A. Directly-Operated Provider New Employee Orientation

MCCMH MCO Policy 3-015 MANDATORY NETWORK TRAINING Date: 8/14/12 C. Child Mental Health Professional Child Mental Health Professional as defined in R 330.2105(b) means any of the following: 1. A person who is trained and has 1 year of experience in the examination, evaluation, and treatment of minors and their families and who is one of the following: a physician, a psychologist, a licensed social worker, a registered professional nurse. V. Standards 2. A person with at least a bachelor s degree in a mental health-related field from an accredited school who is trained, and has 3 years of supervised experience, in the examination, evaluation, and treatment of minors and their families. 3. A person with at least a master s degree in a mental health-related field from an accredited school who is trained, and has 1 year of experience, in the examination, evaluation, and treatment of minors and their families. A. Directly-Operated Provider New Employee Orientation All new directly-operated provider staff (full time, part time, and contractual) shall be required to attend a New Employee Orientation training program. Volunteers and interns, whose attendance is not mandatory, shall be welcome at New Employee Orientation training. Training may take place in more than one session, but all training must be completed within 30 days of hire. Topics covered in the New Employee Orientation program shall include, but are not limited to: 1. Introduction to MCCMH a. MCCMH mission statement and vision statement b. Background of MCCMH c. Role of the MCCMH Board d. Role of the PIHP 2. Administrative Overview a. MCCMH administrative structure Divisions / support functions b. MCCMH relationship to the Michigan Department of Community Health (MDCH) and the Macomb County Board of Commissioners c. Provider Network Overview d. Human Services Coordinating Body e. Citizens Advisory Council 3. Website / Intranet Tutorial 4. Site specific orientation by Program Supervisor or Designee B. Initial Training Requirements Page 2 of 15

MCCMH MCO Policy 3-015 MANDATORY NETWORK TRAINING Date: 8/14/12 All new directly-operated and contract provider staff who provide direct services shall complete an initial comprehensive curriculum of mandatory training within 90 days of hire, that includes but is not limited to the following topics: 1. Person / Family-Centered Services 2. Self-Determination 3. Cultural Diversity / Competency 4. Language Proficiency 5. MCCMH Grievance and Appeals System 6. Crisis Management / Health and Safety 7. Infection Control / Bloodborne Infectious Disease C. Additional Mandatory Training 1. Recipient Rights Training Within 30 days of hire, all directly-operated and contract provider staff shall complete an initial face-to-face training on Recipient Rights. A face-to-face Recipient Rights Update training shall be completed every two (2) years from the date of hire. (See MCCMH MCO Policy 9-140, Recipient Rights Training. ) 2. HIPAA and Corporate Compliance Training Within 90 days of hire, all directly-operated and contract provider staff shall complete an initial training on: a. Provider specific policies on the Health Insurance Portability and Accountability Act of 1996 (HIPAA); b. Provider specific Corporate Compliance Plan. 3. Additional mandatory specialty training is required for certain categories of directlyoperated or contract provider staff, including but not limited to the following: a. Within 90 days of hire, directly-operated and contract provider staff who screen, assess and provide direct services for co-occurring mental health and substance use disorders to consumers shall complete an initial face-to-face training on co-occurring disorders. b. Directly-operated and contract provider staff working directly with consumers (who are not residential direct care workers) must complete training on how Page 3 of 15

