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Title: Home & Community Services Author: Chester County IU Last modified by: CCIU Created Date: 8/29/2012 5:30:45 PM Document presentation format – PowerPoint PPT presentation

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Title: Home


1
Home Community Services
  • Provider Orientation

2
Wraparound Services
  • Also known as BHRS (Behavioral Health
    Rehabilitative Services).
  • Current regulations regarding policy, role of
    staff, and supervision guidelines resulted from a
    lawsuit known as Kirk T, that was settled in 2001.

3
Wraparound Services
  • Who are they for?
  • -Any child or adolescent under the age of 21
    with an Axis I diagnosis
  • -Any child or adolescent presenting with a
    social, emotional or behavioral issue that
    substantially interferes with his/her functioning
    in family, school, or community activities

4
Wraparound Services
  • -What are they?
  • Services are based on Medical Necessity
  • Services are funded through the Department of
    Public Welfare (DPW) or, in some cases, by Act 62
    Insurance.
  • Services are designed to be short-term
  • Services are not intended for crisis situations
  • Services are based on the statewide CASSP
    Principles

5
CASSP
  • Child and Adolescent Service System Program
  • Child-centered
  • Family-focused
  • Community Based
  • Multi-system
  • Culturally competent
  • Least restrictive/least intrusive

6
Wraparound Services
  • Positive Approaches Principles
  • Two basic assumptions
  • people always have good reason to do what theyre
    doing
  • people always do the best they can with what they
    know in that context and at that point in time
  • -- Success is dependent upon building appropriate
    therapeutic relationships

7
Referral Process
  • Client must apply for Medical Assistance (MA)
    through the Department of Public Welfare (DPW).
  • If the client is eligible for Act 62 Insurance,
    the parent/guardian will contact their private
    insurance for additional information.
  • Client receives an axis I diagnoses such as PDD,
    ADHD, ODD, etc from a licensed Psychologist,
    Psychiatrist, or Physician.
  • The clients guardian contacts the county office
    of MHIDD (still known as MH/MR in some counties)
    or Managed Care Organization (MCO) to express an
    interest in receiving Wraparound Services.

8
Referral Process
  • A Core Provider is located.
  • An intake is done to determine the need for
    Wraparound Services.
  • A psychological evaluation is completed.
  • If services are found to be medically necessary
    then an Interagency Systems Planning Team Meeting
    (ISPT) is held and an approved provider of
    wraparound services is located.

9
Psychological Evaluation
  • Within the psychological evaluation
  • The types of services prescribed
  • TSS Therapeutic Staff Support
  • MT Mobile Therapy
  • BSC Behavior Specialist Consultant
  • CM Case Management
  • The hours recommended for each type of service
  • The goals for therapy
  • - The location of services

10
Interagency Team Meeting
  • ISPTs are held every 4 to 6 months.
  • The team will meet to discuss the recommendations
    in the psychological evaluation
  • The team will review and develop treatment
    recommendations
  • An authorization packet is generated and sent
    to the MCO which has 2 days to approve or deny
    the request
  • If the request for services is denied, the family
    has the right to file a grievance

11
Interagency Team
  • The team consists of
  • parent/guardian
  • provider of services
  • BSC (if identified)
  • MT (if identified)
  • Case Management Team
  • school representatives
  • client (if 14 and over)
  • MCO and/or County representative
  • Licensed Prescriber
  • Others involved with the welfare of the client

12
Interagency Team
  • Cross-Systems Initiatives
  • Office of Children and Youth and Families
  • Bureau of Drug and Alcohol Programs
  • Juvenile Justice System
  • School-Based Mental Health Services
  • Family Centers

13
Other Available Services
  • Resource Coordination
  • MH/IDD Case Management
  • Blended Case Management
  • Intensive Case Management services
  • Outpatient services
  • Student Assistance Program
  • Crisis Intervention Services
  • Family-Based Mental Health Service

14
Other Available Services
  • Partial hospitalization services
  • Therapeutic Foster Care
  • Residential treatment facilities
  • Psychiatric inpatient hospitalization

15
Wraparound and You
  • The Team

16
Who Are We?
  • As a TSS, BSC or MT, you will be providing
    services for Chester County Intermediate Units
    (CCIU) Home and Community Services program
    (HCS).
  • You were sent to us by CCRES, a staffing agency.

17
Who Are You?
  • When introducing yourself to families and other
    professionals, please say that you provide
    services for CCIU Home and Community Services.
  • REMEMBER WE ARE NOT CCRES!!!!

18
The Team
  • Behavioral Specialist Consultant
  • Therapeutic Staff Support
  • Behavioral Health Personal Care Assistant
  • Mobile Therapist
  • Case Management Team

19
Behavioral Specialist Consultant
  • The BSC is a masters or doctoral level mental
    health professional
  • Serves as the clinical team leader
  • Provides behavioral intervention consultation
    services to the treatment team
  • These services are generally designed to be
    consultative in nature, rather than direct
    service to the child or family

20
Behavioral Specialist Consultant
  • Responsibilities of the BSC include
  • Collaboration with other members of the treatment
    team
  • Develop and direct the implementation of a
    treatment plan
  • Monitor the effectiveness of the treatment plan
  • consultation with TSS on at least a bi-weekly
    basis
  • collaboration with other team members

21
TSS
  • The TSS provides one-to-one behavioral health
    interventions to a child or adolescent with
    serious emotional/behavioral disturbance.
  • TSS services are intended to prevent more
    restrictive services or out of home placement and
    to promote age-appropriate psychosocial growth
  • The TSS should work collaboratively with the
    parents, caregivers, teachers and other school
    personnel to transfer the skills and techniques
    needed to fulfill the goals of the treatment plan.

