Updated June 29, 2020

ACES is dedicated to the health and wellness of our clients, families, and employees. This COVID-19 Preventative Measures Policy and Procedure outlines the precautions being taken to ensure the safety and health of all.

ACES follows the guidance provided by the Centers for Disease Control and Prevention (CDC) related to Coronavirus (COVID-19). Employees are to comply with the health and wellness procedures and precautions related to the prevention of spreading COVID-19, as set forth below.

Please Note: ACES’ top priority is the well-being and health of our staff, clients, and the broader communities we serve. Our policies and protocols are evolving in real time with the COVID-19 pandemic.

Employees and Clients who are Sick

Employees or clients who have symptoms of acute respiratory illness are instructed to not attend treatment sessions until they are free of fever (100.4° F / 38.0° C or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 72 hours, without the use of fever-reducing or other symptom-altering medicines (e.g., cough suppressants).

Employees and clients should notify the ACES Rescheduling Department, stay home and seek any necessary medical attention  if they are sick.

Employees and Clients with Sick Cohabitants

Employees or clients who cohabitate or have regular prolonged exposure to individuals with symptoms or a diagnosis of COVID-19, should notify ACES and refer to CDC guidance for how to conduct a risk assessment related to their potential exposure.

If an employee has a confirmed diagnosis of COVID-19, ACES will ensure other employees who may have had contact with confirmed COVID-19 diagnosed employees are informed, while maintaining the confidentiality requirements outlined by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment related to their potential exposure.

Routine Environmental Cleaning

ACES employees shall routinely clean all frequently touched surfaces in ACES facilities, such as workstations, countertops, and doorknobs, using the cleaning agents that are appropriate for the given surface, and following any directions provided on the labels. Facility “deep cleanings” are continuously scheduled, in addition to regular guidelines outlined in the ACES site audit tool, cleaning procedures, and daily front desk checklists. Disposable disinfecting wipes are provided so commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down before each use.

ACES front office administrative employees are responsible for providing routine cleaning of all frequently touched surfaces throughout ACES facilities,  as well as ensuring appropriate social distance when greeting and opening doors for clients and employees.

ACES encourages clients/caregivers to follow the CDC’s recommendations for how to to best prepare their homes and clinic treatment areas for treatment visits.

Restrictions on Airline Travel

ACES employees are prohibited from any airline travel for work-related reasons. Requests for exemption from ACES restriction on work-related airline travel may only be granted by ACES Chief Executive Officer (CEO).

Employees considering personal airline travel are encouraged to check the CDC’s Traveler’s Health Notices for the latest guidance and recommendations for each country to which they will travel. Employees should disclose any recent or planned international travel.

Changes to Site of Treatment and Administrative Operations

Upon receiving a request to change session location, please inform the client of the measure ACES is taking to ensure safety (as further set forth below). If a client continues to request a change of location either from home to clinic or clinic to home due to concerns related to COVID-19, the client should be referred to ACES Scheduling Department.

All administrative staff, who are able to work remotely, have been transitioned to remote work from home to reduce exposure risk.

Changes to Clinical Staffing

Whenever possible ACES shall endeavor to schedule consistently the same clinical staff for each client and home.

ACES shall continue to track client requests for holds and discharges utilizing the current procedures. Through these procedures, ACES shall ensure client oversight and planning for client re-engagement and re-authorization, as needed

Facility Closure/Business Continuity

ACES decision to continue to provide services during the current COVID-19 pandemic is based on internal and third-party consultations with advisors and healthcare experts, as well as current guidance from the CDC and local health authorities strongly encouraging all essential businesses, including healthcare organizations such as ACES that provide medically-necessary behavioral health services to remain open.

Please reference ACES Emergency Operation Plan (EOP) for each office and the specific Appendix discussing business continuity plans for each ACES clinic.

Telehealth Services

ACES is committed to transitioning clients from in-person applied behavior analysis (ABA) sessions to treatment delivery via telehealth technologies to the greatest extent possible, in an effort to ensure clients maintain an appropriate continuum of care and access to medically necessary treatment during the COVID-19 pandemic. Telehealth (or telemedicine) refers to supporting and promoting long-distance clinical healthcare (e.g., between a clinical provider in one location, and a patient/client in another location), patient/client and professional health-related education, and/or public health and health administration, using electronic communications, information technology or other means. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional, encounter in person between a provider and a patient/client.

