Home & Community Services
Provider Orientation
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 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
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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:
•
•
•
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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 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
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Interagency Team
The team consists of:
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•
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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 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
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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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Behavioral Specialist Consultant
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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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 biweekly 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 ageappropriate 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 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
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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 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
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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-onone 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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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
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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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.
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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 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
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Case Management Team
Roles
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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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
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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.
–
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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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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)
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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
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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
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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 ongoing evaluation
Procedures chosen based on hypotheses and
confirming data
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Behavioral Interventions
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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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
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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 deescalation 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
in the treatment plan (not IEP)
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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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Working with Schools
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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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.
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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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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.
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Mandated Reporting
Definition of Abuse
– Serious recent physical injury which is nonaccidental; 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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Mandated Reporting
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.
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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 child’s
life or development or impairs the child’s functioning.
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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.
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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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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 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
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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
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….
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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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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.
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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.
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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 to
your email address.
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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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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
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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 Supervision
TSS 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
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.
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TSS Documents
TSS Daily Note
BSC-provided Data Sheets
BHPCA Schedule
BHPCA Daily Log
BHPCA Data Sheets
Weekly Verification Form
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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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Daily and Weekly Paperwork
Behavioral Health
Personal Care Assistants (BHPCA)
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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
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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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Weekly Verification form
The PCA Weekly Verification Form is completed by the PCA on a daily
basis to verify the dates, location and times that the PCA works with a
client. Additionally, the weekly reporting sheet includes the weekly
authorized hours compared to hours provided and the reason for the underdelivery of services (if applicable). The teacher must sign this form every
day after services have been provided.
The Weekly Verification Form is not a time sheet. PCAs are still required to
use the McKesson Practice Choice System to enter their Encounter and
Notes Information.
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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 Codes
0
2
3
4
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 (BSAs, 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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McKesson Billing Procedures
All information about the new "Electronic Medical Records System" (paperwork/timesheets), known as
McKesson Practice Choice, is available on Moodle when you click on the picture icon or on the printed
links under the appropriate icon(s) in the middle of the page. You must scroll down the page to view the
icons. The McKesson icons (links to the videos and instructions) are in the bottom row of picture icons.
There are McKesson Instructional Videos to watch FIRST, and then McKesson printed instructions to
guide you as you begin to familiarize yourself with the program.
The printed instructions also include the Weekly Verification Form (explained in the video) and
information on how to convert hours into units (also explained in the video).
You can enlarge the screen during the video training by clicking on the "gear" symbol near the center of
the page.
We have set up a website for providers to access as the first step to getting to McKesson. It has a link to
the McKesson system, as well as a link to the setup guide and trouble-shooting. You may have to copy and
paste this into your browser. http://mckesson.cciu.org
You will be provided with a log-in and password, and then be prompted to change your password to
something you can remember.
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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
McKesson. 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 “OnSite 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 onsite 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 Page 75 in the H&CS Procedures Manual for more information.
It is available on Moodle.
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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 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.
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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 under Training Information. 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
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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 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
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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 H&CS
Billing: HCSBilling@cciu.org
Questions about Training, including Moodle problems and training
audits, or receiving credit for outside trainings, contact
H&CSTraining@cciu.org
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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
Home & Community Services Trainings
FAQ
Answers to Frequently Asked Training
Questions and All Training Requirements
are posted on Moodle
http://hcsmoodle.cciu.org
Sample questions on next slide
Contact H&CSTraining@cciu.org 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&CSTraining@cciu.org 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 inperson H&CS trainings.
You must request credit from
H&CSTraining@cciu.org for any outside training,
coursework or conferences you have completed.
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QUESTIONS???
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