22
TSS
  • The TSS will produce daily documentation and
    collect data. All documentation and paperwork
    must be completed during prescribed scheduled
    time with client
  • The TSS should consult with the BSC at least on a
    bi-weekly basis

23
TSS
  • Appropriate roles for TSS include
  • Demonstrate alternative activities to redirect
    challenging behaviors
  • Demonstrate therapeutic structure and limits for
    the child
  • Demonstrate behavioral intervention plan for
    caregivers
  • Demonstrate positive relationships with parents,
    siblings, teachers, aides, and peers
  • Assist the parent/teacher in assuring safety to
    the child and others

24
TSS
  • Inappropriate roles for TSS include
  • Continued observation of the childs behavior w/o
    any planned follow-up intervention
  • Adding time with the TSS worker as a reward for
    good behavior or as a reward for the child
    controlling his or her outbursts
  • Providing services to children without knowledge
    and/or permission of the parent(s) or primary
    care giver(s)
  • Providing TSS services without appropriate
    supervision

25
TSS
  • Inappropriate roles for TSS include
  • Performing the duties of school personnel and/or
    academic tutoring
  • Providing services not included or specified in
    the treatment plan
  • Substituting for any type of caregiver
  • General child care or housekeeping
  • Therapeutic interventions not consistent with the
    treatment plan or goals

26
Behavioral Health Personal Care Assistant (BHPCA)
  • School Districts or Early Intervention (EI)
    Programs contract with Home and Community
    Services directly.
  • Rendered to students with both physical and
    mental/behavioral health needs.
  • Behavioral Health Personal Care Assistant is
    considered a one-on-one service but their skills
    may be used within the classroom/home as needed
    and some weekends if approved.
  • BHPCAs may provide services to more than one
    student in a given day, but not at the same exact
    time.
  • BHPCAs encourage and support students by
    utilizing behavioral interventions necessary for
    the students successful progress throughout the
    school day.

27
Behavioral Health Personal Care Assistant (BHPCA)
  • Examples of BHPCA Responsibilities
  • Assisting the student to use equipment including
    augmentative communication devices.
  • Monitoring the incidence and prevalence of
    designated health problems or medical conditions,
    e.g., seizure precautions or extreme lethargy.
  • Can do toileting including physical care if they
    are trained appropriately.
  • Accompanying students on school buses or other
    vehicles. A BHPCAs presence is necessary
    because of a students physical disability or
    mental health disability.
  • Basically, they can do anything a TSS can do plus
    all of the above.

28
Behavioral Health Personal Care Assistant (BHPCA)
  • BHPCA-Teacher-Child Communication
  • Staff work for the school and follow teacher's
    direction
  • Teachers need to deal directly with the student
    as they would with any other student in their
    class, and the BHPCA is there to support the
    child in following directions of the teacher.
  • The students need to learn to deal directly with
    the people in charge of the classroom and to
    decrease dependence on the BHPCA.
  • The BHPCA may remind the student what the teacher
    has said, or to redirect the child when off task,
    not following directions or not obeying the
    rules.

29
Mobile Therapist
  • The Mobile Therapist is a Masters level mental
    health professional that provides child-centered,
    family focused, face-to-face individual or family
    counseling services.
  • Mobile Therapy services are intended to support
    the child and family in coping with issues
    related to the childs diagnosis.
  • Mobile Therapy may extend to assist family
    members with issues related to the childs
    diagnosis/behavioral issues.
  • The child need not be present when other family
    members receive Mobile Therapy.
  • Mobile Therapist may not provide services to the
    same person at the same time as the TSS or BSC.
  • In some instances the Mobile Therapist may serve
    as the clinical leader, if no BSC is assigned to
    the case. In these cases, the MT is able to
    follow the same role and responsibilities of a
    BSC.

30
Mobile Therapist
  • Participants in mobile therapy sessions may
    include any of the following combinations
  • The child alone
  • The child and other members of the childs family
  • The child and teacher, and/or other school
    personnel
  • Mobile Therapy is not a crisis service.

31
Case Management Team
  • YOUR FIRST POINT OF CONTACT
  • Is who you contact when you have a problem or
    need to discuss concerns, etc.
  • Ensures that the multiple BHRS services are
    provided in a coordinated, timely and appropriate
    manner
  • Serves as a liaison between BHRS providers and
    team members, including the family
  • Completes and coordinates paperwork in order to
    obtain all authorizations
  • Facilitates the transition of families to other
    services OR supports as needed

32
Case Management TeamRoles
  • Each client is assigned to a specific Case
    Management Team, consisting of a Case Manager and
    a Case Specialist.
  • Although there may be some differences between
    the counties, the role of the Case Manager is
    generally to assist with clinical questions or
    concerns. The role of the Case Specialist is to
    staff each case and to be responsible for many of
    the administrative issues.
  • In case one member of the CM Team is not
    available, the other member can usually assist
    you or provide you with the next step to take.

33

Who Are Our Clients?
  • Children between the ages of 0-21
  • Focusing on stages of development and behavior in
    the domains of
  • Social
  • Cognitive/language
  • Emotional Development
  • Physical Development

34
About Our Clients
  • Autism Spectrum Disorders
  • DSM-5 299.00

35
About Our Clients
  • Criteria for Autism Spectrum Disorders
  • Deficits in social-emotional reciprocity
  • Qualitative impairment in nonverbal communicative
    behavior used for social interaction
  • Deficits in developing, maintaining, and
    understanding relationships
  • Restrictive, repetitive patterns of behavior,
    interests or activities including stereotypical
    motor movements, echolalia, scripting, insistence
    on sameness, difficulties with change and
    transitions, interests that are fixated and
    abnormal in intensity, and hyper or
    hypo-reactivity to sensory input (pain,
    temperature, sounds, smells, textures)

36
ASD
  • Symptoms must be present in the early
    developmental period
  • Symptoms cause clinically significant impairment
    in social, occupational or other important areas
    of current functioning
  • These disturbances are not better explained by
    intellectual disability or global developmental
    delay (although they may co-occur)

37
Severity Level ASD
  • Severity is based on level of impairment
  • Level 1 Requiring Support
  • Level 2 Requiring Substantial Support
  • Level 3 Requiring Very Substantial support

