Medical Separation Case Studies and Process

1. Medical Separation Case Studies and Process Pamela Alston, DDS, MPP Melissa Cusey, RN, BSN John Kulig, MD, MPH Suzanne Martin, PsyD, MPH Diane Tennies, PhD

2. PRH 6.4 R4 c(5) Medical Separations • “Student is no longer able to participate in Job Corps due to medical, dental, or mental health reasons; documentation of the student’s medical condition must be provided. If at the time of medical separation, the student is determined to be eligible for reinstatement once the medical condition is resolved, the student is then separated as a medical separation with reinstatement rights (MSWR), and may be reinstated within 180 days.”

3. PRH 6.12 R11 Medical Separations • Centers shall ensure that: • Medical separations are initiated by health services staff. • Students are medically separated when: • they are determined to have a pre-existing or acquired health condition which significantly interferes or precludes further training in Job Corps, or • the health problem is too complicated to manage on center, or • the necessary treatment will be unusually costly.

4. PRH 6.12 R11Medical Separations (cont’d) • Centers shall ensure that: • If the center physician estimates that the student will be able to return to the center within 180 days, a MSWR will be given. If the student’s condition cannot be stabilized in 180 days, a regular medical separation will be given and the student may reapply in one year. • Health and social service referrals are provided for all separated students. • For MSWRs, students are contacted monthly by the HWM to assess progress and plan their return to JC within the 180 days allowed.

5. Sample Forms • Refer to Desk Reference Guides for sample forms • Medical Separation Check list • Request for Administrative Information • Administrative Report of Functional Evaluation • Notification of Medical Separation (Regional Office) • Separation and Referral Instructions to Student/Parent/Legal Guardian • Authorization for Release of Medical Information • Medical Separation Log

6. Resources • Policy Requirements Handbook (PRH) Chapter 6, 6.4 (R4) • PRH Chapter 6, 6.12 (R11) • Desk Reference Guides

7. Scenario #1 • List the pros and cons of each option. • What information is still needed? • Which is the best option based on the current information? Why? • How can you help Tulesha receive prenatal care? • Who else from center should be involved in assisting Tulesha?

8. Scenario #2 • What are the options for addressing the wisdom tooth? • What factors/information should be considered in determining if a MSWR is a feasible option? • What are the potential consequences of medically separating Josh? • What is the most feasible option? • How can you turn into a teaching opportunity a response to Josh’s comment about the rumor he’s heard regarding other students being medically separated due to wisdom tooth problems?

9. Scenario #3 • What are the health care needs of the applicant at this time? • What other information is still needed? • What is the appropriate disposition for this student—accommodations, medical separation, MSWR? Why? • Who else from center should be involved in assisting Emily?

10. Scenario #4 • Is this student appropriate for enrollment in a rural center? • Is medical separation, MSWR or return to center the appropriate disposition following his overnight hospital stay? Why? • What effect does the student’s age have on your decision?

11. Scenario #4 (cont’d) • If/when the student returns to center, what measures should be implemented to control his asthma? • Could anything have been done to prevent onset of his asthma symptoms shortly after arrival on center? • Who is financially responsible for the student’s asthma care?

12. Scenario #5 • What other information is needed to make a decision? • What, if any, interventions should be considered before recommending an MSWR? • What is the appropriate disposition for this student? Why? • What could have done at the onset of her Job Corps stay to prevent this?

13. Questions?