Health & Safety Plan for COVID-19
June 30th, 2020
Through this troubling time, Sage Behavior Services remains committed to the health and well-being of our employees, our clients, and their families. The following Health & Safety Plan for COVID-19 outlines in detail the actions that Sage is taking in response to the COVID-19 pandemic. Numerous resources were referenced by Sage in the development of this plan, including information from the Center for Disease Control and Prevention (CDC), the Occupational Safety and Health Administration (OSHA), and the CA Dept. for Social Services.
Sage has developed a brief questionnaire to help screen all clients and staff before the start of a service session. The three questions ask about symptoms, illness, and exposure/contact with COVID-19. If an individual answers “Yes” to any of the questions, then in-person ABA services will be postponed until certain actions are taken/requirements are met. A copy of this screening questionnaire is available upon request. Throughout the ABA therapy session, the 1:1 staff will screen their clients and others present in the service setting for signs/symptoms of illness.
According to the latest information from the CDC:
- fever or chills
- shortness of breath or difficulty breathing
- muscle or body aches
- new loss of taste or smell
- sore throat
- congestion or runny nose
- nausea or vomiting
Severe symptoms include:
- trouble breathing
- persistent pain or pressure in the chest
- inability to wake or stay awake
- bluish lips or face
Services are to be canceled until further notice if signs/symptoms are observed in the client or any family members in the home. If a session is canceled due to a staff showing signs/symptoms, then Sage will attempt to make up the session if alternative team members are available and the family is willing to do so.
It is important that clients and staff practice maintaining a physical distance of at least 6’ or more from others whenever possible. Although we recognize that this practice may be difficult or impossible at times in home settings for 1:1 services, we have asked that our families take steps, such as minimizing staff’s interactions with others who are present in the home, whenever possible. All community outings during sessions are to be prohibited.
In the clinic setting, a number of steps have been taken to promote physical distancing, including the inclusion of markers on the floor to designate safe distances, scheduling only one client per therapy room, scheduling staggered drop off and pick up times, and having clients wait and take turns when using the restroom or outside play area. For supervisor-level employees, working from home is expected whenever possible. Such staff are provided a designated day/time each week when they can be physically present in the office. All other staff are prohibited from visiting the building without prior approval from a member of the management.
Whenever possible, telehealth technology is to be considered for partial or full use in each client’s ABA program. Sage recognizes that the dynamics of each client’s case vary greatly and that a multitude of variables can/will potentially influence the effectiveness of telehealth-based services. Program supervisors and BCBAs at Sage have been provided a telehealth assessment and considerations checklist to help determine the appropriateness of telehealth-based services for a particular client. Each family must sign (or verbally agree to, if signing is not an option) an informed consent form regarding the use of telehealth prior to the start of telehealth-based services with a client.
In addition, telehealth measures are to be used whenever possible for supervision, parent consultation, and assessment appointments in order to minimize the number of Sage staff physically present during a scheduled session.
All Social Skills Group (SSG) attendance will be conducted via telehealth for those clients for which use of the technology is applicable and appropriate.
Masks and other Personal Protective Equipment (PPE)
At the time of the writing of this plan, it is the case that all essential workers are required to wear masks when working. All staff will sign an agreement (if they have not already done so) to acknowledge their understanding of our policy regarding mask usage and other safety policies related to COVID-19. Extra masks are available from Sage for employees if their mask is ever misplaced, or damaged. Clients and family members are encouraged to wear masks as well. Gloves are also available for any staff who requests them. Gloves are required when changing a client or helping them with toileting in the clinic bathroom.
Frequent handwashing is among the most important components of preventing the spread of the virus according to the CDC. Regardless of service setting, staff and children in all settings are encouraged to wash their hands frequently (at least once per hour). We have instructed and trained staff to assist children with scrubbing their hands with soap for 20 seconds and avoiding touching their eyes, nose, and mouth. Thorough handwashing will precede and follow all meal and snack times. Visual supports (i.e., illustrations and text) are posted in all bathrooms for both clients and staff for this purpose in the Sage clinic/office site. Note: each clinic therapy room has its own sink for handwashing and other purposes.
Temporarily Halting ABA Services Due to COVID-19
A client’s ABA services will be canceled temporarily in any of the following situations.
- If an employee or client tests positive for COVID-19
- If an immediate family member or other individual living in the employee’s or client’s household tests positive for COVID-19.
- If an employee or client, or immediate family member or other individual living in the employee’s or client’s household:
- is suspected of having COVID-19
- has come into contact with an individual testing positive for COVID-19
Individuals who test positive for COVID-19 will be asked to quarantine and to contact their doctor immediately for specific guidance if they have not already done so. If the individual has no symptoms but tests positive for COVID-19, then in-person services can resume 10 days after the test. In situations in which a person tests positive for COVID-19, a doctor’s note may be requested designating that services/work may resume.