38
About Our Clients
  • Autism Facts
  • 3 out of 4 children diagnosed with Autistic
    Spectrum Disorder are male.
  • Most children are diagnosed prior to 3 years of
    age.
  • Clients with Level I ASD may do well
    academically, but have poor social skills (ex
    may have formerly been diagnosed as Aspergers
    Disorder.
  • 1 in 50 school-aged children are diagnosed with
    an Autistic Spectrum Disorder (US Centers for
    Disease Control Prevention, 2013)

39
Other Diagnoses
  • We also have clients who have been diagnosed with
    ADHD, Disruptive Behavior Disorders (Oppositional
    Defiant Disorder, Intermittent Explosive Disorder
    or Conduct Disorder) Obsessive-Compulsive and
    Related Disorders, Bipolar Disorder and Anxiety
    Disorders, among others.
  • Our online trainings on Moodle will provide you
    with information about some of these disorders.
    TSS and PCAs can begin taking elective trainings
    beginning with the next training year-- July 1st
    following the year in which they completed their
    6-month probationary requirements.
  • Example You are hired in September, 2013. You
    complete your probationary trainings in December,
    2013. Your probationary 6 months ends in March,
    2014. You do not begin taking any other
    trainings until July 1, 2014.

40
What Will You Be Doing?
41
Behavioral Interventions
  • Home and Community Services adheres to the
    philosophy of Applied Behavioral Analysis
  • the science in which procedures derived from
    the principles of behavior are systematically
    applied to improve socially significant behavior
    to a meaningful degree and to demonstrate
    experimentally that the procedures employed were
    responsible for the improvement in behavior.
    (Cooper, Heron, Heward, 1987)

42
Behavioral Interventions
  • Principles of Challenging Behaviors
  • Problem behavior usually serves a purpose
  • Goal of intervention is skill building, not
    simply behavior reduction/elimination
  • Effects of Problem Behaviors
  • Interfere with learning opportunities
  • Hinder quality of life
  • Results in exclusion

43
Behavioral Interventions
  • 1.) Determine Function of Behavior
  • Attain
  • Attention
  • Objects
  • Internal Stimulation
  • Avoid/Escape
  • Attention
  • Tasks/Events
  • Internal Stimulation
  • 2.) Determine if Function is Acceptable
  • Yes- teach replacement behavior
  • No- rearrange antecedents/consequences to
    eliminate behavior

44
Behavioral Interventions
  • Guidelines for Interventions
  • Least restrictive
  • Natural supports willing/able to continue once
    professional implementation has ended
  • Procedures will be modified as determined by
    on-going evaluation
  • Procedures chosen based on hypotheses and
    confirming data

45
Behavioral Interventions
  • Guidelines for Interventions (cont)
  • Treatment plan should include specific
    instructions on how to implement client-specific
    clinical methods
  • BSC is responsible for describing to the TSS
    his/her role in the implementation of the
    clinical methods
  • BSC is responsible for training the TSS on
    utilization of the clinical methods
  • The TSS only provides interventions that have
    been described in the Treatment Plan by the BSC.

46
Behavioral Interventions
  • Some of examples of Programs/Techniques
  • Accepting No
  • Planned Ignoring with Differential
    Reinforcement
  • Putting a behavior on extinction
  • Use of various reinforcement procedures and
    schedules
  • Use of visual schedules
  • Behavioral Contracting
  • Prompting
  • Shaping
  • Establishing and Maintaining Positive Social
    Interactions
  • Redirection
  • Modeling

47
TSS Interventions
  • TSS Interventions are directed by the treatment
    plan. They may include
  • Obtaining information about the childs
    problematic behavior
  • Reinforcing parental roles and responsibilities
    with the child
  • Helping the child integrate into an identified
    community setting

48
TSS Interventions
  • They may also include
  • Helping the child improve social interactions
    with peers.
  • Helping the child de-escalate when engaging in
    inappropriate behavior
  • Promoting appropriate attitudes and decision
    making by the child
  • Promoting positive behaviors
  • Identifying triggers of negative behaviors

49
Crisis Plan
  • Definition of a crisis
  • The child or youth is actively endangering
    him/herself or others the situation has
    escalated to require the immediate intervention
    of multiple professionals or family members, and
    the situation has by definition long-term
    consequences

50
Crisis Plan
  • Crisis Plan
  • The team should have developed a de-escalation
    plan for this specific child.
  • There should also be a crisis plan for the child
    if de-escalation does not work.
  • When in doubt contact supervisory staff.

51
Working with Schools
  • TSS Responsibilities
  • Review the written purpose and goals for services
    provided to the child
  • Sign in and out at educational facilities
  • Communicate with the teacher before leaving the
    school in order to review concerns and
    recommendations
  • Always follow building rules
  • Reduce use of professional jargon
  • Roles and responsibilities of the TSS are defined
    in the treatment plan (not IEP)

52
In-School Guidelines Meeting
  • If you are a TSS or PCA working in a school,
    daycare or camp setting, you will be required to
    attend what we refer to as the In-School
    Guidelines Meeting, which is facilitated by your
    BSC (or CM, if there is no BSC or MT). A staff
    member(s) from the school/community setting is
    also required to attend. This meeting is held at
    the community location, during the first two
    weeks of the school year, camp session or anytime
    a member of the team (BSC, Teacher/Counselor,
    TSS, PCA) is new. The purpose of the meeting is
    to clarify the roles of team members in the
    school/community setting and to encourage
    collaborative working relationships.

53
Working with Schools
  • Expectations of School Staff
  • Attend ISPT (Interagency Systems Planning Team
    Meetings)
  • Take primary responsibility for the child
    following the schools individual policies and
    procedures
  • Ensure parent notification of school meetings and
    concerns regarding the child
  • Provide for all educational needs of the child
  • Provide BHRS Staff with the schools rules and
    policies

54
Working with Schools
  • Concerns within the School Setting
  • If you have a concern address it with the Case
    Management Team first, and inform the BSC before
    discussing with teacher. DO NOT discuss these
    concerns with the family.
  • If the concern is not resolved at that point
    discuss the situation further with the BSC and
    CM. The BSC and/or the CM Team will take further
    action if necessary.

