The Birchtree Center Coronavirus Disease 2019 (COVID-19)
Outreach Consultation & Direct Service Policy
Working Draft as of September 15, 2021
This policy is current with guidance that has been provided up to this date but is subject to change as additional official guidance is provided.
For information about recent updates made to this document, click here.
As The Birchtree Center resumes delivering in-person services since the shift to remote instruction due to the COVID-19 school closure in March 2020, COVID-19 policies are being implemented in order to safely deliver consultation services and direct service programming for all recipients of The Birchtree Center Outreach Department. Please note that this policy specific to consultation services and direct service programming is to be followed in conjunction with The Birchtree Center COVID-19 Organization Policy. In addition, the Birchtree Outreach staff require access to each district’s COVID-19 policies for their corresponding public schools and student homes, and the Birchtree Outreach staff agree to comply with all requirements set forth in such policies.
Birchtree BCBAs enter schools and student homes for two primary purposes: 1) to provide in-person consultation to those individuals supporting students on their consultation caseloads (e.g., parents, case managers, paraprofessionals); and/or 2) to provide in-person supervision to those Birchtree Clinical Instructors delivering in-person direct service to students on their caseloads. Birchtree Clinical Instructors enter schools and student homes for one primary purpose: to provide in-person direct service to students.
Birchtree staff are committed to the safety and health of all recipients of the Outreach Department’s services. In order to limit contact with others, at times, Birchtree BCBAs utilize teleconferencing methods or phone calls to support the staff and parents of students on their caseload. In addition, Birchtree’s BCBAs maintain a minimum distance of 3 ft. as much as possible when providing in-person consultation. This is in addition to wearing personal protective equipment (PPE) and evidencing hygiene and sanitization practices at all times as described below and outlined in The Birchtree Center COVID-19 Organization Policy. Please note that the Birchtree staff providing services in school and home settings are not permitted to accept drinks, food, or any other gifts. Please do not offer these items.
Entering Schools and Student Homes
- When Birchtree BCBAs and Clinical Instructors enter a school, then the Birchtree staff follows that school’s policies, procedures, and requirements regarding personal protective equipment (PPE), student health screenings, and other COVID safety practices. Regardless of that school’s policies, however, Birchtree’s staff will continue to conduct their own daily health screenings and to wear face masks when working with students.
- When Birchtree BCBAs and Clinical Instructors provide home-based services, Birchtree staff follows Birchtree's policies, procedures, and requirements regarding personal protective equipment (PPE) as outlined in The Birchtree Center COVID-19 Organization Policy. Birchtree’s staff continue to conduct their own daily health screenings, to wear face masks when working with students and families, and to require daily student health screenings for students receiving home-based services.
- Birchtree staff have “Stay Healthy” bins with them at all times as these bins contain very important materials for them to complete their job safely (e.g., touch free thermometer, gloves, face masks, hand sanitizer, sanitizing alcohol wipes, disinfecting wipes, other PPE depending on a specific student’s needs):
- Bins are transported in and out of each school and each student home.
- Bins are sanitized with a disinfecting wipe both before entering a school and/or a student’s home and after leaving a school and/or a student’s home.
- Bins are restocked as needed.
- Each Birchtree staff completes the staff health screening before leaving for work in the morning.
- If a Birchtree staff does not meet the outlined health criteria on the screening, they do not enter a public school setting or a student’s home and they contact the Outreach Department Program Director and The Birchtree Center Human Resources Director immediately.
- When PPE is required, it is worn prior to entering schools and student homes. Outreach staff also have access to additional PPE and can wear those additional pieces if they choose to do so.
- If a mask gets wet or dirty, it is changed immediately. When PPE is required, it is changed fully between consultation and direct service of each student in a public school setting and between each home setting. As applicable, Birchtree staff always sanitize their PPE prior to entering each school and student’s home.
- Birchtree staff wash their hands upon entering each school and each student’s home and practice frequent hand hygiene, washing their hands regularly for at least 20 seconds as needed throughout the consultation and/or direct service session. If they cannot wash their hands, Birchtree staff use alcohol-based hand sanitizer which is readily available (in the “Stay Healthy” bins).
