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Introduction

last modified 2008-07-11

This section includes the following:

Job Corps: Program Overview and Organizational Structure

Job Corps is the nation's largest and most comprehensive residential education and job training program for economically challenged youth, ages 16 through 24. Since 1964, the program has provided more than 2 million disadvantaged young people with the integrated academic, vocational, and social skills training they need to gain independence and get quality, long-term jobs or further their education. There are 122 Job Corps centers located throughout the United States and Puerto Rico operated by both federal agencies (United States Department of Agriculture [USDA] and United States Department of the Interior [USDI]) and private corporations.

The Job Corps program is authorized under The Workforce Investment Act (WIA) of 1998 that establishes the framework for a national workforce preparation and employment system designed to meet the needs of the nation’s businesses and the needs of job seekers and individuals who want to further their careers. The law provides for full involvement of business, labor, and community organizations in the design and operation of the new workforce system and emphasizes accountability at all levels—national, state and local.

The Job Corps national health component is led by the national nurse consultant who is responsible for developing and implementing the policies and procedures that guide the delivery of health care on center. A health support contractor works with the national office, regional offices, and centers to develop and enhance center health and wellness services. For example, the contractor assists the national office in developing policy, training center health and wellness staff on new initiatives, developing resource materials, collecting and analyzing health program data, pilot testing new health and wellness initiatives, and managing a national network of regional health consultants (RHCs).

There is a RHC team (nurse, physician, dentist, mental health professional) assigned to each regional office to:

Conduct assessments of center health and wellness programs for quality and compliance with the Policy and Requirements Handbook (PRH)
Provide technical assistance to health and wellness staff
Assist in the recruitment of health professionals for center
Provide training for health and wellness staff
Coordinate center visits with regional office and center staff
Follow up on recommendations made during center assessments

There is a principal mental health consultant that provides supervision to the regional mental health consultants CMHCs are encouraged to contact their regional mental health consultant (RMHC) when they are in need of policy/procedural advice and/or to report sentinel events on their center, i.e., a student death or a serious mental health event. In addition, the CMHC can give input to policy and procedural changes they would like the RMHC to pass up to national level discussions. Contact numbers for all RHCs are available from the regional office or on the Directory webpage. Contact information for the Principal Mental Health Consultant can also be found on the Directory webpage.

Policies and Procedures

Requirements and guidelines for center health and wellness programs are defined and explained in three sets of documents:

Code of Federal Regulations (CFR), Section 670.525—The CFR states the operating requirements for Job Corps. The promotion and maintenance of student health and wellness is a desirable goal as well as a requirement under the CFR:

“A Job Corps center operator must provide medical services, through provision and coordination of a wellness program which includes access to basic medical, dental, and mental health services for all students, from their date of enrollment until separation from the program.”
Policy and Requirements Handbook (PRH)—The PRH expands the CFR by establishing operating policy requirements for Job Corps centers. There are six PRH Chapters. Chapter 6, sections 6.10 – 6.12, defines the required parameters and services of center health and wellness programs. Although Chapter 6 is critical to understanding health requirements, center staff should be familiar with the other PRH chapters too.

Note: The center mental health consultant should have PRH Chapter 6 available while reviewing this TAG.
Technical Assistance Guides (TAGs)—TAGs contain suggestions and technical assistance for implementing the policies and requirements set forth in the PRH. As new requirements are added to the PRH, new TAGs are developed to assist in implementing the policy. The PRH and all health TAGs should be available in the health and wellness center and can be found on the Documents webpage.

The Job Corps directive and field communication system is used to update the PRH and to disseminate information throughout Job Corps via e-mail, followed by a mailed copy. Directives are distributed to national office senior staff, regional directors, center directors, center operators, and national training and support contractors.