55
TSS
  • Inappropriate interventions by TSS in the school
    include
  • Acting as a classroom aide
  • Acting as a classroom disciplinarian
  • Academic tutoring
  • A small group facilitator

56
Working with Families
  • Parents know their child the best. Respecting
    their role is of critical importance.
  • Show respect for the familys home be aware of
    demands that you make on the family and that by
    the nature of your job you are intruding on their
    space
  • Highlight the strengths of the child and the
    family.
  • Review parameters and expectations. Know your
    role and be sure that the childs parents
    understand your role.

57
Working with Families
  • Be genuine
  • Be observant of the family and their culture
  • Ask the parents about the child
  • Use less industry jargon, while maintaining a
    professional manner
  • Use the agreed upon treatment plan as a reference
    point
  • Acknowledge that professionals dont always have
    the answers immediately

58
Customer Satisfaction
  • Dos and donts.
  • Do be open minded.
  • Do respect both the clients and familys rights.
  • Do listen.
  • Dont give anyone a reason to second guess your
    professionalism or dedication.

59
Respect Members of the Team
  • Dos and Donts
  • Dont discuss problems, weaknesses, or any
    personal business of other team members with the
    client, parent/guardian or school personnel.
  • Do call the Case Management Team, Behavioral
    Specialist Consultant, or Program Coordinator
    immediately with any concerns or need for
    clarification.

60
Guide to Professional Behavior
  • PA CASSP Training and Technical Assistance
    Institute
  • Relationships
  • Staff should never use their professional
    relationship to further their own personal
    interests or endeavors.
  • Staff should be aware of how their own personal
    needs can influence the client or family.
  • Staff should clearly define their role with the
    client and family at the initiation of services.
    Staff should never take on a dual relationship
    where it may impair their professional judgment,
    reduce their objectivity, or increase the risk of
    exploiting the client or family.

61
Guide to Professional Behavior
  • Adhere to business casual work attire unless
    otherwise specified
  • Silence phones and pagers. Never text, take or
    make calls while working with client
  • Never use computer of client or classroom for
    personal use

62
Situations to Avoid
  • Staff should never bring contraband into the
    home/school/ community setting (i.e. personal
    medication).
  • Never take, borrow or loan money from the client
    or family.
  • Never engage in personal/sexual relationships
    with the client or family.
  • Never use foul language in the presence of the
    client or family.
  • Never compete with legal guardians for the
    clients affection.
  • Never share intense personal history without
    prior consultation with a supervisor.
  • Never consume drugs or alcohol before or during
    contact with client or family. Never buy,
    provide or share drugs or alcohol with the client
    or family.

63
Situations to Avoid
  • Never take client or family to staffs home for
    activity.
  • Never bring friends or family members along on
    therapeutic activities or to the family's house.
  • Never engage in illegal acts in the presence of
    the client or family, or discuss such acts.
  • Never engage in conversation and/or activities
    with other minors/students. Make sure all
    interactions are in the behavioral plan,
    documented in a Daily Report, and most
    importantly therapeutically and medically
    necessary for the client.
  • Never attempt to sell the client or family any
    products or services (Mary Kay, raffle tickets,
    etc.)
  • Never form personal relationships with the client
    or family within one year of completing
    treatment.
  • Never accept employment from a client or family
    during or within one year of completing treatment.

64
Situations to Avoid
  • Always seek supervisory consultation for any
    situation that is concerning.
  • Never work in a home or school setting without
    the client being present.
  • Never eat meals with the family unless it is part
    of the treatment plan goals.
  • Never take on the role as a babysitter or
    caregiver.
  • Never promote dependency on services with the
    client or family. Do not enable the client or
    family.
  • Never participate in collusive behaviors with the
    client or family (EX Asking the family to sign
    off on hours not provided or blank forms).
  • Never engage in financial conversations with the
    client or family including, but not limited to
    personal earnings.

65
Situations to Avoid
  • Never judge guardians or client as bad.
  • Never be rigid or uncompromising in conversations
    with the client or family.
  • Never use yelling or confrontational behavior
    when working with the client or family.
  • Never use physical force with the client except
    to prevent the client from physical harm. Any
    physical restraint or force must be reported to
    the CM immediately.
  • Never talk down to a client or family or be
    demeaning in any way.
  • Never lie to a client or family (however, it is
    appropriate to evade personal questions.)
  • Never allow the client or family to provoke you
    into a defensive or angry posture.
  • Always seek supervisory consultation before
    confronting family violence or family drug and
    alcohol use.

66
PA Act 126 Mandated Reporting
  • All mandated reporters (THAT MEANS YOU!), are
    required to take a 3-hour training on Mandated
    Reporting of Child Abuse and Neglect. This will
    be offered to you at no charge.
  • This training (on Moodle) must be completed
    within 30 days of your date of hire.
  • Staff will be required to complete a follow-up
    training every 5 years.

67
Mandated Reporting
  • Who is a Mandated Reporter?
  • Persons who, in the course of their employment,
    occupation, or practice of their profession, come
    into contact with children.
  • A mandated reporter must make a report when
    he/she has reasonable cause to suspect that a
    child under the care, supervision, guidance, or
    training of that person, or an agency,
    institution, or other entity with which that
    person is affiliated is a victim of child abuse.

68
Mandated Reporting
  • Definition of Abuse
  • Serious recent physical injury which is
    non-accidental mental injury (diagnosed by a
    psychiatrist or psychologist) sexual abuse, or
    serious physical neglect of children under age 18
    caused by the acts or omissions of a perpetrator.
    Recent is defined as an abusive act within two
    years from the date Childline is called sexual
    abuse has no time limit.

