Transcript behaviorinterventionservices.com
10176 Corporate Square Dr.
Suite 220 Creve Coeur, MO 63132 (p)314-395-9375 (f)314-395-9381 Hours of Operation 8am-6pm
New Hire Onboarding Welcome to BIS!
Agenda for the day!
JOE DOUGLAS 9:00-9:10am -Collect the rest of paperwork & introductions LYNN BROOK -First section of Orientation packet 9:10-10:30am BERLY FORSYTHE -Policy & Procedure 10:30-12:30pm 12:30-1:30pm LUNCH -Food JOE DOUGLAS -Double check all paperwork & collect JAMIE KLAMERT -ISL Orientation -Therap Training -WhenToWork Training 1:30-2:00pm 2:00-5:00pm
HERE WE GO!
The Mission
Our mission is to help each individual we serve reach their highest potential in life by overcoming barriers and promoting independence, achievement, and inclusion. We utilize proven and positive behavior change strategies to reach this goal, while including all team members, friends, and family in the process.
Defy Limits, Exceed Expectations…
What are the three most popular services at BIS?
Individualized Supported Living (ISL)
Natural Home Personal Care Assistance
Behavior Therapy via our BCBA, BCaBA
Other Services Health and Wellness Classes – For Clients and Staff
Yoga, Cooking, Fun with Fitness Social Skills Opportunities Person Centered Strategies Consultant (PCSC) Counseling and Support Groups Applied Behavior Analysis (ABA)
BIS was founded in 2004 We have experienced substantial growth since its beginning and have changed locations three times We currently hover around 130 Direct Support Professionals (DSPs) and 190 total employees We are one of the largest providers of Behavior Therapy in the state of Missouri!
Dawn Schmitt Executive Director
Bachelors in Psychology and Sociology from Maryville University Over 20 years of experience in the field of developmental disabilities Associate Executive Director for 18 years at Creative Concepts for Living Oversees the day-to-day operations at BIS
Kimberly Forsythe HR Director
Started as a full time PCA in 2006 Promoted to Staffing Coordinator and Human Resources in 2008 Been in the field of developmental disabilities since1993 & HR since 1996 Promoted to Human Resource Director in 2011
Jamie Klamert ISL Director
Graduated from University of Dayton with BA In Psychology; Started at BIS in August 2011 as DSP Became Home Supervisor in January 2012-May 2012 Held Position of CIST from May 2012 November 2012 Became ISL Assistant Director in November 2012-Novemeber 2013; Became ISL Director November 2013
Kim Salls, BCBA Chief Financial Officer
Bachelor in Psychology from St. Louis University Masters in Applied Behavior Analysis from University of Nevada, Reno Received her BCBA in 2004 Started Behavior Intervention Services
Lynn Brook Director of Administration
Came to Behavior Intervention Services in 2006 as an ABA Implementer Promoted to Public Relations and Human Resources in 2008 Promoted to Director of Administration in 2011 Oversees office business, plans functions, & manages recruitment
Brittany Thorn Director of Natural Home Services
Supervises FCAs Assigns FCAs to client caseloads Performs phone screenings and forwards Applicants to FCAs
Sherrie Shannon BCBA, LBA Shannon Riemersma BCBA Kyler Hasl-Wright BCaBA Andrea Mazo BCaBA Lindsay Brefeld BCBA Beth Munkwitz BCBA, LBA Melissa Atis BCBA, LBA Maija Graudins BCBA, LBA
Board Certified Behavior Analyst
Requires a minimum of a Bachelor’s degree in a human services field and a Master in Applied Behavioral Analysis as well as Board Certification Makes initial contact with all potential clients Completes interviews with client and family and completes assessments to determine the needs of the client Develops a behavior plan to address all applicable behavioral needs Provides initial and ongoing training of all staff on client specific behavior plan
Gina Noble PCSC, DSP Trainer
Therapy Support Staff
BCBA Board Certified Behavior Analyst BCaBA Board Certified Assoc. Behavior Analyst PCSC Person Centered Strategies Consultant DSP Trainer Direct Support Professional Trainer
Kyle Swendig ISL Support Specialist Amy Clarke ISL Financials Tiffany Hultz Community RN Amy Gaultney *Hedge ISL *Turf ISL Beth Pinkley *Mehlville ISL *Redbird ISL *Hazelwood ISL *Wise ISL CIST CIST Jessica Barfield *O’Fallon ISL *Ridge ISL *St. Charles ISL *King ISL Kelsie Ballance *Fenton ISL *Crestwood ISL CIST CIST Lauren Phillips *Rock Hill ISL CIST
Brittany Zahn Family Care Advocate
Central, South County, West County
Jessica Bartram Family Care Advocate
St. Charles County, North County, West County
Jesse Bray Family Care Advocate
Wes County, Central, South County
Lindy Kline Family Care Advocate
Central, West County, Jefferson County
Lindsey Moore Family Care Advocate
West County South County, Illinois
Sarah Bartholic Family Care Advocate
St. Charles County Central, West County
Liz Robertson
St. Charles County Central West County
Family Care Advocate
Family Care Advocates
Meet with all Natural Home Families on their caseload to discuss services and to create a schedule within allotted funding Meet will all Natural Home DSPs to discuss client specific training and schedules Ensure all allotted funding is used appropriately Work 20 hours per week of direct care or supervision shifts within their caseload Available for emergency coverage when necessary Collect Daily Progress Notes from each household within their caseload and compile these notes into summaries for DMH Create time sheets for DSPs based on time in/time out on Daily Progress Notes Provide positive and constructive feedback to DSPs working within their caseload Work with DSPs and Families ongoing to ensure proper services are being rendered Help families receive additional resources for services when necessary
Lynn Brook Director of Administration Debby Schaefer Payroll Alicia Heddy Payroll Kim”Berly” Forsythe Human Resources Director Joe Douglas Human Resources Assistant Lisa Arnett Receptionist
• …will be contacted by the FCA to discuss scheduling, initial training dates, and shadowing of current DSP staff • …are responsible for carrying out activities or programs set forth by the client specific behavior plan, treatment plan, or individual support plan. Programs and activities differ depending on your clients ability level and living situation but may include living skills, personal hygiene, socialization etc..