MCCMH MCO Policy 3-015 MANDATORY NETWORK TRAINING Date: 8/14/12 to identify when a behavior plan may be needed, and how to implement the plan prior to plan implementation. c. Directly-operated and contract provider staff who are Child Mental Health Professionals and who provide direct mental health services to minors with serious emotional disturbances shall complete initial (within 90 days of hire) and on-going training in children s services that includes identifying and treating the needs of minors and their families, and shall meet the State s requirement to complete 24 hours of training relevant to children s services annually. d. Directly-operated and contract provider staff who provide Assertive Community Treatment (ACT) shall complete State-approved ACT specific training within six months of hire, and must also complete at least one Stateapproved ACT specific training annually. Directly-operated and contract provider staff who provide in-home and community-based services to consumers shall be offered opportunities to complete In-Home and Community-Based Services Safety Training. (See MCCMH MCO Policy 2-031, In-Home and Community-Based Services Safety Training. ) e. Other than residential direct care staff, whose training includes a module on working with challenging behaviors (see V.D., below), directly-operated and contract provider staff working directly with consumers, including front desk personnel (e.g. secretaries, clerical staff, account clerks, etc.), shall complete initial training in Nonviolent Crisis Intervention within 90 days of hire. D. Residential Direct Care Staff 1. Contract provider staff who provide residential direct care shall complete Residential Direct Care Worker Training (full curriculum) within ninety (90) days of hire. Training shall begin within thirty-five (35) days of hire. (Initial face-to-face Recipient Rights training shall be completed within 30 days of hire.) 2. Newly hired residential direct care staff may perform limited assigned direct care tasks as long as: a. The new staff has successfully participated in and completed all of the following: (1) Face-to-face cardiopulmonary resuscitation (CPR) training course (2) Basic first aid course (3) Bloodborne pathogens training course b. The new staff is trained to a level of competency as described in the Administrative Rules R 400.14202 of the licensing rules for adult foster care small group homes by successfully completing the following sections of the Training Toolbox: Page 4 of 15

MCCMH MCO Policy 3-015 MANDATORY NETWORK TRAINING Date: 8/14/12 (1) Supporting People: Why You Are Here (Including Person-Centered Planning) (2) Protected Health Information: The Privacy Rule of the HIPAA Act (3) Fire Safety Must Know Information (4) Environmental Emergencies (5) Personal Care and Hygiene (6) Signs of Illness and What to Do About Them (7) Infection Control Network providers may submit their own training curriculum relative to Toolbox sections to the MCCMH Network Training Office for equivalency evaluation. 3. A new staff person who has completed only the Toolbox Training is restricted in the duties he/she may perform as follows: a. He/she shall be closely supervised by a fully trained staff until his/her Residential Direct Care Worker Training (full curriculum) is successfully completed. The fully trained staff should be in close enough physical proximity to respond to any emergency. b. He/she shall not administer medications until successfully completing Residential Direct Care Worker Training (full curriculum). 4. Contract providers shall maintain documentation of the training status of each employee. Documentation will be monitored as part of the network monitoring process. Documentation of training shall be provided to MCCMH in accordance with terms of the MCCMH provider contract. 5. Any individual, including a volunteer, shall not be considered in determining the ratio of direct care staff to residents unless the individual has completed the training elements identified in V.D.2. a b. E. Annual Training Requirements Directly-operated and contract provider staff who provide direct services shall complete annual refresher training in the following areas: 1. Provider specific policies on the Health Insurance Portability and Accountability Act of 1996 (HIPAA); 2. Provider specific Corporate Compliance Plan; 3. Infection Control / Bloodborne Infectious Disease. F. Directly-operated and contract provider staff may be required to complete ongoing or refresher training in any area in response to findings and recommendations identified through internal and external audit/reviews and/or contract monitoring processes. Page 5 of 15

MCCMH MCO Policy 3-015 MANDATORY NETWORK TRAINING Date: 8/14/12 G. MCCMH shall accept staff training provided by other CMHSPs and their provider networks to meet the training requirements set forth in this policy when: 1. That staff training is substantially similar to the training offered by MCCMH (as evaluated by the responsible MCCMH entity based on training curriculum and upon documentation submitted); and 2. Staff member completion of such training can be verified. This is applicable to any staff training area. This includes any required staff training in the areas of recipient rights, person-centered planning, cultural diversity, HIPAA, language proficiency, grievance and appeal, as well as State-approved training for direct care workers in specialized residential settings, and certificates earned from specific clinical training in evidence-based, best and promising practices such as ACT, DBT, FPE, etc. H. MCCMH directly-operated providers shall document training according to the provisions of MCCMH MCO Policy 10-041, Documentation of Staff Participation in In-services and Continuing Education Activities. I. MCCMH contract network providers shall maintain documentation on individual staff training, and shall make it available to MCCMH for review on a periodic basis on request for the purposes of audit / review and contract monitoring. J. A detailed description of training requirements can be found in Exhibit A, MCCMH Mandatory Training Requirements, and Exhibit B, MCCMH Training Requirements Grid. VI. Procedures A. Procedures shall be contained in Provider Manuals. VII. References / Legal Authority A. Michigan Mental Health Code: 1. MCL 330.1201 2. MCL 330.1755(5)(f) B. Michigan Department of Community Health, Mental Health and Substance Abuse Services, Administrative Rules: 1. R 330.1806 2. R 330.2125 3. R 330.2807(10) C. Michigan Department of Consumer and Industry Services Division of Adult Foster Care Licensing, Small Group Homes, Administrative Rules: Page 6 of 15