69
Mandated Reporting
  • Child abuse also includes any recent act, failure
    to act, or series of acts or failures to act by a
    perpetrator that creates an imminent risk of
    serious physical injury to or sexual abuse or
    exploitation of a child under 18 years of age.
    These are situations that would have caused
    serious injury if not prevented by happenstance
    or some other intervention.

70
Mandated Reporting
  • Types of Abuse
  • Serious Physical Injury- An injury that causes
    severe pain or significantly impairs the childs
    physical functioning, either temporarily or
    permanently
  • Serious Mental Injury-A psychological condition,
    as diagnosed by a physician or licensed
    psychologist, including a refusal of appropriate
    treatment that renders the child chronically and
    severely anxious, agitated, depressed, socially
    withdrawn, psychotic or in reasonable fear of the
    childs life or safety OR seriously interferes
    with a childs ability to accomplish age
    appropriate tasks.

71
Mandated Reporting
  • Types of Abuse
  • Sexual Abuse- Contacts or interactions between a
    child and an adult in which the child is used for
    sexual stimulation of the perpetrator or another
    person. Sexual abuse may also be committed by a
    person under the age of 18 (age 14-17) if they
    are at least four years older than the victim or
    is in a position of control over the other person
  • Medical/physical neglect serious physical
    neglect by perpetrator constituting prolonged or
    repeated lack of supervision or the failure to
    provide the essentials of life, including
    adequate medical care, which endangers a childs
    life or development or impairs the childs
    functioning.

72
Mandated Reporting
  • Imminent Risk- The exposure of a child to the
    substantial probability of serious physical
    injury or sexual abuse or exploitation which but
    for happenstance, intervention by a third party
    or actions by the child does not occur.

73
Student Abuse
  • Student Abuse is defined as suspected abuse of a
    student by an employee or contractor of the
    school district.
  • As an HCS provider in the school, if you suspect
    (proof is not needed) that a student is being
    abused by someone employed by the school
    district, you must report this immediately to
    your HCS Case Management Team or Coordinator.
  • You will learn at the Mandated Reporter training
    that all suspicions of Student Abuse are reported
    directly to Law Enforcement by the designated
    supervisor.

74
Mandated Reporting
  • When should neglect concerns be reported? This
    usually occurs over time and there is no time
    frame within which the neglect must have
    occurred.
  • Abandonment
  • Lack of adequate food, shelter, or clothing
  • Medical neglect (physical, psychiatric, dental)
  • Lack of age appropriate supervision.
  • There is no designated age in PA when it is legal
    to leave a child unsupervised. It depends on the
    childs developmental or cognitive level,
    maturity, nearby resources if needed, and the
    childs lack of fear of staying alone.
  • Failure to comply with compulsory school
    attendance regulations
  • Lack of necessary care for special needs

75
Mandated Reporting
  • Information on Reporting Child Abuse is available
    on the Resources page of Moodle under Mandated
    Reporter.
  • http//hcsmoodle.cciu.org
  • Who to call
  • 1. Childline 1-800-932-0313
  • Follow-up phone call with your county Child and
    Youth Agency
  • Complete the CY-47 form with your HCS supervisor
    and send to your county Child and Youth Agency.
  • To answer questions you may have, the HCS
    Procedures for Reporting Child abuse begin on the
    next slide.

76
HCS Procedures for Reporting Child Abuse
  • Your responsibility is to contact your Case
    Manager, Case Specialist or Coordinator within 24
    hours if you suspect child abuse in the course of
    your employment.  Do not discuss with family,
    school personnel or community activity staff
    until you have spoken with a member of your Case
    Management Team.
  •    
  • The Case Manager, Case Specialist or Coordinator
    will ask you to come into the office within 24
    hours to support you while you make the call to
    ChildLine and/or Children Youth, and fill out
    the CY-47 form.  You must also fill out an
    Incident Report.

77
Reporting Child Abuse
  • If you are a TSS at school with your client and
    you have reason to suspect that your client is in
    imminent danger and shouldn't go home, contact a
    member of your case management team.  Unless
    there are unusual circumstances, s/he will direct
    you to immediately report your suspicions to the
    teacher and the designated administrator at
    school, whether it is the nurse, principal,
    guidance counselor or mental health specialist.
     The administrator will contact ChildLine or Law
    Enforcement as needed.   You should collaborate
    with the administrator and teacher in making this
    report.  
  • If you are a PCA or TSS at school and you suspect
    that another student (not your client) is a
    victim of abuse, report this to the teacher
    and/or designated school personnel with whom you
    will collaborate in making the report to
    ChildLine.  Notify your Case Manager or Case
    Specialist of the situation.

78
Reporting Child Abuse
  •   
  • If school does not respond to your suspicions but
    you believe that your suspicions are reasonable,
    contact your CM to discuss the situation.  
  • S/he may suggest that you immediately
    report it yourself.
  • If it is after 4 PM and you are working with your
    client at home or in the community, and you have
    reasonable suspicion that your client has been
    abused, you should leave an email message for
    your Case Manager or Case Specialist and phone
    him/her first thing the next morning .  S/he will
    ask you to come into the office to make the call
    to ChildLine and/or Children and Youth, and will
    assist you in filling out the CY-47 and the
    incident report.

79
Reporting Child Abuse
  • If it is a weekend or holiday, you only have 48
    hours in which to send in a CY-47 following your
    report (which must be made within 24 hours).
     Call ChildLine, follow up with a courtesy call
    to Children Youth, and then download, print out
    and complete a CY-47 form from our Moodle
    Resources page (Mandated Reporter resources).
     Send the CY-47 to Children Youth yourself and
    report this to your Case Manager or Case
    Specialist on the next workday.  Also complete an
    Incident Report.
  •   
  • You should always feel comfortable following up
    with the county Children Youth agency after 30
    days to learn whether your report was determined
    to be unfounded, indicated or founded, and what
    steps have been taken.