Three types of directives are issued:

PRH Change Notices—Contain new or revised policy with instructions to delete, replace, or add pages to the PRH.
Program Instructions—Provide one-time instructions with a designated expiration date and usually require center response (e.g., dental equipment survey).
Information Notices—Provide one-time announcements with information that is of interest to centers (e.g., data summaries, flu vaccines, etc.). The Job Corps health and wellness website maintains copies of all Job Corps health-related materials (PRH, TAGs, directives, resource guides) for viewing and downloading. Center health and wellness staff should visit the website frequently to receive the latest information about both Job Corps and the health and wellness program.

Mental Health and Wellness

Mental health and wellness is an integral component of general physical health. Mind and body are inseparable: health is a complete state of well-being and there is no health without mental health. Many physical conditions are actually rooted in a state of mind, or in a history of stress that has never been balanced. Our personal relationships and work abilities are affected by both physical and mental health issues. Mental health problems are a common fact of life – we know that around one in five people of working age have a mental health problem. Many people will be able to resolve these problems successfully, with few long-term consequences, but for some people mental health problems can be the catalyst for some of the most entrenched forms of social exclusion – long-term unemployment, homelessness, poor physical health, alcohol and substance misuse. The Surgeon General's report defines mental health as "the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity. Mental health generally refers to an individual's thoughts, feelings and actions, particularly when faced with life's challenges and stresses. Good mental health isn't just the absence of mental health problems. Although different cultures have differing expectations for health, many of the following characteristics are likely to be present in individuals with good mental health:

Sense of well-being and contentment
Zest for living—the ability to enjoy life, to laugh and have fun
Resiliency—being able to deal with life's stresses and bounce back from adversity
Self-realization—participating in life to the fullest extent possible, through meaningful activities and positive relationships
Flexibility—the ability to change, grow, and experience a range of feelings, as life's circumstances change
Sense of balance in one's life—between solitude and sociability, work and play, sleep and wakefulness, rest and exercise, etc.
Sense of well-roundedness—with attention to mind, body, spirit, creativity, intellectual development, health, etc.
Ability to care for oneself and for others
Self-confidence and good self-esteem

Connection to Employability

Mental illness has a significant economic and social affect. Approximately 217 million days of work are lost annually due to productivity decline related to mental illness and substance abuse disorder, costing U.S. employers $17 billion annually. The prevalence of mental illness in the workforce is substantial. In any given year, 39 million adults age 18-54 (the “working” population) experience a mental illness and/or substance abuse disorder. In the “working population”, alcohol abuse/dependence and major depression are the most prevalent behavioral health problems. In 2003, 8.2 percent of full-time employed adults experienced a mental illness. However, the good news is that although the number of people with a diagnosable mental illness is increasing, the efficacy of treatment for mental illness has been well documented and has improved dramatically over the last 50 years. Employment is a critical part of recovery and obtaining self-sufficiency for people with mental illness. In 2004, approximately 72 percent of adults with a mental illness were employed and working.¹

The message is clear. Helping students learn to identify and manage their mental health issues and illness can lead to improved productivity and employability. Optimal mental health and wellness promotes social and employability skills. For example, it assists students in sustaining concentration, interacting with persons on the job, responding to negative feedback from supervisors, responding to change in the work environment, and host of other skill sets. An individual does not lose a job due to a mental illness, but the behaviors connected to the illness. For long-term employment success, good mental health is paramount.

Mental Health and Wellness Program Philosophy

Job Corps employs a training approach that prepares youth for employment. Similarly, Job Corps employs a holistic wellness approach that integrates students’ overall well-being, employability skills, and optimal health status through a combination of on-center health services and related health programs to prepare students for stable, long-term employment. Mental health and wellness is key to undistracted learning, meaningful and positive relationships, balancing stress, self-confidence, as well as to uninterrupted training and work attendance.