• …attend scheduled team meetings and required trainings to maintain current agency and state certifications • …are responsible for taking data per BIS and state guidelines, communicating with the family and team in a communication log, and reporting any incidents to supervisory staff (FCA or behavior support professional) • …will report directly to their client’s BT and FCA • …will be scheduled for hours based on the availability provided upon hire and client needs, and must provide two weeks’ notice for change in availability • …will keep all clients within line of sight unless otherwise dictated in the client’s BSP
• • • • • • • • • • • …will be contacted by the ISL Staffing Coordinator to discuss training shift.
…will be contacted by their supervising CIST or BCBA for BSP and ISP training before initial worked shift.
…are responsible for carrying out activities or programs set forth by the client specific Behavior Support Plan (BSP).
…will attend monthly team meetings as planned by the CIST.
…will keep all clients within line of sight unless otherwise dictated in the client’s BSP.
…will maintain required trainings to satisfy current agency and state certifications.
…are responsible for taking data per BIS and state guidelines, communicating with team in the house communication log, and reporting any incidents to the CIST.
…will be scheduled within the availability they provided upon hire and must provide two weeks notice to change that availability …will report directly to Lead Staff and CIST.
…will treat their clients with respect.
…will nominate their coworkers for Employee of the Week to recognize a job well done!
First Steps, or Tier 2 DSP Natural Home
…must have a Bachelor's degree or 60 credit hours in a Human Services Field …must attend Discreet Trial Training (DTT) …will be responsible for working under the assigned ABA consultant to implement discreet trial programs as well as any other programming set forth by the consultant …must pass an FBI fingerprint background check Please speak with Family Care Advocates about possible openings
From the Desk of Human Resources… Policy and Procedures overview
Where do I fit in?
Residential Supervisory staff
Direct Support Professionals
Office Team Natural Homes
Trainings
Pre-Hire Requirements – Congratulations! - Unpaid Prerequisites CPR/First Aid – Two year certification if taken at BIS Mandt – Annual certification Annual training forms: A & N, BBP, Confidentiality, HIPAA, ORR, Seizure training Orientation – Day 1 typically 9a-5p -Paid on first paycheck, min. wage Agency Policy and Procedure ISL Policy and Procedure training
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Orientation – Day 2 typically 9a-5p- Paid on first paycheck at min. wage Behavior Management #1 & #2 Orientation Wrap-Up
Must complete prior to working any single shifts with the client: Medication Administration Level 1
- 2-day course, 9a-5p each day, paid at minimum wage Required in order to work in all ISL, some NH Please make sure to turn in a timesheet for this class in order to be compensated!
Must complete within 60 days of hire date Behavior Management #3 & #4
- typically 9a-4:30p, paid at minimum wage
Mandatory For Tier 2 DSPs Only, But Open To All
Discreet Trial Training (DTT) – typically 9a-5p, unpaid training
Funding Sources How they effect YOU
Work Opportunity Tax Credit
Encourages hiring of individuals with barriers to employment.
Completion of forms 8850 and 9061 is voluntary.
May assist members of Rural Renewal Counties and Empowerment Zones in securing employment.
New Hire Probationary Period
Every employee’s first 90 days is considered a probationary period during which at any time BIS can retract it’s original offer of employment. Part-time employees will be scheduled between 10-29 hours per week on average.
Full-time employees must comply with all requirements to set a full-time start date.
Employees may at times be asked to work over the 29 hour per week part time maximum but that does not make them full-time staff. You must submit your intent to move to a full-time position in order to start the process of moving to a full-time position if you were not hired in at full time.