MCCMH MCO Policy 3-015 MANDATORY NETWORK TRAINING Date: 8/14/12 1. R 400.14204(3) 2. R 400.14206(3) D. Michigan Department of Consumer and Industry Services Division of Adult Foster Care Licensing, Adult Foster Care Large Group Homes, Administrative Rules: 1. R 400.15204(3) 2. R 400.15206(3) E. MDCH/MCCMH Managed Specialty Supports and Services Contract, FY 12 F. Department of Energy, Labor, and Economic Growth MIOSHA G. Michigan Department of Human Services, Office of Children & Adult Licensing - Adult Foster Care Licensing Division, Office of Foster Care Group Home Technical Assistance H. Commission on Accreditation of Rehabilitation Facilities (CARF) 2012 Standards Manual VIII. Exhibits 1. 1.H., Health and Safety, 4.b.(7)., p 64; 10., p 71 (medication management and infection control ) 2. 1.I., Human Resources, 5, p. 77 3. 2.F., Nonviolent Practices, 2., p 131 4. 5.A., Program / Service Structure, 14., p. 257 A. MCCMH Mandatory Training Requirements B. MCCMH Training Requirements Grid Page 7 of 15

MCCMH MANDATORY TRAINING REQUIREMENTS (March 2012) All directly-operated and contracted providers shall demonstrate that staff meet the Macomb County Community Mental Health Services Board s (the BOARD s) mandatory training requirements as described in this Section. Training described herein DOES NOT constitute all training that may be required by law, license, accreditation, certification, credential or service setting. A. RIGHTS OF PERSONS SERVED Full and part-time employees and independent contractors of the provider must complete Recipient Rights training. The training may be provided by the BOARD s Office of Recipient Rights (ORR) or a training curriculum that has been reviewed and approved by the ORR. Recipient Rights training must be completed within 30 days after being employed by the provider. A face-to-face Recipient Rights Update training shall be completed every two (2) years from the date of hire. Additional training may be required to be completed in response to findings / recommendations from recipient rights complaints / investigation reports / recipient rights audits. Recipient rights training applies to all provider staff. B. PERSON / FAMILY-CENTERED SERVICES Person / Family-Centered training encompasses training in the values and principles, guidelines and implementation of person / family-centered planning. Person / family-centered training must also incorporate an advance crisis planning component. Training must be completed within 90 days of hire for directly-operated and contract provider staff. Additional training may be required to be completed in response to findings / recommendations identified through the audit / review or contract monitoring processes. Person / family-centered training applies to provider staff involved in managing, planning and delivering support and/or treatment services to MCCMH consumers. C. SELF-DETERMINATION Training encompasses an overview of the philosophy and methods of self-determination, the core belief that people who require support from the public mental health system as a result of a disability should be able to define what they need in terms of the life they seek, have access to meaningful choices, and have control over their lives. Training includes teaching provider staff how to inform consumers about self-determination and the possibilities, models and arrangements involved, so that consumers of MCCMH will have access to the tools and mechanisms supportive of self-determination, upon request. Training focuses on the partnership between MCCMH and the consumer, once a consumer requests participation in self-determination, whereby staff actively assist and support the consumer, to provide a range of options for consumer choice and control of personalized provider relationships within an overall environment of person-centered supports. Training also includes recognition and remediation of conflicts of interest of involved entities. Finally, provider staff are trained in recognizing and addressing issues of health, safety and well-being using the person-centered planning process, balancing consumer preferences and opportunities for self-direction with MCCMH obligations under federal and state law. Training must be completed within 90 days of hire for directly-operated and contract provider staff. Additional training may be required to be completed in response to findings / recommendations identified through the audit / review or contract monitoring processes. Self-determination training applies to provider staff MCCMH Mandatory Training Requirements, MCCMH MCO Policy 3-015, Exhibit A (rev. 8/12) Page 8 of 15

