Home & Community Services

Home & Community ServicesProvider Orientation

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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.

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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

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Wraparound Services

-What are they?Services are based on Medical NecessityServices are funded through the Department of Public Welfare (DPW) or, in some cases, by Act 62 Insurance.Services are designed to be short-termServices are not intended for crisis situations

Services are based on the statewide CASSP Principles

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CASSP

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

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Wraparound Services

Positive Approaches Principles– Two basic assumptions:

• people always have good reason to do what they’re 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

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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 client’s 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.

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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.

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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

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Interagency Team Meeting

ISPT’s are held every 4 to 6 months.The team will meet to discuss the recommendations in the psychological evaluationThe team will review and develop treatment recommendationsAn authorization “packet” is generated and sent to the MCO which has 2 days to approve or deny the requestIf the request for services is denied, the family has the right to file a grievance

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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

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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

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Other Available Services

Resource CoordinationMH/IDD Case ManagementBlended Case ManagementIntensive Case Management servicesOutpatient servicesStudent Assistance ProgramCrisis Intervention ServicesFamily-Based Mental Health Service

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Other Available Services

Partial hospitalization services

Therapeutic Foster Care

Residential treatment facilities

Psychiatric inpatient hospitalization

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Wraparound and You

The Team

Who Are We?

As a TSS, BSC or MT, you will be providing services for Chester County Intermediate Unit’s (CCIU) Home and Community Services program (H&CS).

You were sent to us by CCRES, a staffing agency.

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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!!!!

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The Team

Behavioral Specialist Consultant

Therapeutic Staff Support

Behavioral Health Personal Care Assistant

Mobile Therapist

Case Management Team

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The BSC is a master’s 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

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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

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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.

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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

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TSS

Appropriate roles for TSS include:Demonstrate alternative activities to redirect challenging behaviorsDemonstrate therapeutic structure and limits for the childDemonstrate behavioral intervention plan for caregiversDemonstrate positive relationships with parents, siblings, teachers, aides, and peersAssist the parent/teacher in assuring safety to the child and others

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TSS

Inappropriate roles for TSS include:

Continued observation of the child’s 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

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TSS

Inappropriate roles for TSS include: Performing the duties of school personnel and/or academic tutoringProviding services not included or specified in the treatment planSubstituting for any type of caregiverGeneral child care or housekeeping Therapeutic interventions not consistent with the treatment plan or goals

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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 student’s successful progress throughout the school day.

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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 BHPCA’s presence is necessary because of a student’s physical disability or mental health disability.

Basically, they can do anything a TSS can do plus all of the above.

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BHPCA-Teacher-Child Communication Staff work for the school and follow teacher's directionTeachers 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.

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Mobile Therapist

The Mobile Therapist is a Master’s 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 child’s diagnosis.Mobile Therapy may extend to assist family members with issues related to the child’s 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.

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Mobile Therapist

Participants in mobile therapy sessions may include any of the following combinations:• The child alone• The child and other members of the child’s family• The child and teacher, and/or other school

personnel

•Mobile Therapy is not a crisis service.

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Case Management Team

YOUR FIRST POINT OF CONTACTIs 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 mannerServes as a liaison between BHRS providers and team members, including the familyCompletes and coordinates paperwork in order to obtain all authorizationsFacilitates the transition of families to other services OR supports as needed

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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.

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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

Who Are Our Clients?

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About Our Clients

Autism Spectrum Disorders

DSM-5 299.00

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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)

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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)

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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

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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 “Asperger’s Disorder”.

– 1 in 50 school-aged children are diagnosed with an Autistic Spectrum Disorder (US Centers for Disease Control Prevention, 2013)

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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.

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What Will You Be Doing?

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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)

Behavioral Interventions

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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

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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

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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

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Guidelines for Interventions (con’t):• 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.

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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

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TSS Interventions

• TSS Interventions are directed by the treatment plan. They may include:– Obtaining information about the child’s

problematic behavior– Reinforcing parental roles and

responsibilities with the child– Helping the child integrate into an identified

community setting

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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

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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

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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.