Full-Time Employee Benefits
Must work at least 37-40 hours per week Accrued Paid Time Off (PTO)
accrued after one year of full-time employment 5 days available after 1 st year 10 days available years 2 -4 15 days available years 5-9 20 days available 10+ years
Retirement Plan
Eligible to employees that are: 21 or older Employed for 1 year while working a minimum of 19 hrs per week Contribution matching of 100% of 3% and 50% of 5% 100% vested from initial contributions
Vision and dental
start date at a premium of $4.00 per pay period or $8 per month.
insurance 30 days after full time
Healthcare benefits
90 days after full time start date at a premium of $60 per pay period or $120 per month. 2 healthcare options: Group PPO coverage or Health Savings Account (HDHC)
Steps to move to a full-time position:
Full-time positions are offered based on merit, performance and agency need. If there is a need for additional full-time staff, employees may apply for a position by following these steps (in the order listed): Submit a letter of intent to move to full time stating why you would be a good candidate for full time. Have a current BIS supervisor write a letter of recommendation for you, supporting your request for full time Secure a work schedule that is conducive to maintaining a minimum work week of 37 hours.
Schedule a meeting time with HR to set a full time start date, discuss and sign up for any full-time benefits, sign a change in status form and discuss any additional questions at that time. (This will be scheduled after the first 3 items have been completed).
Failure to maintain a minimum of 37 hours for each ongoing work week will result in the following:
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Immediate demotion to a part-time status Decrease in pay rate Limitation on hours to no more than 29 per week Loss of all accrued PTO time Loss of all benefits (if applicable) after last paid through date Inability to seek a full-time position for a minimum of six months
All BIS Employees are Mandated Reporters
This will be covered more thoroughly in Abuse and Neglect
Anyone holding any of these positions is considered by the state of Missouri to be a Mandated Reporter. As a Mandated Reporter it is your responsibility, in good faith, to report any allegation of abuse or neglect of a client to an immediate supervisor who will in turn report this allegation to the Department of Mental Health. As a Mandated Reporter, if you negligently or intentionally fail to report you could be found guilty of a misdemeanor and be liable for damages caused by your failure to report.
As a Mandated Reporter, if you intentionally file a false report you could be liable in a civil suit for any damages suffered by the accused or the report facility No BIS employee will be retaliated against for submitting a good faith report.
If your last name begins with A-M, these items are
Required each January of employment
If your last name begins with N-Z, these items are
Required every June of employment
Abuse & Neglect (A & N) Blood Borne pathogens (BBP) Confidentiality agreement HIPAA test Observe, Record and Report test (ORR) Seizure training acknowledgement Abuse & Neglect (A & N) Blood Borne pathogens (BBP) Confidentiality agreement HIPAA test Observe, Record and Report test (ORR) Seizure training acknowledgement
Relationship with Families
Smoking Sexual Harassment
Rate of pay Cell phone use
Med Administration Dress code
Client’s Siblings / own children Drug and alcohol use
Name Badge Confidentiality/HIPAA
Client Transportation Respect
Seatbelt Line of Sight
Driver License Arms length
Insurance Supporting a client vs. the appearance of Sleep
Agitated State NO TEXTING/TALKING on phone WHILE DRIVING Page 3 Page 13
How do I request time off? (RTO requests)
Make sure you are not scheduled for any shifts for the day you wish to take off Log into the W2W system Click on “Request Time Off (Full or Partial day) Choose either full day or Partial Day or Repeating Days off Comment as necessary Receive approved or rejected based on previous stipulations/requirements
If you know of any days that you need off currently (within the next 4 months), please enter them into W2W as soon as you receive your log in information!
Holidays in the ISL
Time and a half for hours worked on the following Holidays: •New Year’s Day •Easter •Thanksgiving •Christmas
ISL Holiday Guidelines
Holidays in the Natural Home
• New Year’s Day • Easter • Thanksgiving • Christmas • Memorial Day • Independence Day • Labor Day Natural Home DSPs are not paid above their hourly rate to work on the listed Holidays Communicate with your clients ahead of time and relay your plans!
Timesheets, W2W, DPN’s and Pay:
Please clock in and out on the master timesheet located in the client binder in each home. Do not clock in before your scheduled shift time and do not clock out on the sheet until you leave your shift.
Time in and out must match your client’s Daily Progress Note (DPN) as well as your W2W shift assigned to you.
Any deviations or problems with any forms may result in a lack of pay for the shift.
DPN’s (in home only) are used as your weekly timesheets. 2 ways to receive pay:
Via mail or direct deposit – individual issues will be handled on a case by case basis. Time must be reported in 15 min increments – do not clock into shift before your scheduled time!
DO NOT FALSIFY A TIME SHEET or a DPN – Medicaid/Insurance Fraud Mileage logs are to be turned in at the same time as your timesheets
Mileage logs and guidelines
To claim mileage with a Natural Home client, you must do the following:
*Have a shift that is at least 3.5 hours long *Travel a minimum of 20 miles with that client within that shift *Complete mileage logs with starting and
ending mileage and destinations
*Mileage logs must be turned in according to pay cycle. Please refer to Pay Cycle doc for dates** *Failure to turn in mileage logs on time, will result in non-payment.
*receive $4 per shift as a mileage stipend
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C L I E N T S D E P E N D O N U S !
!
If you are going to miss a shift with a client in the natural home setting you must….
Natural Home:
Call all team members
• With as much advanced notice as possible to see if anyone can cover your shift
Page 18-19 Call the office and the BT
• Contact the team’s Family Care Advocate and immediate supervisor regarding whom you have contacted and what, if any, resolution has been made
Call the family
•If coverage was found, let the family & FCA know who will be working
that shift so that changes can be entered into W2W.
