultant.

(c) A MSWR cannot be granted in lieu of ZT separation when a positive follow-up test is reported during the intervention period.

(d) If a student is placed on a MSWR during the intervention period, the intervention period is suspended and resumes the day the student is scheduled to return to the center.

R2. Health Aspects of Sports

a. All students participating in organized contact or rigorous sports (e.g., football, basketball, boxing, and running) must be medically cleared by a health professional prior to participating. Physical examinations performed by center health personnel within one year of the organized sports activity can fulfill this requirement, at the discretion of the Center Physician. After one year, a current physical examination is required.

b. A staff member trained in CPR/first aid, with specific authorization in the center’s standing orders, must be present at all organized contact or rigorous sports activities, including practice sessions and sports events.

c. At a minimum, staff certified in CPR/first aid must be present at all student boxing events and contact football games.

d. In case of possible emergency, adequate transportation must be on the scene of all center-sponsored organized sports.

R3. Tobacco Use Prevention Program (TUPP)

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 must be appointed (he or she need not be a health services staff member). At a minimum this program must include:

a. Educational materials and activities that support delay and/or cessation of tobacco use

b. A smoke-free, tobacco-free environment that prohibits the use of all tobacco products in center buildings and center-operated vehicles

c. Designated outdoor smoking areas located a minimum of 25 feet, or as required by state law, away from the building entrance

d. Prohibition of the sale of tobacco products on center

e. Adherence to federal and state laws regarding the use of tobacco products by minors

f. Minors who use tobacco products must be referred to the TUPP

g. All services provided should be documented in the student health record

R4. Family Planning Program

a. A family planning program must be provided to all students on a voluntary basis. At a minimum, this program must include counseling, health promotion activities, and medical services, including birth control. The Center Director must appoint a staff member to implement and monitor this program.

b. Students who are pregnant and/or experiencing pregnancy-related medical conditions must 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.

c. Once a center learns that a student is pregnant, pregnancy-related services must include:

1. Prenatal services on center and/or in the community until separation, to include a comprehensive gestational record.

2. The Center Physician, in conjunction with an obstetrical/gynecological 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.

3. The center must identify available community health/social resources and services, and will make arrangements for transportation for the purpose of obtaining such resources and services consistent with PRH Chapter 6, Section 6.6, R4 (d). 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.

4. The center cannot 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. (NOTE: The Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 2014, Title 5, Sec. 507(a) (P.L. 113-76) provides that the prohibition on the use of Federal funds for abortions described in Section 506 “shall not apply to an abortion (1) if the pregnancy is the result of an act of rape or incest; or (2) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.”​)

5. A student that is experiencing a pregnancy-related medical condition may be placed on paid administrative leave in accordance with Exhibit 6-1 (see Pay status: Paid, Duty status: Not Present for Duty-Administrative Leave with Pay).

d. Pregnancy-related services must include information on the options of continuing or terminating the pregnancy.

e. If required by applicable state laws in which the center is located, the center must 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.

R5. HIV/AIDS

Centers must:

a. Test students for HIV infection under the following circumstances:

1. As part of the cursory medical examination (see PRH Chapter 6, Section 6.10, R1.c)

2. If a student exhibits signs and/or symptoms of a possible AIDS-related condition

3. Upon reasonable suspicion of student exposure to HIV

4. When student is diagnosed with a newly contracted sexually transmitted disease

5. Upon student request and after physician consultation

b. Submit specimens for HIV testing to the nationally contracted laboratory. Centers shall not be reimbursed for HIV tests performed at other than the nationally contracted lab.

c. Provide pre-test counseling, in accordance with state laws, to all students regarding the HIV test.

1. Counsel each student about the test and its implications and document in the health record that the student received the HIV pre-test counseling and signed the “HIV Testing Information Sheet” in Exhibit 6-12​

2. Student refusal (see PRH Chapter 6, Section 6.10, R1, b1)

3. Testing waiver (see PRH Chapter 6, Section 6.12, R7, Waiver of Medical Care​)

d. Provide post-test counseling, in accordance with state laws, to all students regarding HIV test results:

1. HIV Negative Students: Individually inform and counsel (e.g., measures to prevent HIV infection/transmission) all students with a negative HIV test result within 14 calendar days after receipt of test results.