80
HCS Procedures for Reporting Student Abuse
  • If you suspect that a school employee or
    contractor  is abusing a student, your
    responsibility is to contact your Case Manager,
    Case Specialist or Coordinator within 24 hours.
  • Do not discuss with family or school personnel
    until you have spoken with a member of your Case
    Management Team.  
  • The Case Manager, Case Specialist or Coordinator
    will ask you to come into the office or will
    speak with you by phone within 24 hours to
    discuss the suspected incident or situation with
    you.  You will also fill out an Incident Report.
  • The CM, CS or Coordinator will work with you in
    reporting your suspicions to the designated
    school administrator, who must then contact law
    enforcement as required by the CPSL.    
  • Only school administrators can directly report
    suspected Student Abuse.

81
Confidentiality
  • HIPAA Health Insurance Portability and
    Accountability Act
  • Under the Mental Health Procedures Act
  • Parents have rights over records for children
    under the age of 14.
  • At age 14 the adolescent has rights over his/her
    own records.

82
Confidentiality
  • There are no second chances when breaching
    confidentiality
  • You must have a signed release of information to
    release any information or discuss the childs
    treatment with other service systems (e.g.,
    school, JPO, etc) even if you are working in the
    school
  • Be aware of who may be able to overhear
    conversations
  • When sending e-mails use initials and include
    confidentiality statement.

83
Confidentiality
  • Do not talk about your client/family in public
    including to school personnel
  • Discuss past experience(s) without breaking
    confidentiality
  • Medical records (e.g., daily progress reports,
    treatment plan, incident report) and school
    records (e.g., Individualized Education Plan) are
    to be kept confidential
  • If you have confidential documents to discard,
    shred them. If needed, contact CM to have them
    shredded.

84
Confidentiality
  • All records relating to clients and families,
    including data sheets, daily notes, Treatment
    Plans, PCCNs, charts and graphs must be kept in a
    secure place at all times.
  • These records must never be kept in the open in
    your car. If you must carry them with you from
    client to client, please carry them inside in a
    closed bag, purse, briefcase, etc. or leave them
    locked securely in the trunk of your car, with
    all car doors locked.
  • Client records MUST NEVER be left in a car
    overnight. They must be brought into your home
    with you.

85
Ethical Decision Making
  • Use the supervisory process to strengthen ethical
    decision making skills
  • Objectively define the ethical dilemma
  • Consult the guidelines (if any) that are
    available that might apply to the resolution of
    the case
  • Evaluate the rights, responsibilities, and
    welfare of each person

86
Ethical Decision Making
  • Generate all possible actions
  • Consider the consequences of making each decision
  • Consider the probability that the consequences
    will occur
  • Make a decision
  • Evaluate the decision

87
Fraud
  • Any falsification of documentation of any kind is
    fraud
  • May bill only for working with client as stated
    in Treatment Plan
  • TSS (working for the CCIU) must bill in 30 minute
    increments, never round up
  • Always fill in date and times prior to obtaining
    certifying signature
  • Obtain certifying signature after each contact

88
The World of Social Media
  • Facebook, Twitter, Instagram
  • As professionals working in confidential
    situations, we must be extremely careful to
    maintain appropriate boundaries.
  • That being said, we offer the following
    suggestions

89
Social Media Suggestions
  • 1. Never talk or text during work hours.
  • 2. Do not take photos at work of your client or
    any other children in the classroom.
  • 3. You should not Friend any of your clients or
    families, nor any of the teachers who are working
    with your client at the current time.

90
Social media Suggestions
  • 4. When you post photos, links or comments on
    your Facebook, Twitter or My Space pages, be
    aware that they are on public display.
  • 5. Your email address should be professionally
    appropriate since you will be sharing it with
    clients, schools and your employers/supervisors.
    You can keep your personal email address and
    obtain a new one for professional use.
  • 6. Do not forget to notify CCRES, My Learning
    Plan, and your professional contacts of any
    changes to your email address.

91
Starting a New Assignment
92
Obtaining An Assignment
  • Go to your CCRES Provider Page under Staff
    Information System and follow the directions for
    requesting an assignment.
  • Available cases are posted by county.
  • Go to your CCRES Provider Page under Staff
    Information System and follow the directions for
    requesting an assignment.
  • Available cases are posted by county.

93
What to consider before accepting a case
  • Does it realistically suit my schedule?
  • Can I make a 6-12 month commitment?
  • Am I willing to drive to this location?
  • A I comfortable working with this type of client?
    (age, home or school setting, diagnosis, problem
    behaviors, etc)
  • Am I comfortable with the behavioral
    interventions?
  • Do I have any allergies that prevent me from
    working in this location? (pets, smoke, etc)

94
Your First Day
  • Obtain Directions to Assignment
  • Wear Appropriate Attire
  • Bring Identification (badge)
  • Bring the Current Treatment Plan (emailed to you
    in advance by BSC or CM)
  • Bring several blank Daily Reports/Logs and/or
    data sheets
  • Have a blank Incident Report with you.
  • Have important contact information readily
    available
  • Use Blue or Black Ink Pen only
  • Silence your Cell Phone

95
FIRST DAY
  • Review the Treatment Plan with BSC, who will try
    to meet TSS at start of assignment
  • Introduce self as TSS for client name
  • Ask teacher, parent or caregiver about child,
    what is plan for the day, what the child likes to
    be doing, what main concerns are, etc.

96
A Day in the Life of a TSS
  • First few sessions will consist of rapport
    building. BSC and Case Management Team should
    inform caregiver that that is what you will be
    doing.
  • If first assignment with HCS, On-site
    Supervision will be completed (see upcoming
    slides for details)
  • Be sure to take your lunch break if working 6 or
    more hours.
  • At the end of the day review services provided
    and make plans with caregiver for next session.
  • Complete documentation and enter information into
    your electronic timesheet (to be discussed
    later).
  • Follow up with BSC and Case Management Team as
    needed.
  • Enroll in Weekly TSS Supervision Group

97
New TSS Onsite Supervision
  • New TSS who have never worked as a TSS in any
    agency must receive 6 hours of on-site
    supervision from the BSC prior to working alone
    with the client and family. This is determined by
    CCRES when you are hired.
  • The On-Site Supervision may be done in one
    session or during numerous sessions, depending on
    the length of each authorized session. However,
    you cannot work with the client without a BSC
    overseeing you until all 6 hours have been
    completed, even if you only work for 2 hours one
    time per week (youll need 3 sessions of
    on-site then).