•If coverage was not found, a discussion must take place with the
family regarding make up hours before the end of the service month.
Changes should be reported to the Family Care Advocate.
Attendance and Punctuality Policy Call in/shift coverage Page 18
Be sure to review and sign the form in your packet. What you need to know: Employees that call off to a scheduled shift during the hours of Friday at 3pm to Monday at 8am will receive a first and final disciplinary action (DAF). Employees that call off to a second shift during the hours of Friday at 3pm to Monday at 8am during a six month period will be terminated.
Employees that have three call offs of any nature during a six-month period (unless excused by a physician's note) will be terminated. Employees that are late to three scheduled shifts in a 6 month period will receive a first and final disciplinary action (DAF). Employees that are late to
an additional shift in a 6 month period and have already received a first
and final warning regarding tardiness will be subject to termination. Poor attendance and excessive tardiness are disruptive. Either may lead to disciplinary action, up to and including termination of employment.
Any BIS employee found to be in violation of these or any policies/ procedures will be subject to disciplinary action
up to and including termination.
Progressive Disciplinary Action:
Verbal Feedback Written Feedback
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Action plan/suspension (Final notice for improvement) *
disqualified for annual increase or pay rate for that calendar year
Termination – Training repayment policy enforced Recovery of any agency/client items HIPAA and confidentiality agreements invoked
BIS Grievance Procedure
Express grievance verbally to your immediate supervisor. If resolution has not been reached within one week then… Put the grievance in writing and submit it again to your immediate supervisor. If issue is not resolved with in a reasonable amount of time then….
Contact the office to request a hearing with a Behavior Intervention Services BCBA. All parties will state their case and the BCBA will provide a resolution.
Workers Compensation
All employees will sign a copy of the Workers Compensation policy stating that they understand it’s contents
If you are injured during billable time with a client you must call your immediate supervisor to start the Workers Comp process. You will be asked a series of questions and a treatment determination will be made
All Workers Compensation claims will begin with a drug test
This test must be completed within 24 hours of the incident. Workers Compensation will not cover an injury if the drug test is outside of these parameters. Should you decline to take a drug test, you must sign a waiver form or your refusal will be deemed a positive drug test and you will be terminated.
We ask that all employees visit a Urgent Care facility when possible. Emergency rooms will only be approved when the injury is classified as a catastrophic event: broken bone, large laceration to a vital area, etc.
All paperwork acquired must be presented to BIS for submission to the Insurance company An injured employee will not be permitted to return to active duty until a letter from a health care professional has been received permitting the individual to return to work Page 14
Community Event Report Forms (CERF) & Medical Event Report Forms (MERF)
What is considered a “Community Event” for one client may be a daily occurrence for another. Please make sure to speak with your clients Behavior Therapist or DSP Trainer to better understand your particular clients and when a CERF may be necessary.
Forms will be located in your clients home in the data binder
All CERFs must be turned in within 24 hours of the event
All CERFS must be legible and precise
If you are uncertain as to whether an CERF should be completed, please call your Supervisor for clarification
Questions?
With ISL Director Jamie Klamert ISL Support Kyle Swendig
What is an ISL?
-Individualized Supported Living -Requires staff to be committed, reliable, and enthusiastic about the Direct Support Professional position -Residential living with around the clock support staff -able to provide safe environment for our consumers -provide 24 hours behavior intervention -promotes independence and a quality lifestyle for individuals -There are specific policy and procedures of Direct Support Professionals within the ISL Department.
Medication Administration
Must be Med Certified to pass any medication to a consumer (this includes creams and treatments)
Must complete DMH Med Level 1 Certification Class before passing meds Must have Supervised Medication Administration Sign-off Signed before passing meds at any ISL Label and Storage of medications Controlled Substances must be double locked !
All staff (med certified or not) must count controlled substances every shift
If you are not med certified: It is a Direct Support Professional’s responsibility to ensure that a consumer receives their medication Page 15 Always check the MAR when entering the ISL.
This will inform you what time the consumer takes their medication You must notify your CIST that you will need someone to pass meds for your consumer
Medication Administration Continued…
Medication Errors
The importance of the “Triple Check”
Reporting a Medication Error: 1) Inform the CIST immediately 2) Leave medication in the bubble pack 3) Fill out specific Med Error ERF
Med Error Policy
MEDICATION ERRORS
A medication error includes any failure to administer medication as prescribed for a particular consumer, including failure to administer the medication: 1. To the right client
2. Right medication 3. In the right dose 4. In the right route 5. At the right time 6. For the right reason 7. Right response 8. Right documentation after the medication is administered. *Please note that documentation/charting errors are also considered medication errors.
Staff must report a medication error within one hour from the start of their shift or when first arriving at the home or they assume the same medication error as the staff who made the error and all disciplinary action that follows.
In the event of a medication error, (staff see a blank on the MAR, medication still in bubble pack, and no documentation on PRN medications or any other errors) staff are to immediately notify the QDDP.