The mental health and wellness program is designed to increase students’ awareness of their own personal responsibility in achieving and maintaining mental health and wellness. The philosophy of the Job Corps mental health and wellness program is based on the following:

Mental health is integral to a students’ general physical health status and vice versa. Students cannot be healthy without good mental health.
Optimal mental health plays an important role in interpersonal and social relationships.
Certain mental health conditions, when left untreated, present major psychosocial barriers to students’ well-being and prevent students from adapting completely to Job Corps and the workplace.
Optimal mental health is the personal responsibility of each student. One task of a Job Corps center is to make students aware of this responsibility and encourage them to assume it.
Job placement upon completion of training is often influenced by learning how to manage mental health issues that could affect performance and relationships in the work place.
Mental health issues that are not identified and treated can cause a significant amount of problems with other students and increases absenteeism from training and jobs.

Mental health issues in our population can range from crisis behavior resulting from a relationship break-up to a major psychiatric illness. Because the Job Corps program is designed primarily to serve youth and young adults, it is important to note that:

Some of our students experiencing mental health issues may not meet the DSM-IVTR criteria for a mental health diagnosis. These are students who have brief episodes of situational stress (e.g., family problems, relationship problems).
Some of our younger students will encounter adolescent crises that may not meet the DSM-IVTR criteria for a mental health diagnosis, but require intervention.
Some of our students will have significant mental health histories with documented DSM-IVTR diagnoses before arrival on center.

Mental health issues can affect vocational training and employment in a variety of ways. All students experience emotional reactions as they go through their training and some may need extra guidance. The irregular nature of mental illness can make it difficult for some students to maintain consistent training/work schedules, handle day-to-day stress, and appropriately navigate social interactions. The challenge facing the Job Corps mental health and wellness program is to help build a safe and constructive environment within Job Corps for these youth that supports psychological, intellectual, and social growth and ultimately prepares them for employment.

Job Corps operates within a framework entitled, Career Development Services System (CDSS). CDSS is a career-focused approach that provides individualized services to each student using activities and experiences as learning models. CDSS places a priority on collaborative career planning between Job Corps and the students. CDSS ensures that a career manager or career management team assesses the needs of the student and arranges, coordinates, monitors, evaluates, and advocates an array of services to meet the student’s needs. This model compliments the structure of the mental health and wellness program’s emphasis on an employee assistance program (EAP) and case management model.

There are four CDSS periods within which health and wellness services and activities are conducted:

Outreach and Admissions (OA) Period—During the OA period, applicants are introduced to the kinds of health and wellness services available at the center. Also, OA staff review requests for accommodation and secure partners in providing requested accommodations.
Career Preparation Period (CPP)—Students are introduced to health and wellness services so that they understand and feel comfortable and supported by the health and wellness staff, including the center mental health consultant (CMHC); and staff serve as models for students who wish to job shadow for health-related training.
Career Development Period (CDP)—Career management teams coordinate with the health and wellness center to provide appropriate interventions for students who need services. For example, CDP staff make sure students with disabilities receive necessary services/devices to participate, and assist students in perceiving good health as being critical to achieving career goals.
Career Transition Period (CTP)—Students understand health-related aspects of independent living, students with special needs have support systems in place to support transition to and retention of employment, and post-center service providers know how to coordinate with Job Corps when needed to help graduates succeed.

The mental health and wellness program is integrated into each CDSS period throughout a student’s tenure at Job Corps. See Integration of TEAP, MHWP, and CDSS for suggested CDSS activities for the mental health and wellness program. The mental health and wellness program is an essential part of the Job Corps program as required by the Policy and Requirements Handbook (PRH), Chapter 6: 6.10, R3. Although the center director is ultimately responsible for the provision of all aspects of the mental health and wellness program, the center staff implement the program with the support and technical assistance of the CMHC.

Acting in a consultant capacity, the CMHC should clearly define his/her role in the mental health and wellness program, provide program focus and material, and prepare the center staff to assume responsibility for various program components. The mental health and wellness program should reflect the CDSS model with a focus on employability, and the CMHC should view his/her role as the program’s administrator. Program effectiveness is directly related to the ability of the center director, key staff members, and the CMHC to (1) focus on the mental health aspects of the center program and (2) develop staff members' capabilities for recognizing and addressing students' mental health needs as it relates to wellness and employability.