involved in managing, planning and delivering support and/or treatment services to MCCMH consumers. D. CULTURAL DIVERSITY / COMPETENCY Cultural diversity / competency training is to include an understanding of cultural attitudes about healing systems held by consumers of various ethnic or cultural groups, knowledge of and respect for various cultures, faiths, and/or multi-racial family dynamics of consumers, and skills needed to conduct specialized assessment and treatment for consumers with diverse ethnicity. Training must be completed within 90 days of hire for directly-operated and contract provider staff. Additional training may be required to be completed in response to findings / recommendations identified through the audit / review or contract monitoring processes. Cultural diversity / competence training applies to all provider staff who provide direct services to MCCMH consumers. E. LANGUAGE PROFICIENCY Language proficiency training is to encompass an understanding of the resources available to provide effective communication with persons of limited English proficiency, those who are illiterate or have low literacy skills, and individuals with sensory impairments or other disabilities. Training must be completed within 90 days of hire for directly-operated and contract provider staff. Additional training may be required to be completed in response to findings / recommendations identified through the audit / review or contract monitoring processes. Language Proficiency Training applies to all provider staff who provide direct services to MCCMH consumers. F. GRIEVANCE AND APPEALS Grievance and Appeals training is that training which describes the processes that MCCMH has in place in order to resolve consumer dissatisfaction with services (grievance); or to resolve disagreements related to a denial of requested services, or a reduction, suspension, or termination of services that a consumer is currently receiving (local appeal). This training also encompasses a description of the State s Medicaid Fair Hearing process that is afforded to Medicaid consumers when action is taken on a Medicaid covered service. Training on grievances, local appeals, and State Medicaid Fair Hearings shall include, but shall not be limited to time frames for filing, the method(s) for filing, availability of assistance in the filing process, when benefits may continue on an appeal of an action, and when a consumer may be held liable for the cost of continued benefits. Training information is available via consumer information materials (e.g., MCCMH consumer handbook, grievance and appeal brochures) as well as through MCCMH MCO Policies. All information is available on the MCCMH Website. Training must be completed within 90 days of hire for directly-operated and contract provider staff. Additional training may be required to be completed in response to findings / recommendations identified through the audit / review or contract monitoring processes. This training applies to all provider staff who provide direct services to MCCMH consumers. G. CRISIS MANAGEMENT / HEALTH AND SAFETY Crisis Management / Health and Safety refers to the training provided to staff for addressing accident procedures, emergency responses to consumer crisis(s), and health and safety emergency drills such as fire, tornado, disaster, medical emergency, etc. Training must be completed within 90 days of hire for directly-operated and contract provider staff. Additional MCCMH Mandatory Training Requirements, MCCMH MCO Policy 3-015, Exhibit A (rev. 8/12) Page 9 of 15