The QDDP will notify the ISL Director. The QDDP is to determine if the error is a documentation error or a medication error. The QDDP shall then notify the parent or guardian and Community RN upon discovery of a medication error. Documentation errors will be handed by the QDDP. The QDDP or supervising employee shall document the effort to reach the parent or guardian. If there is a question of potential harm to the consumer, the QDDP or supervising employee shall also notify the consumer’s health care provider/physician. In addition, poison control can immediately be notified (1-800-222-1222), particularly if the consumer’s physician is not immediately available. Home Supervisors or QDDP are to circle the medication error on the MAR after notification has been made to the QDDP. Staff shall fill out a medication error form, fax it to the office and file the original form behind the MAR. If the error is a reportable event to DMH then the QDDP or supervising employee will need to complete a Community Event Report Form within 24 hours of discovery. The Community Event Report Form should then be faxed to DMH within this timeframe. These reports shall be retained in the consumer’s permanent file at the agency location. They shall be made available to the Department of Mental Health and/or any other joint agency.
If an employee is found at fault or negligent in medication administration, that employee may be subject to any of the following disciplinary action: 1. Involuntary unpaid meeting with QMRP, which may be handled via phone, but will include feedback form placed in employee’s permanent work file 2. Written warning that includes 30 day probation 3. Additional unpaid meeting/training by Community RN or the RN designee (Staff that fail to take have the meeting within seven days will be suspended without pay. 4. Repeat of Medication 1 training/re-certification at expense of employee within 30 days.
5. Termination for serious offense and/or intentional failure to report -The above disciplinary action will typically occur in a sequential fashion starting with step 1 and progressing as additional medication and documentation errors occur depending on the severity of the incident. Once a period of 6 months passes, previous medication/documentation errors will be potentially disregarded when taking into account future disciplinary action at the discretion of the ISL Director and HR Director.
If the medication error is life threatening or has serious consequences to the client the disciplinary action can accelerate to termination. If any employee has any doubt as to how to properly administer a medication, a supervisor should be contacted.
Restraints
MANDT
Last Resort
Keeping you and your client safe
& Time Outs
Cannot be used as a punishment
Must be the choice of the consumer
Time out = No Break = Yes
Consumer Rights
Treatment of Client: ERF and State Documentation language:
• Do not say “NO!”—The use of positive talk • Consumer Rights • The importance of positive language on state documents • Consumer Rights/ Limitations • HIPPA • Eliminating the words “must” “have” “don’t” “can’t” “no” “stop” from your vocabulary • Role of Parents/Guardians • Rights of Parents/guardians
Please find your Report Worksheet!
At 5:50pm I prompted SP that she needed to take one bite of food in the next five minutes or she would not have her snack tonight. I prompted SP every minute explaining how many minutes she had left to take one bite. SP refused to take any bites. After the five minutes were over I explained to SP that we would sit at the table until it was time to take her bath and go to bed. SP continued to sit and look. SP began to rest her head on her hand as if she was going to sleep. At 7:00pm, her room mate began to eat her dinner, Subway. SP began pointing to her roommate's plate saying she was hungry. I gave SP her meds and prompted her to eat her food. SP responded by scratching staff, ripping her shirt and punching her body. She was prompted to have nice hands. At 7:15 SP threw her spoon at roommate and was removed to her bedroom where she sat with nice hands. At 7:30, SP chose her clothes for the next day, her night clothes and began her bath routine. She required help washing her hair and verbal prompts to wash her body. SP independently dressed herself, brushed her teeth and went to bed at 8:30pm. Overall SP had an okay day with the exception of several target behaviors and refusals.
Consumer Funds
• • • • Each consumer within an ISL receives funding from the state. Some consumers may receive additional funding from additional sources At the start and end of each shift, you will be responsible for checking and recording consumer funds
Personal Funds
Each consumer receives a set allowance from the state each month. These funds are used for activities in the community, as well as, personalized items (i.e. hair products, soap, OTC medications, hygiene products) • • These funds are tracked on a financial tracking sheet in the ISL Set monthly amount varies per consumer
Pocket Money
This funding comes from parents, guardians, family members Can be spent on activities in the community, personal items, food, whatever the client might want or need Amount varies per consumer These funds are tracked on a financial tracking sheet in the ISL • • • • • • • • •
Chaperone Funds
These funds are for staff to use when doing activities in the community • These funds are tracked on a financial tracking sheet in the ISL The set monthly amount for each consumer is $30.
• These funds can ONLY be used with Personal Funds Must have a personal fund receipt to match chaperone receipt
Household funds
All consumers receive a set $30 monthly allowance for household items Includes all cleaning products Paper towels, toilet paper, hand soap, laundry detergent These funds are tracked by the CIST Must use these items sparingly Once the house hold is out of money, THAT’s IT!
MUST KEEP ALL RECEIPTS NO MATTER WHAT FUND IS USED!!