If an individual develops symptoms after testing positive (or suspects that he/she has symptoms of COVID-19 and was unable to obtain a test), the individual can resume services/work after 72 hours with no fever, respiratory symptoms such as cough and shortness of breath are no longer present, and 10 days have passed since the symptoms first appeared.
Per the CDC, symptoms may appear 2-14 days after exposure to the virus. In order to prevent the further spread of disease, individuals who have come into close contact with a person with COVID-19 but who do not get tested are encouraged to stay home and maintain physical distance (quarantine) from others until 14 days after their last exposure. Sage will not provide in-person services (or face-to-face work hours) to such individuals for a period of 14 days. These individuals should monitor themselves by checking their temperature twice daily and watching for symptoms of COVID-19 (see above for a comprehensive list of signs/symptoms).
Individuals who have tested negative for COVID-19 but have symptoms will not be scheduled for services (or work) until they are free of fever for 72 hours, have no signs of fever or other symptoms, and have no signs/symptoms without the use of fever-reducing or other symptom-altering medicines (e.g. acetaminophen, cough suppressants, etc.).
In secondary contact situations (i.e., an individual came into contact with a person who was identified as a close contact with a person who tested positive for COVID-19), the secondary contact person will be asked to monitor for symptoms. According to CDC guidelines at this time (June 2020), such individuals do not need to self-quarantine.
For additional information and specific guidance, please refer to the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html.
If an employee or client is confirmed to have contracted COVID-19, Sage will notify the health department/relevant authorities and will implement tracing protocols by reviewing the scheduling system to identify all other staff and clients potentially exposed. Sage staff and clients who came into potential or actual contact will be informed immediately and it will be recommended that they seek testing. To protect confidential health information, the confirmed person’s identity will not be revealed even if asked.
If the individual who tested positive for COVID-19 was present in the clinic/office, then CDC recommended guidelines will be followed. Areas known to be used by the sick person will be immediately closed off. Sage will wait 24 hours before cleaning and disinfecting the areas to minimize the potential for other employees to be exposed to respiratory droplets. Surfaces and areas will then undergo a deep cleaning and disinfection procedure. The clinic/office will reopen once the cleaning and disinfection are completed. During this period, home-based or telehealth services will be offered as an alternative to those families who want it and who previously were receiving clinic-based services.
Specific Protocols for Services in our Clinic Setting
For clients scheduled to receive ABA services in the Sage clinic, certain actions are being taken. These include:
- Check in/pick up outside – The office staff will call the family before or at the scheduled session time. A questionnaire will be reviewed for screening purposes (see above). When given confirmation to do so, the family will walk the client up to the clinic entryway and stand on the designated marker on the ground (a red circle). Sage staff will then meet the family outside for the transition which will include a temperature check prior to entry. At this time, Sage has also modified its policy regarding its sign-in/sign-out procedures to limit unnecessary exchanges and eliminate shared objects, such as pens, pencils, and touchscreens.
- Temperature checks – Sage staff will conduct a temperature check each day upon arrival for both staff and clients. A digital thermometer will be used on the individual’s forehead to check for fever. The thermometer is disinfected before and after each use.
- Restricted entry into building – Only staff and clients will be allowed inside the Sage clinic/office building. Families will not be able to enter the clinic for any reason, but they can schedule consultation sessions and observations of their child’s ABA therapy sessions via video conferencing with the program supervisor.
- Staggered pick up and drop off – To promote physical distancing, Sage schedules staggered drop off and pick up times across clients’ sessions. This will help ensure that there is only one family dropping off or picking up their child at a given time.
- PHYSICAL distancing – Sage will schedule one child and staff member per clinic room. In our larger clinic rooms, Sage may also use large pieces of furniture or partitions/barriers to facilitate physical distancing of two or three clients. The only other individual who typically enters the therapy room are those individuals responsible for cleaning/disinfecting. The clinic bathroom and play area outside are also permitted for use by only one client at any given time.
- Cleaning/disinfecting – Common surfaces that are touched throughout the day, such as switches, knobs, tabletops, countertops, etc. will be disinfected multiple times per day. Sage engages in cleaning/disinfecting of each therapy room using chemical disinfectants that are recommended by the CDC. In addition, if a room is not in use, it remains locked to prevent access by others. Each therapy room and the bathroom will be cleaned/disinfected after each client’s session. All items that were used by the client and 1:1 staff during the session will be placed aside in a designated bin for cleaning afterward. Designated individuals working onsite each day will clean/disinfect as described. Toys/items that are porous and cannot be readily disinfected have been removed. Sage will allow families to send their own items such as blankets to be used only by their child. Cleaning supplies are stored in the corporate side of the building away from our clients’ access.
- Limited food storage – The clinic’s microwave, mini-fridge, and water cooler will not be available for use. If a family sends a snack or a meal for their child, the items should consist of things that can be maintained in a lunch bag and do not require heating or refrigeration.
- soiled clothing – If a client’s clothing become soiled or contaminated with body fluids, they will be placed in a plastic bag to be sent home (Occupational Safety and Health Administration, 29 C.F.R. § 1910.1030).