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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

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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.

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• Expectations of School Staff– Attend ISPT (Interagency Systems Planning Team

Meetings)– Take primary responsibility for the child following

the school’s 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 school’s rules and

policies

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• 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.

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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

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Working with Families

• Parents know their child the best. Respecting their role is of critical importance.

• Show respect for the family’s 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 child’s parents understand your role.

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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 don’t always

have the answers immediately

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Customer Satisfaction

• Do’s and don’ts.– Do be open minded.– Do respect both the client’s and family’s

rights.– Do listen.– Don’t give anyone a reason to second

guess your professionalism or dedication.

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Respect Members of the Team

• Do’s and Don’ts– Don’t 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.

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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.

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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

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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 client’s 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.

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Situations to Avoid

• Never take client or family to staff’s 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.

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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.

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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.

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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.

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• 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.

Mandated Reporting

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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.

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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.

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• Types of Abuse: – Serious Physical Injury- An injury that causes severe pain or

significantly impairs the child’s 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 child’s life or safety OR seriously interferes with a child’s ability to accomplish age appropriate tasks.

Mandated Reporting

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• 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 child’s life or development or impairs the child’s functioning.

Mandated Reporting

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• 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.

Mandated Reporting

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Student Abuse

• Student Abuse is defined as suspected abuse of a student by an employee or contractor of the school district.

• As an H&CS 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 H&CS 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.

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• 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 child’s developmental or cognitive level, maturity, nearby resources if needed, and the child’s lack of fear of staying alone.

– Failure to comply with compulsory school attendance regulations

– Lack of necessary care for special needs

Mandated Reporting

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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

2. Follow-up phone call with your county Child and Youth Agency

3. Complete the CY-47 form with your H&CS supervisor and send to your county Child and Youth Agency.

To answer questions you may have, the H&CS Procedures for Reporting Child abuse begin on the next slide….

Mandated Reporting

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H&CS 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.

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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.

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•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.

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• 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.

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H&CS 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.

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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.

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Confidentiality

• There are no second chances when breaching confidentiality

• You must have a signed release of information to release any information or discuss the child’s 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.

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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.

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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.

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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

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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

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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

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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:

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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.

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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

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Starting a New Assignment

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.

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• Go to your CCRES Provider Page under Staff Information System and follow the directions for requesting an assignment.

• Available cases are posted by county.

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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)

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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

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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.

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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 H&CS, “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

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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 (you’ll need 3 sessions of “on-site” then).

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Onsite SupervisionTSS who have worked in other agencies

• New TSS to H&CS 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 (you’ll need 2 sessions of “on-site” then).

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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- 8:00 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 4:00 PM, and lasting 3 hours.•The second electronic entry would be for the same date, but the time would be starting at 7:00 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.

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Entering TSS On-Site Supervision on your Daily Report

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• At the end of your on-site supervision session for the day, you will enter it here on your written daily progress note:

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TSS On-Site Supervision

• And you will sign the BSC’s On-Site Supervision summary:

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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.

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Documentation

• Documentation

– There are dozens of forms that will cross your desktop—the physical one, and the digital one—and 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.

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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.5/13/14 104

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TSS Documents

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

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BSC and MT Documentation

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

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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 exceptions—you must take the break for the entire 30 minutes.

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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 8:30 AM -3:30 PM•You take your break at 11:30 AM for 30 minutes

You would enter:•Start: 8:30 AM End: 11:30 AM•Start: 12:00 PM End: 3:30 PM•You may do this on the one side of the daily progress note. There is room for multiple times.

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Behavioral Health Personal Care Assistants (BHPCA)

Daily and Weekly Paperwork

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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

PCA Documentation

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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.

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BHPCA TREATMENT KEYS

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The Weekly Reporting Sheet includes:

•Name of PCA, billing week and client’s 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 4:00 PM along with any corresponding paperwork.