Consumer Funds Continued…
Buying consumers gifts
Any additional purchase made outside of the provided consumer funding, must be approved by the CIST for each consumer This is to prevent perceived gift/purchase entitlement of the consumer Set-up expectations that all staff should buy them something Staff cannot bribe clients… If you do/stop that…then I will buy you… “Be a good girl today, and I will take you to McDonald’s”
Behavioral Crisis Procedure
In the event that a behavioral crisis or injury to staff occurs at the time of a shift change or while on shift that places the safety of our consumers and/or staff at risk, it is expected that staff is not to leave the ISL prior to the following procedure: the CIST and/or Behavior Therapist for the team has been contacted The Event Report Form has been filled out and faxed to the BIS office the staff relieving you on shift has arrived the situation has deescalated a supervisor (CIST, BT, ISL director) gives permission to leave Failing to remain with the consumer before these steps have been taken will constitute consumer neglect and job abandonment, and employment with BIS will be terminated. The situation will also be submitted to the state for investigation.
ISL
Holiday Guidelines Please turn to pg. 3 of the ISL Policy and Procedure packet Holidays in the ISL:
New Year’s Eve, New Year’s Day, Thanksgiving, Christmas Day, Christmas Eve, Memorial Day, 4 th of July, Labor Day, These holidays are paid at Time and a half for specific times throughout the day
Memorial Day: 1pm-8pm 4 th of July: 12pm-10pm Labor Day: 1pm-8pm Thanksgiving: 1pm-8pm Christmas Eve: 5pm-12am Christmas Day: 12am-12am NYE Eve: 7pm-12am NYE Day: 12am-3pm Holiday staff is required since we cannot leave consumers unstaffed Holiday shifts are broken down into 3 or 4 hour shifts for the following dates:
New Year’s Day, Easter, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Eve, Christmas Day Each member on the team will be required to work a small portion of each holiday
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Time off requests will not be approved for the any of the afore mentioned holidays
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DSP members will be given at least one month’s notice of their time slots for holidays
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If a DSP member wants a holiday off you must follow proper protocol of finding coverage and informing the CIST and ISL Staffing Coordinator of any changes
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For any improper Call-off that does not follow the policy guidelines will result in disciplinary action
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First infraction
• •
Second infraction Third Infraction
Individualized Support Plan
What is the person centered approach? According to DMH, person centered planning is a process directed by the individual, with assistance as need from a represented. This process allows the individual to access supports that will allow him/her to achieve personally defined outcomes and the training, supports, therapies, treatments, and other services to become part of the plan.
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All consumer’s within the ISL will have an ISP. Each staff member is required to receive ISP training (and BSP training if applicable) before working their first shift with any consumer
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It is important to remember that the Individualized Support Plan is the document that drives all that we do with our consumers.
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ALL STAFF MUST FOLLOW THE ISP AT ALL TIMES
Individualized Support Plan
What information is in the ISP?
• • • • • • • • • • • • The individual’s demographic information Contributors to the plan Who is important to the individual What is important to the individual What do you need to know to appropriately support the individual What supports are needed for health, if any?
What support are needed for safety, if any?
Requirements of family of minor child or guardian How the person communicates (i.e. verbal vs. non-verbal) Issues to be resolved/ concerns Action plans toward meeting outcomes Legal Issues • Some homes require locks on doors, cabinets, refrigerators • Any restriction put in place in the home must be approved by the Human Right Committee
Missouri Quality Outcomes
1) People belong to their community 2) People have a variety of personal relationships 3) People have valued roles in their family and in their community 4) People are connected with their past 5) People’s communication is understood and receives a response 6) People are provided behavioral supports in positive ways 7) Prepare are provided with support in a manner that creates positive image 8) People express their own persona identity 9) People have control of their daily lives 10) People have the opportunity to advocate for themselves, for others, and for causes they believe in 11) People’s plans reflect how they want to live their lives, the supports they wants, and how they want them to be provided 12) People live with dignity 13) People feel safe and experience emotional well being 14) People are supported to attain physical wellness 15) People are actively supported throughout the process of making major lifestyle changes 16) People are supported in managing their home
Paperwork in ISL
We are going to touch on a few of the aspects of daily paperwork. There may be more or less depending on the consumers you work with. You will learn more about client-specific paperwork during your training shift with the Lead Staff. It seems like a lot at first, but once you get used to it, it’s a breeze!
Daily Progress Notes (DPN)
DPNs track the progress of consumers toward their ISP goals and Missouri Quality
Outcomes
These DPNs must have your accurate time in/time out , date , printed name, signature DPNs must be fully filled out—do not leave anything blank! Circle or write in N/A if that particular task was not completed DPNs are different for each consumer
Daily Progress Notes (DPN)
• • • • • • • • • • • •
What information is included on a DPN?
Progress made towards outcomes Any doctor’s appointments attended Any medications that have been given Any new medical information specific to the consumer (i.e. illness, new medication order, etc.) Any visitors to the home Any pertinent phone conversations Any unusual incidents Behavior Incidents The emergence of any new behavior concerns Emergency Situations Community Outings Any new skills that have been mastered
Behavior Data Sheets
Behavior Data Sheets collect information that is needed for Behavior Therapy. Not all ISL consumers have Behavior Data Sheets separate from DPNs, but they are just as important! These sheets help you and the Behavior Therapist track the behavioral progress that the consumer is making and help justify their need for services.