All treatment services provided via telehealth will be safe, clinically appropriate, confidential, and efficient and designed so treatment delivery meets or exceeds the quality of care provided in the in-person setting of care, to the greatest extent possible. Telehealth treatment services shall only be offered and provided when clinically appropriate, approved/authorized by health plan partners, and applicable state and federal regulations have been met. Providers will use their best clinical judgement in assessing the propriety and effectiveness of using telehealth to deliver treatment services, informed by direct knowledge of each client’s specific clinical needs.

ACES will generally permit use of telehealth technology for clinical interviews/assessments, case management, parent/caregiver training, clinical supervision, and direct ABA.  ACES especially promotes use of telehealth technology, if otherwise appropriate, during the COVID-19 pandemic where the delivery of parent/caregiver training and/or supervision services is compromised due to limited access to clinicians and/or to increase client access to services/staff to which/whom clients would not otherwise have access. At this time, ACES only supports synchronous interactions (i.e., real-time

Health Screening Procedure

Employees are required to conduct a self-health screening prior to the beginning of each session to confirm they are not feeling sick with fever (>100.4° F / >38° C), respiratory symptoms (e.g., a cough or difficulty breathing), or other flu-like symptoms. ACES recommends employees take their own temperature prior to the start of any treatment session

Risk Assessment Procedure

Prior to the beginning of each session, employees and clients are required to complete a community risk screening (https://blog.acesaba.com/forms/covid-19-pre-session-screening-2/) to confirm: 1)they have not traveled outside of the state or country to any location with widespread sustained (ongoing) transmission within the last 14 days (countries that have a Level 3 Travel Health Notice); 2) no one in their household has traveled outside of the state or country to any location with widespread sustained (ongoing) transmission within the last 14 days (countries that have a Level 3 Travel Health Notice) and is/are exhibiting any symptoms of COVID-19; 3) they have not been formally diagnosed with COVID-19; 4) have not had prolonged, unprotected close contact with a person with symptomatic, confirmed COVID-19; and 5) they are not experiencing any of the following symptoms: cough (a new, continuous cough – this means coughing frequently for more than an hour, or three or more coughing episodes in 24 hours), fever (>100.4° F / >38° C), or shortness of breath.

As part of the screening, employees and clients are also reminded:

• If they are feeling sick with fever (>100.4 F° / >38° C), respiratory symptoms (e.g., a cough or difficulty breathing), or other flu-like symptoms, they should notify the ACES Rescheduling Department (855-223-7123 ext. 1) and contact their healthcare provider right away. They should avoid contact with others and avoid visiting ACES’ facilities until, at minimum, they have no fever for 72 hours, without fever medication.
• If they have traveled to any location with widespread sustained (ongoing) transmission, or if they have been in close contact with a person with a laboratory-confirmed case of COVID-19, they should stay home for a period of 14 days from the time they left the area with widespread or ongoing community spread or last made contact with the person with a laboratory-confirmed case of COVID-19.
• Any person present at ACES’ facilities observed to exhibit flu-like symptoms, or symptoms of COVID-19, while onsite will be sent home immediately.
• In the event any client or caregiver is observed to exhibit flu-like symptoms, or symptoms of COVID-19, ACES maintains the right, in its sole discretion, to discontinue the treatment session immediately.

Result Indicating Medium/High Risk for Employee

If any employee: 1) indicates they traveled outside of the state or country to any location with widespread sustained (ongoing) transmission (countries that have a Level 3 Travel Health Notice); 2) a member of their household has traveled outside of the state or country to any location with widespread sustained (ongoing) transmission and is/are exhibiting any symptoms of COVID-19; 3) they have been formally diagnosed with COVID-19; 4) they have had close contact with a person with symptomatic, confirmed COVID-19; or 5) they are experiencing any of the following symptoms: cough (a new, continuous cough – this means coughing frequently for more than an hour, or three or more coughing episodes in 24 hours), fever (>100.4° F / >38° C), or shortness of breath, staff are advised to contact their physician and ACES Human Resources immediately.