- Birchtree staff must have access to a bathroom when in a public school and/or a student’s home, if needed, during their consultation and/or direct service session. Birchtree staff clean and sanitize the bathroom using products from the “Stay Healthy” bin after using the bathroom.
Health Policy for Students
- For students receiving consultation by a Birchtree BCBA in their home or for students receiving direct service provided by a Birchtree Clinical Instructor in their home, screening is required. Screening includes daily parent completion of the health screening documentation (either paper format or online via Google Forms) and temperature taking by the Birchtree BCBA or the Clinical Instructor. The daily health screening forms and temperature documentation are collected by and stored with the Outreach Department Program Director. Please note that if the student is not present and in person for a scheduled home consultation session, then the below-described completion of the student health screening is not required.
- Daily Health Screening Questions & Procedures Are as Follows:
- Does the student have any symptoms of COVID-19 or does the student have a fever of 100.4 degrees or higher? Symptoms include: fever, or feeling feverish; respiratory symptoms such as runny nose, nasal congestion, sore throat, cough, or shortness of breath; general body symptoms not due to another chronic medical condition, such as fatigue, muscle aches, joint aches, or headache; gastrointestinal symptoms such as nausea, vomiting, or diarrhea; and changes in a person’s sense of taste or smell.
- Healthy students with the following symptoms/conditions are not excluded from receiving consultation and/or direct service: a) allergy symptoms (with no fever) that cause coughing and clear runny nose if they have medically diagnosed allergies and follow medical treatment plans; b) well-controlled asthma
- Has the student had any close contact with anyone who was diagnosed with COVID-19 in the past 10 days?
- If you answered “yes,” is the student fully vaccinated for COVID-19 AND has it been at least 2 weeks since the student’s final vaccination dose?
- Has the student traveled in the prior 10 days outside of the United States or by cruise ship?
- If you answered “yes,” is the student fully vaccinated for COVID-19 AND has it been at least 2 weeks since the student’s final vaccination dose?
- A student with symptoms of COVID-19 will not receive in-person home-based consultation and/or direct services until any of the following three criteria are met:
- The student tests negative for COVID-19 with an appropriate test to detect active infection. In-person instruction can resume when students are fever-free for at least 24 hours off fever-reducing medication with other symptoms improving as long as they have no risk factor for COVID-19 exposure that would require them to complete a period of quarantine even after testing negative (see below).
- The student has immunity/protection against COVID-19 from being fully vaccinated against COVID-19 (i.e., the student is 14 days or more beyond completion of COVID-19 vaccine) or from recently being diagnosed with COVID-19 in the prior 90 days, AND their healthcare provider has assessed their symptoms and determined they do not require testing for COVID-19 because of being low-risk for COVID-19 (based on symptoms and assessment of potential COVID-19 exposures). In-person instruction can resume when students are fever-free for at least 24 hours off fever-reducing medication, and other symptoms are improving.
- The student has met CDC criteria for discontinuation of isolation (which applies to people who test positive for COVID-19, or for symptomatic people who are not tested but don’t have immunity/protection from vaccination or prior infection, as described above): at least 10 days have passed since symptoms first appeared AND at least 3 days (72 hours) have passed since recovery (recovery is defined as resolution of fever off any fever reducing medications plus improvement in other symptoms).
- Students who report close contact with someone diagnosed with COVID-19 will be required to quarantine for 10 days AND get a COVID test 5-7 days after exposure.
- Students who travel internationally or by cruise ship will be required to quarantine for 10 days.
- Home Consultation: Student health screening is conducted by the Birchtree BCBA upon arrival at the student’s home prior to entering the home. This includes asking the required screening questions to the student’s guardian or caretaker and taking and documenting the child’s temperature (using a touch free thermometer). If a student does not meet the outlined health criteria on the screening or if the student has a temperature of 100.4 or higher, the Birchtree BCBA either reschedules the consultation session or conducts the consultation session via teleconferencing or by phone. If a student develops symptoms during the home consultation session, the Birchtree BCBA uses their discretion to determine if they can socially distance from the student in order to continue the session in person. If the BCBA determines that they cannot socially distance from the student, the BCBA either reschedules the session or shifts to remote consultation for the remainder of the consultation session.