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Utilization Reason CodesUtilization Reason Codes

0 Services provided as authorized.2 Staff available to provide service but family cancels scheduled session. For

example: the child is sick or family is on vacation.3 Staff could not provide service during their scheduled session. For example, staff

is sick, personal day, training, vacation4 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 client’s TSS that week, and additional hours would be unnecessary or intrusive/inconvenient for the family that week.

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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.

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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

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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 H&CS Procedures Manual for more information.The Manual is available on Moodle.

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• 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 Manager’s 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.

Reporting Absence

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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.

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TSS Supervision

• One hour each week• Supervision Schedules and Registration instructions are posted

on http://hcsmoodle.cciu.org• 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 H&[email protected]

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http://hcsmoodle.cciu.org/



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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

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Home & Community Services RESOURCES

http://hcsmoodle.cciu.org

Use this website to access updated:•Online courses•Training Information•Supervision Schedules•H&CS Procedures Manual•Paperwork and Forms for each county•H&CS Staff Directory•BHPCA policies and procedures•My Learning Plan website•Links and addresses to other resources

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CCRES RESOURCESBilling, 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

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http://www.ccres.org/

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Who to ContactWho 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 H&CS Billing: [email protected]

Questions about Training, including Moodle problems and training audits, or receiving credit for outside trainings, contact H&[email protected]

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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 client’s family, contact your Case Management Team.

If you have problems with your case management team, contact your Coordinator

If you have problems with client behaviors, the Treatment Plan or interventions, contact your BSC

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Recap of Wraparound

• Services are meant to help a client remain in the least restrictive environment

• The current array of services may not necessarily meet all of the clients needs

• Services are not meant to last forever• Services are not meant to take the place of a caregiver or

substitute for another appropriate service or agency• Wraparound (BHR) Services must be authorized by DPW or

MCO• Services are about building appropriate therapeutic

relationships

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Home & Community Services Trainings

Frequently Asked Questions

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Home & Community Services Trainings FAQ

Answers to Frequently Asked Training Questions and All Training Requirements are

posted on Moodle

http://hcsmoodle.cciu.orgSample questions on next slide

Contact H&[email protected] with ANY training questions or problems

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Home & Community Services Trainings FAQs (go to Moodle for answers!)

1. What is our Training “Year”?

2. How will you know that I took a training if there is no paper training record for me to turn in?

3. How many credit hours do I need per year?4. How do I sign up for My Learning Plan?5. Can I get credit for trainings taken elsewhere?

6. When will the training schedule be provided, and how will I know?

7. What are the web (Moodle) trainings?

8. How do I register for them?

9. How do I get paid for trainings?

10. How do I enter my trainings on my Electronic Time Sheet?

11. How do I register for the Autism training for Chester and Lancaster Counties?

12. What is the Autism Training for Delaware/Montgomery Counties?

13. What do I do if I cannot make it to a training for which I registered?

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PCAs: Trainings that are required by the school district in which you provide services

• If you are a PCA and your contracted school district requests that you take certain trainings with them such as CPI (instead of our NCI training), do the following:

• Notify your Case Management Team of the request.

• Do Not bill as a PCA on training days unless training finishes early and you are directed to return to the classroom.

• Email H&[email protected] and your Case Specialist or Case Manager to notify them that you completed the training.

• Your CM or CS will take care of verifying your training completion and will notify H&CS Training so that you will be credited.

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New staff cannot access My Learning Plan to register for in-person trainings until after the following:

• Completion of today’s H&CS Provider Orientation

• Activation into the system (usually a few work days following this Orientation)

IMPORTANT:

Be sure that when you register for a training on My Learning Plan, that you click on DISTRICT CATALOG on the left side of the main page under “Activity Catalogs”.

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Final Points

• Training completion is not entered on to your Electronic Timesheets (ETS).

• Training credit is taken care of administratively for both in-person and online H&CS trainings.

• Be sure to sign the sign-in sheet available at any in-person H&CS trainings.

• You must request credit from H&[email protected] for any outside training, coursework or conferences you have completed.

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QUESTIONS???

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