We remain confident that clients in therapeutic programs, including wilderness programs, are safer than healthy teenagers in the normal activities of daily life. We are seeking research to support that, and we will post it when we find it.  

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Nevertheless, accidents and illnesses are possible anywhere. Very rarely –  extremely rarely –  we do hear of deaths of natural causes in therapeutic settings. These are no more common than deaths by natural causes anywhere. Again, death by natural cause among teenagers is extremely rare, just as it is back home.  We suspect but cannot prove that death by natural causes in a wilderness setting is less frequent (proportionate to numbers of participants) than in athletic practices and events in town. 

Preventable accidents in treatment tend to be of these kinds and remain infrequent enough to make mainstream programs safer than normal activity back home. But those that occur tend to fall into these categories:

·Improper restraint. A program staff member intervenes with a client he or she believes to be acting in a dangerous manner, and the means of restraint puts too much pressure on the client’s chest or windpipe, causing death.

·Failure to respond to a client who is ill -- believing the client to be faking.

·Suicides or manipulative suicidal gestures that result in accidental death.

·Dehydration (usually a wilderness program concern, but can arise otherwise, for example with athletics and with students taking certain medications).

Some of the guidelines we have suggested in other sections are beyond the current state of the art in this industry. In 2008, we will begin to request written information on conformity to our guidelines in general.  We do not by any means anticipate or require over-all conformity to our guidelines, but we do believe there is great urgency in addressing these four primary causes of death in programs. However we believe guidelines addressing these four greatest areas of risk should be met by all.

In addition, while it rarely happens, there are instances of psychiatric de-compensation of young people in wilderness programs and other therapeutic and behavioral change settings.   We believe that every such program needs an agreement with a hospital or other inpatient facility that will provide immediate admission and hospital level of care when such events occur. 

It is reasonable to anticipate all programs providing care for clients have effective procedures in place to prevent death or injury in these categories.  Schools and programs that fail to meet those standards should be avoided. 

Our guidelines for safety for all programs accommodating clients and students with emotional and behavioral issues, are as follows:

·Whether or not a program’s policies allow for restraint, all staff should be trained in effective means of intervening physically in behavior that would potentially cause injury to a client without risking injury (especially chest or neck injury) to the client acting out. With great respect for schools and programs that do not knowingly admit or retain students / clients they suspect might need restraint, the question needs to be answered by formal policy:  What do you do if there is an episode of violent acting out that threatens the safety of staff and/or students?

·All client claims of illness must be assumed to be truthful unless or until ruled out by competent, credentialed medical personnel. If the judgment at issue is not made by a licensed physician, it needs to be made by person with credentialing authorizing such judgments. 

·A licensed medical doctor should sign a detailed protocol to be followed when accident or illness is reported and for dispensing any medications

·Programs must have written policies describing screening for suicide risk and what they will do when risk is assessed. These policies should show that they are authorized by a specific licensed clinical psychologist or psychiatrist whose signature and license information is attached to the policy.

·Programs need to have policies regarding minimal food and water intake, and what action to take if the client resists adequate food and water.

·Programs should be able to describe credibly and convincingly why professionals and parents can be confident that these policies are met with 100% compliance.

·Medically competent staff must be accessible to clients at all times.  Minimally that involves EMT trained staff.  There should never be a time that a client cannot immediately access a person of at least EMT competence. 

·Programs and schools taking students/clients off campus for "adventure" programming similar to wilderness programming should meet wilderness program guidelines, noting specifically guideline for access to helicopter evacuation and communications (access to satellite phone and two way radio).

·Program is fully compliant with safety standards of therapeutic facilities in the jurisdiction where located even if the facility at issue is for some reason legally exempt from compliance with such standards.  (This is true of some faith-based programs and some facilities licensed only as schools). In addition to compliance with safety standards of the local jurisdiction, we ask that the school's own safety standards be adequate to meet requirements of the State of Utah.  (We choose Utah, despite the fact that Utah standards need to be strengthened, because there has been a serious effort to set meaningful standards without creating a counter-productive burden on programs).

·Schools and programs meet common sense expectations of providing for the health and safety of students in the programs.

·Schools and programs, in  providing medications for students administer them according to the expectations of the original prescribing practitioner, recording evidence that the medications have truly been taken.  (Exception, of course, where there is a properly documented reason for students /clients to self-administer. 

·Schools and programs need to have confirmed arrangements for placing students and clients in psychiatric hospitals for stabilization if needed.

Feedback is invited. We will publish selected feedback.  Email FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last update 10-21-08