Program Purpose and Objectives

The importance of mental wellness to the student's ability to develop a positive self-image and to succeed in Job Corps and employment after graduation is recognized in the Code of Federal Regulations (20 CFR 638.510) and PRH-6: 6.10, R3. The PRH requires that each center director provide a mental health and wellness program that includes routine mental health services/intervention for all students, 24-hour emergency mental health care, qualified personnel to implement these services, and ongoing staff development. The center mental health and wellness program should:

Provide environment that promotes the mental wellness of all students
Support student mental health and wellness through the use of prevention-oriented principles and techniques that promote employability
Provide an EAP model that includes the availability of professional evaluative and diagnostic services for students, brief intervention, group sessions, and a referral system that affords ready access to these services
Promote a drug-free environment and workplace
Provide mental health care to students through specific center programs as recommended by the Job Corps national office
Provide staff development programs to enable staff to identify and appropriately respond to students undergoing periods of emotional stress

Each center's mental health and wellness program must include the services of a CMHC, a trainee employee assistance program (TEAP) specialist, and a counseling component that focuses on students' individual needs and progress in personal and social development, basic education, and vocational training. These counseling services are to be provided by career counselors, residential living staff, and other appropriate staff with the support and guidance of the CMHC.

In utilizing the center mental health and wellness program, students should learn:

About the center’s health care delivery system and how to seek on-center health care
How and when to access community health services
About wellness concepts and the steps to take to maintain personal wellness
About their individual mental health condition and prescribed treatment
About appropriate lifestyle choices
How to take personal responsibility for maintaining optimal health
How employability skills can be enhanced in the course of obtaining mental health and wellness services
That optimal mental health and wellness is a prerequisite to employment readiness

General Program Components

The mental health and wellness program can be divided into two equally important functional areas: clinical services and staff development. Clinical services are the responsibility of center health professionals: CMHCs, TEAP specialists, physicians, and nurses. Folder reviews, disability accommodations, clinical assessments, TEAP support brief problem-focused psychotherapy, case disposition recommendations, and crisis intervention are mainly reserved for these professionals. However, all personnel in contact with students, particularly career counselors, have roles to play in these and the other vital clinical functions (e.g., crisis prevention and intervention, and counseling). Some of these roles are described in the Responsibilities of Center Staff section.

Given the limitations of the CMHC’s time, the focus on employability, and the great needs of the students, it is best to conceptualize the clinical services of the mental health and wellness program as an EAP model with the following components:

Initial evaluation and triage
Specific problem-focused treatment plan that has a primary focus on employability and provides detailed follow-up requirements
Referrals to groups, TEAP, community services
Daily or regular check-ins with counselors or nurses that focus on coping skills to get through the program: “What are some ways to deal with your anger rather than punching a wall or cutting on yourself?”

The staff development component should focus on the center organization and the personal development of staff members' skills. Organizational development is the responsibility of the center director who will call upon the CMHC for technical assistance. No less than 1 hour per 100 students per week of the CMHC's time will be spent on ongoing staff consultation and training (PRH-6: Exhibit 6-5). More detailed information on staff development can be found in Mental Health and Wellness Program: Staff Development Supplement.

The general emphasis of both clinical services and staff development must be on prevention rather than treatment (PRH-6: 6.10, R3 (a)). An integrated blend of preventive and treatment services, based on interaction among all center staff members, can best fulfill the variety of student needs.

¹ Source: An Employer’s Guide To Behavioral Health Services: A Roadmap and Recommendations for Evaluating, Designing and Implementing Behavioral Services, National Business, Group on Health, December, 2005, page numbers 3-6, 15-39.

Job Corps Health

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