2. HIV Indeterminate Students: Individually inform and counsel all students with an indeterminate HIV test result within five calendar days after receipt of test results. A student who has an indeterminate test result must be retested at three-month intervals until a conclusive test result (i.e., negative or positive) is obtained. If a conclusive result is not obtained within 6 months, no further testing is required.

3. HIV Positive Students:

(a) Inform and Counsel: Individually inform and counsel all students with a positive HIV test result, preferably within 24 hours, but not later than 5 calendar days, after receipt of the written positive result. The Center Mental Health Consultant must be in attendance to assist in informing and counseling.

(b) Contact Notification: HIV positive students must be instructed in how to notify their sexual contacts and intravenous drug contacts that they may have been exposed to HIV infection and to refer them for counseling and testing.

The Center Physician or designee must report the student’s HIV infection to the state and/or local health department, which will be responsible for contact notification both on- and off-center.

4. Students Off-Center: If a student is not on-center (e.g., Unauthorized Absence, Missing Minor Student, on leave) when his or her positive or indeterminate test result is received by the center, the Center Director or designee must make every attempt to contact and inform the student of his or her result. The health department at the student’s location must be used to assist with the task of informing students who are no longer on-center.

5. Document post-test informing and counseling activities in the student’s health record, including attempts to contact students not on-center (d.4 above).

e. Ensure that students who test positive for HIV infection are engaged in an interactive process to determine if an accommodation plan is needed (see center reasonable accommodation policy/process or national reasonable accommodation guidelines for specific requirements of accommodation process).

f. Ensure that students who test positive for HIV infection are engaged in case management for chronic illness on center.

g. Provide all students with information on HIV infection; including transmission and prevention (see PRH Chapter 3, Section 3.18, R1, and PRH Chapter 6, Section 6.12, R10).

R6. Sexual Assault Prevention and Response

Centers must:

a. Establish a program for sexual assault prevention, counseling, treatment, and follow-up care.

b. Develop a team response to sexual assault and involve center staff and outside resources.

c. Report sexual assaults:

1. To law enforcement authorities as required by state and local law

2. As significant incidents (see PRH Chapter 5, Section 5.5, Management and Reporting of Significant Incidents) in the SIR System

R7. Healthy Eating and Active Lifestyles

Centers must provide students with an environment that supports healthy eating and active lifestyles, and provide students with education and experiences that promote lifelong health and physical well-being. At a minimum, this program must include the following components:

a. Planning

1. Establish a Healthy Eating and Active Lifestyles Committee to oversee and coordinate this program. At a minimum, this committee must include the Health and Wellness Manager, Food Services Manager/Supervisor, Recreation Supervisor or Specialist, TEAP Specialist, Residential Manager/Counseling Manager, and student representative. 

2. Incorporate student interests and preferences when planning activities.

3. Demonstrate collaboration between various departments on center.

b. Environment

1. Provide a variety of fitness activities open to all students, as outlined in PRH Chapter 3, Section 3.19, R2.

2. Provide healthy eating selections and limit non-nutritious eating selections, as outlined in PRH Chapter 6, Section 6.7, R1​.

c. Education and counseling

1. Provide educational activities and materials to all students that support regular physical activity, nutrition, and achieving a healthy weight, as outlined in PRH Chapter 3, Section 3.18.

2. Provide individualized weight management programming and/or counseling. Student participation in this program is highly recommended.

3. Incorporate motivational interviewing and goal setting at student’s level of readiness for change.

d. Assessment

1. Documen​t, monitor, and assess program.

 

 Exhibits

 
  
Exhibit 6-1 Duty-Pay-Leave Status Chart
Exhibit 6-4 Job Corps Basic Health Care Responsibilities
Exhibit 6-12 HIV Testing Information Sheet
 

 Legal/CFR Requirements

 
  
49 CFR Part 391
42 CFR, Part 2