training may be required to be completed in response to findings / recommendations identified through the audit / review or contract monitoring processes. Crisis management / health and safety training applies to all provider staff who provide direct services to MCCMH consumers. H. HIPAA HIPAA is the Health Insurance Portability and Accountability Act of 1996 that establishes requirements for workforce training in privacy and security practices. HIPAA training requirements apply to all covered entities, as defined under HIPAA, under contract with the BOARD. Training must be completed within 90 days of hire. Annually thereafter, provider staff shall complete a refresher HIPAA training. The BOARD will monitor the provider to ensure that the required training has taken place. HIPAA Training applies to all provider staff. I. CORPORATE COMPLIANCE Corporate compliance plan/function refers to the requirement of the BOARD that requires the provider to maintain a corporate compliance function/plan. A required component of the corporate compliance plan is education of provider staff on the provider s corporate compliance plan and procedures. Training must be completed within 90 days of hire. Annually thereafter, provider staff shall complete a refresher Corporate Compliance training. The BOARD will monitor to ensure that the required training has taken place. This training applies to all provider staff. J. INFECTION CONTROL / BLOODBORNE INFECTIOUS DISEASE Infection Control/Bloodborne Infectious Disease training reviews the content specified in the Michigan Occupational Safety and Health Act (MIOSHA) 154 of 1974. Training must be completed within 90 days of hire for directly-operated and contract provider staff. Annually thereafter, provider staff shall complete a refresher Infection Control / Bloodborne Infectious Disease training. The BOARD will monitor to ensure that the required training has taken place. This training applies to directly-operated and contract provider staff who provide direct services. K. CO-OCCURRING DISORDERS Co-occurring disorders training provides a comprehensive overview in the provision and integration of substance abuse and mental health treatment. Training must be completed within 90 days of hire. Additional training may be required to be completed in response to findings / recommendations identified through the audit / review or contract monitoring processes. The BOARD will monitor to ensure that the required training has taken place. This training applies to all provider staff who screen, assess and provide direct services for cooccurring mental health and substance use disorders for MCCMH consumers. L. BEHAVIOR MANAGEMENT Behavior management training pertains to staff working with individuals who provide direct services (who are not residential direct care workers.) Staff must be trained on how to identify when a behavior plan may be needed, and how to implement the plan prior to implementation. Training shall be provided by a psychologist participating in the development of the consumer s Behavior Treatment Plan, and shall be documented in the clinical record. The BOARD will monitor contract providers where this function has been delegated. This training MCCMH Mandatory Training Requirements, MCCMH MCO Policy 3-015, Exhibit A (rev. 8/12) Page 10 of 15

applies to provider staff working with MCCMH consumers who have or need a behavior management plan. M. CHILDREN S SERVICES Provider staff who are Child Mental Health Professionals and who provide direct mental health services to minors with serious emotional disturbances shall complete initial (within 90 days of hire) and ongoing training that includes identifying and treating the needs of minors and their families. Provider staff who provide children s services shall complete 24 hours of training relevant to children s services annually. N. RESIDENTIAL DIRECT CARE WORKER TRAINING Direct care worker training refers to a State approved curriculum for all residential group home staff. Residential Direct Care Worker Training (full curriculum) includes but is not limited to training on medications (basic and advanced), first aid/cpr, working with challenging behaviors, nutrition and health / advanced health. Training shall be completed before performing assigned direct care tasks. Residential direct care staff may perform limited assigned direct care tasks as long as they are certified in CPR, first aid, bloodborne pathogens, MCCMH-approved Recipient Rights training and demonstrate competence in the areas as listed in Administrative Rule R 400.14204 of the licensing rules for adult foster care small group homes. Competency may be demonstrated through completion and evaluation of the appropriate sections of the Training Toolbox or other MCCMH-approved curriculum. Prior to completing the full curriculum, residential direct care staff must be closely supervised by a fully trained staff. This means a fully trained staff must be in close enough physical proximity to respond to any emergency. Training must begin within thirty-five (35) days of hire, and the complete Direct Care Worker training shall be completed within ninety (90) days of hire. This training applies only to the provider s residential group home staff. Residential group home staff who do not perform direct care staff responsibilities are not required to complete this training. O. NONVIOLENT CRISIS INTERVENTION Nonviolent Crisis Intervention training focuses on crisis prevention and intervention and offers strategies for resolving situations when confronted by hostile, anxious, or violent behavior. Training includes how to recognize causes of and respond to threatening behavior using a continuum of alternative interventions. This training applies to provider staff who do not participate in the State-approved Residential Direct Care Worker training, but who provide direct services to MCCMH consumers, and includes front desk personnel (e.g. secretaries, clerical staff, account clerks.) This training shall be completed within 90 days of hire. P. ASSERTIVE COMMUNITY TREATMENT (ACT) Employees and independent contractors of the provider who provide ACT services to MCCMH consumers shall have a basic knowledge of ACT programs and principles acquired through State-approved ACT specific training within six months of hire, and must also complete at least one State-approved ACT specific training annually. MCCMH Mandatory Training Requirements, MCCMH MCO Policy 3-015, Exhibit A (rev. 8/12) Page 11 of 15