In these circumstances, the employee shall be placed on immediate leave for a minimum of fourteen (14) days. All positive tests of the disease should be recorded on the OSHA 200 form and report to OSHA.

Return to Work Criteria

Use one of the below strategies to determine when employee may return to work:

Symptomatic Employees with Suspected or Confirmed COVID-19

Symptom-based strategy

Exclude from work until:

• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications; and
• Improvement in respiratory symptoms (e.g., cough, shortness of breath); and
• At least 10 days have passed since symptoms first appeared.

Test-based strategy

Exclude from work until:

• Resolution of fever without the use of fever-reducing medications; and
• Improvement in respiratory symptoms (e.g., cough, shortness of breath); and
• Negative results of an FDA Emergency Use Authorized molecular assay for detection of COVID-19 from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens).

Asymptomatic Employees with Confirmed COVID-19

Time-based strategy. 

Exclude from work until:

• 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test. If they develop symptoms, then the symptom-based or test-based strategy should be used (see above).

Test-based strategy. 

Exclude from work until:

• Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of COVID-19 from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens).

 

If the employee was never tested for COVID-19, but has an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.

After returning to work, employee should:

• Wear a facemask, instead of a cloth face covering, for source control until all symptoms are completely resolved or at baseline. After this time period, employees may revert to wearing a cloth face covering during the pandemic.
• Be restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology).
• Adhere to hand hygiene, respiratory hygiene, and cough etiquette in the CDC’s interim infection control guidance (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles).
• Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen.

Result Indicating Medium/High Risk for Clients

If any client/caregiver: 1) indicates they traveled outside of the state or country to any location with widespread sustained (ongoing) transmission (countries that have a Level 3 Travel Health Notice); 2) a member of their household has traveled outside of the state or country to any location with widespread sustained (ongoing) transmission (countries that have a Level 3 Travel Health Notice) and is/are exhibiting any symptoms of COVID-19; 3) they have been formally diagnosed with COVID-19; 4) they have had close contact with a person with symptomatic, confirmed COVID-19; or 5) they are experiencing any of the following symptoms: cough (a new, continuous cough – this means coughing frequently for more than an hour, or three or more coughing episodes in 24 hours), fever (>100.4° F / >38° C), or shortness of breath, clients/caregivers are advised to contact their physician and their ACES supervisor immediately.

In these circumstances, the in-person treatment services shall be placed on immediate hold until the client/caregiver are cleared to return to treatment. ACES shall comply with ongoing instructions from the client/caregiver’s healthcare provider on treatment and/or clearing clients to resume in-person treatment.

If clinically indicated and funder authorized, a client may participate in ABA treatment via telehealth until they are able to resume treatment in-person.

Return to Treatment Criteria

Use one of the below strategies to determine when a client/caregiver may return to treatment:

Symptomatic Client/Caregiver with Suspected or Confirmed COVID-19

Symptom-based strategy

Exclude from treatment until:

• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications; and
• Improvement in respiratory symptoms (e.g., cough, shortness of breath); and
• At least 10 days have passed since symptoms first appeared.

Test-based strategy

Exclude from treatment until:

• Resolution of fever without the use of fever-reducing medications; and
• Improvement in respiratory symptoms (e.g., cough, shortness of breath); and
• Negative results of an FDA Emergency Use Authorized molecular assay for detection of COVID-19 from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens).

Asymptomatic Client/Caregiver with Confirmed COVID-19

Time-based strategy. 

Exclude from treatment until:

• 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test. If they develop symptoms, then the symptom-based or test-based strategy should be used (see above).

If the client/caregiver was never tested for COVID-19, but has an alternate diagnosis (e.g., tested positive for influenza), criteria for return to treatment should be based on that diagnosis.

After returning to treatment, the client/caregiver should, to the extent possible:

• Wear a facemask for source control until all symptoms are completely resolved or at baseline.
• Adhere to hand hygiene, respiratory hygiene, and cough etiquette in the CDC’s interim infection control guidance (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles).
• Self-monitor for symptoms, and seek re-evaluation if respiratory symptoms recur or worsen.