- Direct Service in a Home Setting: Student health screening is conducted by the Birchtree Clinical Instructor upon arrival at the student’s home prior to entering the home. This includes asking the required screening questions to the student’s guardian or caretaker and taking and documenting the child’s temperature (using a touch free thermometer). If a student does not meet the outlined health criteria on the screening or if the student has a temperature of 100.4 or higher, the session is cancelled and the Birchtree Clinical Instructor contacts the Outreach Program Director immediately. If a student develops symptoms over the course of the session, the Birchtree staff contacts the Outreach Program Director and they leave and end the session.
For home based sessions occurring after school hours, a responsible adult (18 years or older), must assume responsibility for the student and be present for the entire duration of the session. The responsible adult must be able to be accessed immediately if needed. Birchtree staff will maintain a minimum of 3 ft. distance from others (aside from students they are directly supporting), as much as possible.
- Student Illness: If a student develops symptoms of COVID-19 during an in-person home-based consultation session with a Birchtree BCBA or a direct service session with a Birchtree Clinical Instructor, Birchtree’s staff are required to end the session and call the Outreach Program Director. In addition, if a student develops symptoms of Multisystem Inflammatory Syndrome in Children (MIS-C) while receiving in-person home-based consultation services, Birchtree staff are required to end the session, and call the Outreach Program Director. These symptoms include: trouble breathing, pain or pressure in the chest that does not go away, new confusion, inability to wake or stay awake, bluish lips or face or severe abdominal pain. If the student is determined to be positive for COVID-19, quarantine protocols for those who were in contact with the student would apply. We recommend parents/guardians seek medical advice if their child is experiencing any of these symptoms. We ask parents to carefully monitor their child’s overall health status and notify their child’s Birchtree BCBA if they believe their child is not feeling well for any non COVID-19 related illness.
- Student Mask Use: NH DHHS (which is one of the agencies informing The Birchtree Center’s COVID-19 Organization Policy) does not require certain students to wear masks or face coverings because the effectiveness of masks and other face coverings is impacted by proper handling and use, and some students are more likely to play with the masks, adjust them, or remove them without washing their hands before or after touching the masks, touch their face, etc. Some students with sensory issues may not be able to tolerate wearing a mask. There are also safety issues with students having cloth, ties, elastics, etc. around their mouths and necks which can pose choking or strangulation hazards, or may interfere with the functioning of certain medical equipment or assistive technology, such as hearing aids. If mask-wearing is required or encouraged by a student’s school district or if a student’s family wishes to have their student wear a mask during home-based services, then students who are able to safely and properly wear a mask are encouraged to do so and are provided with instruction and support to help make mask-wearing possible. Staff implement mask-desensitization protocols for students as needed and as appropriate. If a personally owned mask is used, it must be clean and must be washed before the student’s next scheduled session.
- Community: For students receiving school-based services or home-based services funded by their school district, Birchtree’s staff will follow that school’s or district’s policies regarding field trips and community outings. Students accessing any other after school hours, home-based programming may participate in community-based activities and outings with a Birchtree staff while accompanied by a responsible adult (18 years old or older). The responsible adult must assume responsibility for the student and be immediately accessed if needed at any point during the community-based activity. During community-based activities, Birchtree staff will avoid being within 3 ft. or less from others (except momentarily) with the exception of the student they are supporting.
Communication in Student Homes
- Communication in student homes between a parent or supervising adult and a Birchtree Clinical Instructor or RBT should be limited to conversations about the child/student and their current in-home programming.
- Parent questions or concerns regarding scheduling, changes to programming, or Birchtree's protocols and policies should be directed to the child/student's BCBA or a Director at Birchtree.
 This 10-day quarantine and testing requirement does not apply to students who have been fully vaccinated for COVID-19, as long as it has been at least two weeks since their final vaccination dose.
 This 10-day quarantine requirement does not apply to students who have been fully vaccinated for COVID-19, as long as it has been at least two weeks since their final vaccination dose.