MCCMH Training Requirements Grid Training described herein does not constitute all training that may be required by law, license, accreditation, certification, credential or service setting. All training must be documented. Training Topic Frequency Application Training Resource Options Rights of the Person Served Face-to-face within 30 days of hire. Face-to-face repeated training every two years Additional training in response to findings / recommendations / RR complaints, etc. provider staff. Office of Recipient Rights. alternative provider with the approval of the MCCMH Office of Recipient Rights. Person / Family Centered Services Self-Determination Completed within 90 days of hire. Updated if problems are identified via review/audit. Completed within 90 days of hire. Updated if problems are identified via review/audit. provider staff involved in managing, planning and delivering support and/or treatment services. provider staff involved in managing, planning and delivering support and/or treatment services. Training Office. Module of New Employee Orientation for direct staff. alternative provider with the approval of the MCCMH CSI Division Director or Designee. Training Office. Module of New Employee Orientation for direct staff. alternative provider with the approval of the MCCMH CSI Division Director or Designee. Staff is defined as full and part-time employees and independent contractors of the MCCMH Board and of the MCCMH contract network provider. MCCMH Training Requirements Grid, MCCMH MCO Policy 3-015, Exhibit B (rev. 8/12) Page 12 of 15

MCCMH Training Requirements Grid Training described herein does not constitute all training that may be required by law, license, accreditation, certification, credential or service setting. All training must be documented. Training Topic Frequency Application Training Resource Options Language Proficiency Language Proficiency Corporate Compliance Infection Control / Bloodborne Infectious Disease Co-Occurring Disorders Completed within 90 days of hire. Updated if problems are identified via review/audit. Completed within 90 days of hire. Updated if problems are identified via review/audit. Initial training within 90 days of hire, per provider specific Compliance Plan/policy. Annual refresher. Completed within 90 days of hire. Annual refresher. Initial training within 90 days of hire. Updated if problems are identified via review/audit provider staff who provide direct services. provider staff who provide direct services. provider staff. provider staff who provide direct services. All directly-operated providers and contract provider staff who screen, assess and provide direct services for cooccurring mental health and substance use disorders. Training Office. Module of New Employee Orientation for direct staff. alternative provider with the approval of the MCCMH CSI Division Director or Designee. Training Office. Module of New Employee Orientation for direct staff. alternative provider with the approval of the MCCMH CSI Division Director or Designee. Staff must receive training based on individual provider Corporate Compliance Plan and policies. Direct staff initial and refresher training available on the MCCMH Intranet. Training Office. alternative provider with the approval of the MCCMH CSI Division Director or Designee. alternative provider with the approval of the MCCMH CSI Division Director or Designee. MCCMH Training Requirements Grid, MCCMH MCO Policy 3-015, Exhibit B Page 13 of 15

MCCMH Training Requirements Grid Training described herein does not constitute all training that may be required by law, license, accreditation, certification, credential or service setting. All training must be documented. Training Topic Frequency Application Training Resource Options Behavior Management Children s Services Residential Direct Care Worker Training Staff must be trained on how to identify when a behavior plan may be needed, and how to implement the plan prior to implementation. Initial (within 90 days of hire) and ongoing training requirements (24 hours annually). Residential Direct Care training must begin within 35 days of hire and must be completed within 90 days of hire. Staff may perform assigned limited direct care tasks as long as they are certified in: CPR, first aid, bloodborne pathogens, MCCMH approved Recipient Rights training and are evaluated as competent in areas listed in R 400.14204 of the licensing rules for adult foster care small group homes through utilizing the appropriate sections of the Training Toolbox or other MCCMH-approved curriculum. provider staff who provide direct services (who are not residential direct care workers.). provider staff who are Child Mental Health Professionals (R 330.2105(b)) and who provide direct services to children who have serious emotional disturbances. provider staff working in a group home setting. Staff not performing direct care staff responsibilities are not required to complete training. Training is to be provided by a Psychologist participating in the development of the Treatment Plan. Training must be documented in the clinical record. MCCMH Training Office regularly offers training sessions that count toward this requirement. Training on appropriate topics may be received from any provider with appropriate documentation. Training Office. alternative provider with the approval of the MCCMH CSI Division Director or Designee. MCCMH Training Requirements Grid, MCCMH MCO Policy 3-015, Exhibit B Page 14 of 15