Intake, Sleep, and BM Logs
• These logs are very simple to complete, but it is important to keep track of Intake (what the consumer eats/drinks), sleep (times that the consumer is sleeping), and BM (times that the consumer has a Bowel Movement) to maintain communication in the house and to monitor the consumer’s health.
These Medical Data sheets must be completed every shift • If any consumer has not had a BM in 3 days you MUST notify the CIST immediately • Some consumers require their blood pressure, weight, fluid intake, or temperature to be recorded everyday, these are important medical records that must be kept up with accurately to ensure the quality of our consumer’s health
Monthly Nursing Reviews
The Community RN looks for signs and trends that may be medically, behaviorally, and mentally intertwined and affecting the clients behavior or well-being • • • Intake, Sleep, and BM logs are also reviewed by the BIS Community RN who does monthly visits to each ISL with every individual consumer Many people don’t realize that physical and physiological symptoms can all effect our behavior, the monthly RN visit are essential to maintaining our consumers health and over all well being It’s important for staff to familiarize themselves with why medical data is being taken and who to notify if abnormal observations are made • Always notify the CIST if there are any abnormal medical changes or medication concerns • The CIST contacts the Nurse for further instructions
• • • • • • • • • •
ISL time sheets are due every other Monday after the Sunday overnight (9am) All time sheets will be sent electronically to the office from the ISL by whomever works Sunday overnights Timesheets are submitted to behaviorinterventionservices.com
•
Timesheet Submission One time sheet per HOME Only use 15-minute increments when signing in and out Time sheet times MUST match Daily Progress Notes (DPN) Do NOT falsify the time sheet. This is Medicaid fraud! Sign in and out ACCURATELY!
Mileage logs are turned in with time sheets.
ANY questions regarding time sheets may be directed to your CIST or Amy Clarke , Financial Administrator (Time sheets are completely different in Natural Home settings— please get clarification before working any Natural Home shifts.) 401 Timekeeping & Mileage Logs Behavior Intervention Services, LLC Direct Care Staff Time Sheet Log ISL Name (Clients’ name(s)): ___________________________________________
Please keep track of your hours worked on this log. Hours not logged will not be paid.
Pay Cycle Dates: ______________________________________________________
Date PCA Name Mileage for this shift: On Call Client’s Initials: Time In Time Out Hours Worked
TIMESHEETS ARE FAXED TO THE BIS OFFICE EVERY TWO WEEKS AFTER THE SUNDAY OVERNIGHT. SEND THEM TO FAX # 314-395-9381. FAXED IN BY:________________________________________ ON:__________________
(Staff Name) (Date)
o
Every ISL consumer is allotted a budget for a certain number of miles for the DSP staff to receive reimbursement.
o
Mileage logs can be found in ISL
o
The amount of miles allotted to each consumer varies
o o
Mileage is paid out at .45 cents per mile. If over miles, payout is recalculated to stay within budget.
o
E.g. Consumer budget = 400 miles/month equaling $180.
o
If 450 miles that month, new payout = .40 cents/mile to stay within $180 budget.
Mileage Logs are submitted on the last day of the month by midnight (12am) with timesheets and will be paid out according to the dates on the Pay Cycle Document
o
It is the responsibility of the DSPs to submit mileage correctly and on time (if mileage is not submitted correctly or on time you will not be reimbursed).
o
Mileage Logs must be filled out legibly, accurately, and completely
o
Mileage logs are submitted to behaviorinterventionservices.com
o
Mileage log submission STAFF ARE NOT ALLOWED TO USE THEIR PHONE AT ANY TIME WHEN TRANSPORTING CONSUMERS!
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Home Supervisors
Direct Supervisor when in the ISL Provide Verbal feedback Can be contacted about general household questions or concerns Conduct in-home training and training shifts Report to CIST at least twice week Collaborate and work side by side with the CIST during staffing and behavioral difficulties
CISTs
Supervise all DSP staff within the ISL Manage 2-3 ISLs Provide additional staff training and written feedback Must be contacted any time a med error occurs, injury to consumer, behavioral crisis, or an ERF/med error occurs, scheduling Must be contacted for approval before using any PRN medication Provides communication between day programs, schools, case managers, family/guardians, and DSP staff
Communication policy
BIS hopes to create an environment in which all employees are timely and professional when communicating or seeking a response to a question or query.
There are certain communication expectations that should be followed by all individuals at BIS to ensure accepted forms of communication are followed and the response times are honored according to the method of communication.
• • • • • • • • • • • •
Call Site Supervisor’s cell and leave your phone number when:
You witness or suspect abuse/neglect Non-medical emergencies A client is ill A client is missing Staff injury (workers comp) Situations when staff/client are feeling threatened Whenever an EMT/internal incident report is filled out You do not have a vehicle with you Questions or concerns about your shift Items not completed or completed correctly by the shift you are relieving When you are calling off and only after initiating the call in/shift coverage procedures You are not properly relieved on time.
• • • • • •
Send an email to the appropriate person when you have:
Paycheck concerns Personnel types of concerns Guardian/case manager concerns that are not emergencies Something that the supervisor needs to respond to or be made aware of Supplies are needed but are not necessary to complete your job General information that does not require immediate attention by the supervisor
Non-emergency phone calls to your supervisor are to only be placed between the hours of 8am and 6pm
• • • • • • •
Exercise….