98
Onsite SupervisionTSS who have worked in other
agencies
  • New TSS to HCS who have worked as a TSS in
    another agency must receive 3 hours of on-site
    supervision from the BSC prior to working alone
    with the client and family. This is determined by
    CCRES when you are hired.
  • The On-Site Supervision may be done in one or
    two sessions, depending on the length of each
    authorized session. However, you cannot work with
    the client without a BSC overseeing you until all
    3 hours have been completed, even if you only
    work for 2 hours one time per week (youll need 2
    sessions of on-site then).

99
On-Site Supervision
  • If your "on-site supervision" hours do not take
    up your total TSS/PCA session that day
  • For example 3 hours of on-site supervision is
    required per your contract
  • Your session today is authorized for 4 hours
  • You enter into your electronic timesheet under
    TSS Services On Site Supervision-3
  • (because your contract said you needed 3 hours
    of on-site. )That covers the first 3 hours of
    your session.
  • You can bill from 4- 800 PM, for 4 hours, on
    your paper sheet, checking off the on-site
    information and the total hours on your paper
    daily sheet, but you would make two separate
    entries into your electronic timesheets. The
    first entry would be designated On-site
    supervision 3, with start time of 400 PM, and
    lasting 3 hours.
  • The second electronic entry would be for the same
    date, but the time would be starting at 700 PM,
    and the session would last for 1 hour, and be
    marked as TSS under the TSS services on your
    ETS.
  • Even if you only complete one hour of on-site
    during a session, you would mark On-site
    Supervision 3 if you were told that you needed 3
    hours of On-Site Supervision. The same would go
    for 6 hours.

100
Entering TSS On-Site Supervision on your Daily
Report
  • At the end of your on-site supervision session
    for the day, you will enter it here on your
    written daily progress note

101
TSS On-Site Supervision
  • And you will sign the BSCs On-Site Supervision
    summary

102
On-Site Supervision PCA
  • If you are working as a PCA for your first case,
    you are still required to complete 3 or 6 hours
    of On-Site Supervision as designated in your
    contract with CCRES, however.
  • PCAs can work with clients without the BSC
    providing on-site prior to starting, although
    it is preferable that the BSC is present on your
    first day for awhile.
  • The BSC may provide on-site for an hour or two
    the first day, and then return several days later
    or within the next two weeks.
  • If you have questions, please ask your Case
    Management Team.
  • Some PCA cases may not have a BSC assigned. In
    that case, discuss this with your Case Management
    Team.

103
Documentation
  • Documentation
  • There are dozens of forms that will cross your
    desktopthe physical one, and the digital oneand
    you'll need to know the best ways to find them,
    fill them in, and send them back.
  • Incident Reports must be with you at all times
    and submitted within 24 hours of incident that
    may include, but not limited to physical
    aggression, harm, or any incident out of the
    ordinary.
  • When in doubt, fill it out. Follow-up with a
    phone call to your Case Management Team.

104
More On-Site
  • TSS and PCAs must collect behavioral data during
    their On-Site Supervision.
  • The BSC or CM will review the Tx Plan with you
    and will model interventions, introduce you to
    appropriate people and assist you with data
    collection.
  • TSS and some PCAs Your BSC will generally visit
    you when you are with the client (on site) at
    least twice per month, but this is not considered
    On-Site Supervision once the 3 or 6 required
    hours have been completed.
  • Enter these regular sessions with your BSC
    present as TSS on your timesheet once the
    on-site supervision requirement has been
    completed.

105
TSS Documents
  • TSS Daily Note
  • BSC-provided Data Sheets
  • BHPCA Schedule
  • BHPCA Daily Log
  • BHPCA Data Sheets
  • BHPCA Weekly Report

106
BSC and MT Documentation
  • BSCs and MTs will receive information about their
    billing process and paperwork during their
    orientation with their Coordinator.

107
Entering Hours Provided
  • On an upcoming slide about filling in TSS
    paperwork, you will see a space for entering
    Start and End times for your session. There are
    several things to keep in mind.
  • 1. If you work a session that is 5.5 hours or
    less, you enter your start and end time as usual.
  • 2. If your TSS session is scheduled for six hours
    or more, you are required to take a 30-minute
    break away from your client. You are not working
    for this time, and therefore you are also not
    being paid for this 30 minutes. No
    exceptionsyou must take the break for the entire
    30 minutes.

108
On your daily progress note, you must put the
Start and End times for both before and after
your break.
  • For example
  • You are working from 830 AM -330 PM
  • You take your break at 1130 AM for 30 minutes
  • You would enter
  • Start 830 AM End 1130 AM
  • Start 1200 PM End 330 PM
  • You may do this on the one side of the daily
    progress note. There is room for multiple times.

109


110


111
Daily and Weekly Paperwork
Behavioral Health
Personal Care Assistants (BHPCA)
112
PCA Documentation
Some PCA assignments will require online
documentation in lieu of the written PCA Daily
Log that will be described in the next slides.
If you are assigned to a case that requires
this process, you will be provided training
upon acceptance of the assignment
113
PCA Daily Schedule
When applicable to your client, your BSC will
provide you with a Schedule which will guide you
in writing your Daily Log as described on the
next slide.
114
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115
BHPCA TREATMENT KEYS
116
  • The Weekly Reporting Sheet includes
  • Name of PCA, billing week and clients full name
  • Service dates in chronological order
  • Start time- One Start Time per day
  • End Time
  • Number of Hours (prior to Break(s) if taken).
  • It will be necessary to document IF you took a
    Break, but not the specific time (see sample).
  • Your Total Time for the day that services were
    provided MUST BE DIVISIBLE BY FIFTEEN (15)
    MINUTES.
  • Travel time (if applicable)
  • Service Code
  • Location of services (home, school, community)
  • Obtain certifying signature for each date
  • Weekly authorized hours, hours provided, and
    Utilization Code
  • PCA signature
  • Submit weekly by the following Tuesday no later
    than 400 PM along with any corresponding
    paperwork.