ACES Facility Procedure

Infrared thermometers are used to take temperatures of clients and employees entering the facility.  We ask caregivers take their own temperature prior to the start of any treatment session.

Employees and clients are required to sign-in and verify, prior to the beginning of each session, that they have participated in a self-health screening and confirm they: 1) are not exhibiting any symptoms of influenza or COVID-19 (including, without limitation, fever, cough, or difficulty breathing); 2) no person(s) living in their immediate household is/are exhibiting any undiagnosed influenza-like symptoms or symptoms of COVID-19; 3) have not traveled to any affected international location with widespread sustained (ongoing) transmission; and 4) have not been in contact with a person with a laboratory-confirmed case of COVID-19.

Additionally, prior to the beginning of each session, employees and clients are required to complete a community risk screening (https://blog.acesaba.com/forms/covid-19-pre-session-screening-2/).

ACES employees and clients at ACES’ facilities are advised to promote basic hygiene as follows:

• Any coughing or sneezing should be directed into one’s sleeve, rather than into hands or the air.
• Wash hands after using and handling used tissues, after blowing nose, before/after eating, and after toilet use.
• Wash for 20 seconds with soap, rub between fingers and under nails; and then rinse and dry. Use alcohol (60%+) hand gel if sinks are not readily available.
• Avoid rubbing your own eyes, nose, and mouth.
• Do not share utensils, cups, etc.
• Reduce physical touch (e.g., no high fives, handshakes)

Additional precautions include:

• If the parent/caregiver desires to observe a client’s center-based session, they will be allowed to do so using telehealth technology.
• Hand sanitizer is offered to all employees and clients upon entering.
• Regular and frequent hand washing is prompted by automated notifications on the Behavior Interventionists’ iPads.
• Disinfectant wipes are available throughout the facility. High traffic surfaces are wiped hourly.
• Social distancing of maintaining six-foot separation from all persons is to be practiced at all times, to the extent possible.
• Each client is to have their own designated space and ABA materials. No sharing of materials.
• All pillows and plush have been removed from facilities.
• Facility “deep cleanings” are continuously scheduled in addition to regular guidelines outlined in the ACES site audit tool, cleaning procedures, and daily front desk checklists.

ACES In-Home Procedure

ACES recommends employees take their own temperature prior to the start of any treatment session.

Prior to the beginning of each session, employees and clients are required to complete a community risk screening (https://blog.acesaba.com/forms/covid-19-pre-session-screening-2/).

After the community risk screening is completed by the client/caregiver,  the client/caregiver shall be reminded of the CDC’s recommendations on how to best prepare their homes for treatment visits.

ACES employees and clients are advised to promote basic hygiene in the home setting as follows:

• Any coughing or sneezing should be directed into one’s sleeve, rather than into hands or the air.
• Wash hands after using and handling used tissues, after blowing nose, before/after eating, and after toilet use.
• Wash for 20 seconds with soap, rub between fingers and under nails; and then rinse and dry. Use alcohol (60%+) hand gel if sinks are not readily available.
• Avoid rubbing your own eyes, nose, and mouth.
• Do not share utensils, cups, etc.

Additional precautions include:

• Hand sanitizer is offered to all employees to take into home sessions.
• Regular and frequent hand washing is prompted by notifications that arise on the Behavior Interventionists’ iPads.
• Disinfectant wipes are available to all employees to take into home sessions. High traffic surfaces and surfaces within the treatment area should be wiped frequently whether in the clinic or home setting.
• Social distancing of maintaining six-foot separation from all persons is to be practiced at all times, to the extent possible.
• Non-essential visitors and participants such as siblings and other family members will be limited. For clients under 18, we are asking that only one parent/caregiver participate in the session.
• Reduce physical touch (e.g., no high fives, handshakes)

Policy Review

This Policy shall be reviewed daily by the Vice President of Clinical Service Delivery, for as long as the current National Emergency is in effect, to ensure the information is current and accurate, and to add any additional information.