You notice you’re running low on paper towels… You’re giving your consumer a bath when you notice a bruise on their lower back… While out in the community you consumer requests to buy a soda, but you forgot their personal funds… You’re realize you’re going to be 15 minutes late picking up your consumer from their day program… When filling out Ernie’s BM log you realize that a 0 has been put for the last 4 days… You are working an overnight one night and you discover you’re out of floor cleaner You’re taking Joey’s blood pressure and receive a reading of 80/40; the parameters for Joey’s blood pressure are: Systolic: if this number is greater than 200 or less than 90
Diastolic:
if this number is over 100 or less than 50 • • • • • On your first shift from 3pm-11pm, you go to the MAR and see that Charlie has 5pm meds, you are the only staff member in the house and you are not med certified… You have a question about how to fill out the Daily Progress Note… You’re in the community with your consumer when suddenly they begin having a behavioral crisis and are refusing to leave, the store manager has already asked you one time to leave the store… While out for a walk Sally trips and scraps her knee. The cut requires minor First Aid including her PRN Neosporin… Jimmy wants to go out to eat, but his ISP states that he can only go out to eat once a week, you notice that his chart does not indicate whether or not he’s been out to eat for the week…
Timesheets need to match DPNs
Scheduling of Clients
Will be scheduled for hours based on the availability provided upon hire, and must provide two weeks notice for change in availability • • • • Hours are specific to the individual needs of clients or their parents or guardians Unassigned shifts are assigned to staff using inverse seniority Flexible scheduling available if requests are made in a timely fashion & needs are met for families All schedules will be posted on the When to Work websites. Requests for time off will also be made and approved or denied using this system • • • • Any ongoing change to a schedule, be it for personal reasons or at the request of a parent/guardian, must be reported and approved by the staffing coordinator and the BT or CIST It is the responsibility of all employees to update their preferences on When2Work Anytime there is a shift addition/change that is outside of your normal schedule will be followed up by an email from the ISL staffing coordinator All employees (especially DSPs) should be checking WhenToWork at least twice per week.
Anyone working in an ISL must..
Call all other team members
• With as much advanced notice as possible to see if anyone can cover your shift
Page 18-19
Call Staffing Coordinator
• With as much advanced notice as possible to make them aware of who will be working the shift
Contact
• Contact your CIST, Lead Staff member, and Staffing Coordinator so that an appropriate Floater DSP may be contacted
T HERAP
is an Online Software System for Providers Supporting People with Developmental Disabilities for Effective and Efficient Documentation, Reporting and Communication.
Currently every DSP and ISL staff member is responsible for medication administration, T-logs (daily summaries), and some health tracking on THERAP every shift.
Each ISL has a laptop and a jetpack (wireless internet provider) which is kept in the locked med closet Laptops are not allowed out around consumers Laptops are to be used for work related repurposes ONLY Sites like YouTube, Pandora, and Netflix are strictly prohibited Lead Supervisor, CIST, and ISL Assistant Director track data usage and web history for each laptop within the ISL
www.therapservices.net
How to…
Log in Create a T-log summary Create a T-note Check and create S-comms (messaging system)
Reward Programs
Employee of the Week and Month
Family Feedback Bonus
Applicant Referral Bonus
Perks for All Employees!!!
(After 30 days employment)
Corporate Wellness
•Club Fitness •$10/month •Minimum of
8 visits per month
•Concierge
Wellness is also available to all employees!
Discounted Phone Service
• Verizon & AT &
T Wireless
• 8% discount
on monthly services
• Bring your
check stub to the nearest store for details.
Legal Shield
• Prepaid
Lawyer Services
• Credit
Monitoring
• Identity Theft
protection
• $15.95-$22.24
per month Supplemental Insurance
• AFLAC • Short Term
Disability, Cancer Screening, Wellness Plans, etc.
• Safe Harbor
401 (k) retirement plan
• 21 years of
age
• Employed
for 1 year, minimum of 19 hours per week
• BIS matches
100% of 3% employee contribution and 50% of up to 5% Reinforcement Programs
• Employee of
the Week
• Employee of
the Month
• Employee of
the Year
• Applicant
Referral Bonus
• $25 at 90
days
• Family
Feedback Bonus
• $10 and 1
per quarter
Scheduling System Individual user id and password 24/7 access to schedules, team member contact info, intranet email system Request Time Off (RTO) abilities Scheduling preferences Urgent text alerts Employee Bulletin Board Trade Board Inclement Weather Alerts BIS Agency Website
Upcoming events and trainings BIS Buzz Employee Nominations Staff-only section to access Annual forms/trainings due:
January for A-M June for N-Z
Like us on Facebook!
https://www.facebook.com/behaviorinterventionservices Facebook is a great place to find out: • • • • Upcoming events Client function updates EoW and EoM winners About your co-workers and other members of the agency
Any Questions?
Please complete all new hire packet forms with signatures and dates
Please turn in any additional items that are needed for your file
Verify your next training date and time of that class