117
(No Transcript)
118
(No Transcript)
119
Utilization Reason Codes
  • 0 Services provided as authorized.
  • Staff available to provide service but family
    cancels scheduled session. For example the
    child is sick or family is on vacation.
  • Staff could not provide service during their
    scheduled session. For example, staff is sick,
    personal day, training, vacation
  • This code applies to school being closed for
    holiday and/or weather.
  • 7 (BSCs, MTs) This code should be used
    sparingly and means that services were not needed
    this week but should resume normally next week.
    If this occurs more than a couple of weeks in a
    row or more than one time every month or so, a
    decrease in hours authorized should be
    considered. This may also occur if the BSC has
    provided on-site supervision to that clients TSS
    that week, and additional hours would be
    unnecessary or intrusive/inconvenient for the
    family that week.

120
Billing
  • Special Circumstances
  • Non-billable services such as meetings w/o
    client, shadowing current TSS, etc.
  • Non-billable services do not require a
    corresponding daily report, must be entered
    electronically, and must be pre-approved by Case
    Management Team.
  • Enter Non-Billable services as non-billable in
    your ETS. CCRES can provide information about
    that hourly rate.

121
Entering On-Site Supervision On Your Electronic
Timesheet
  • Select Home or School
  • Choose service provider type under TSS Services
    either On-Site Supervision 3 or On-Site
    Supervision 6 depending on what was in your
    contract.
  • Enter 3 or 6 hours as your Authorized Hours (in
    this case, your required hours per your
    contract.
  • For example, you completed 3 of your 6 required
    on-site hours. You enter 6 under Authorized
    Hours, and click on On-Site Supervision 6 under
    TSS Services.
  • The Utilization Reason Code can be 0 even if
    all required on-site hours were not completed.
    This is different from regular authorized hours
    where you need a specific utilization code for
    billing purposes and any hours not completed must
    have a utilization (reason) code other than zero.
  • Click Submit when finished

122
Reporting Your Absence
  • TSS and BHPCAs When you are going to be absent
    from your assignment that day due to illness or
    personal reasons, or you are planning to be
    absent on a future date(s) due to a planned
    vacation, etc., YOU MUST DO THE FOLLOWING
  • If planned absence, submit "Request for Time Off
    Form" and if applicable submit "Substitute
    Request Form" to case management team
  • Inform the site (school, home, etc) that is
    expecting you
  • Inform the BSC
  • See the HCS Procedures Manual for more
    information.
  • The Manual is available on Moodle.

123
Reporting Absence
  • Log on to the CCRES site (www.ccres.org) as you
    do when you complete your electronic billing.
  • Click on Staff and then Staff Information System,
    and then click on the rectangle for Report
    Absence on the left side of the page.
  • In the drop down inside, you will find your Case
    Managers name. Click on that, provide the
    information requested, and press Submit.
  • You do not have to contact your Case Management
    Team or submit a printed form. This electronic
    form will take care of that for you.

124
Reporting Your Absence Chester County BHPCAs
ONLY
  • If you receive an assignment as a BHPCA in
    Chester County, you may additionally be required
    to report your absence to AESOP. Your Case
    Management Team will advise when assigned if you
    are responsible for this step.
  • Please refer to the Resources section in Moodle
  • (http//hcsmoodle.cciu.org) for the powerpoint on
    BHPCA Procedures and Policies. This includes
    information on how to access AESOP.

125
TSS Supervision
  • One hour each week
  • Supervision Schedules and Registration
    instructions are posted on http//hcsmoodle.cciu.o
    rg
  • Click on this icon on main page of Moodle
  • Register for Supervision with the designated TSS
    Supervisor.
  • If you are doing Saturday Supervision, register
    via Google Docs each Friday prior to noon.
  • Do not enter supervision on your time sheet
  • If you have additional questions about weekly
    supervision, contact HCS_at_cciu.org

126
BSC/MT MONTHLY SUPERVISION
Group Supervision is monthly, and is offered in
each county. You may attend any supervision
session, and you can switch between them.
Schedules are posted on Moodle
http//hcsmoodle.cciu.org
127
Home Community Services RESOURCES
  • http//hcsmoodle.cciu.org
  • Use this website to access updated
  • Online courses
  • Training Information
  • Supervision Schedules
  • HCS Procedures Manual
  • Paperwork and Forms for each county
  • HCS Staff Directory
  • BHPCA policies and procedures
  • My Learning Plan website
  • Links and addresses to other resources

128
CCRES RESOURCES Billing, Payroll and Contact
Information
  • www.ccres.org
  • Click on Staff
  • Then click on Staff Information System to
  • Update your availability (i.e. omit from
    searches, add requests, request sub cases, etc.)
  • Update your contact information
  • Enter billing on a daily or weekly basis into
    Electronic Timesheet
  • Download work-related accident form
  • Obtain Payroll Information
  • Reporting absence via AESOP
  • Link to My Learning Plan and Moodle

129
Who to Contact
  • Questions about clearances, contracts/service
    agreements, car insurance contact CCRES at
    484-593-5040.
  • Questions about payment or timesheets, contact
    Christine Daniels at CCRES.
  • Questions about billing and paperwork due dates,
    contact HCS Billing HCSBilling_at_cciu.org
  • Questions about Training, including Moodle
    problems and training audits, or receiving credit
    for outside trainings, contact HCSTraining_at_cciu.o
    rg

130
Who To Contact
If you have questions about issues with your
paperwork content, your TSS/BHPCA schedule or
absences, contact your Case Management Team. If
you have problems with your BSC, other members of
the BHRS team or problems with the clients
family, contact your Case Management Team. If
you have problems with your case management team,
contac
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