Safety Guidelines
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When we first developed this page, we did so intending to mention on our guidelines only issues we believed called for more attention than they were getting, but we did not intend to address issues getting attention. This was one of the earliest pages and was developed with that limitation in mind.  Although we now consider the original version of the Guidelines complete, we have this page marked for revision to be more comprehensive. We believe that combining all of our guidelines pages, we have covered the topic well, but a future revision will summarize all safety related guidelines here.

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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FamilyLightsm is an educational consulting firm specializing in work with families with a young person with behavioral, emotional or psychological difficulties.  We offer in-depth personal guidance to families on a fee basis and free guidance on the internet. FamilyLightsm attempts to be fully objective and accepts no advertising nor referral fees. The only revenue at FamilyLightsm comes from client fees. 

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. We are currently beginning to request written information on conformity to our guidelines in general.  We do not by any means anticipate or require absolute conformity to all of our guidelines, but we do believe there is great urgency in addressing these four primary causes of death in programs. We do believe that any school or program in less than full compliance with our guidelines as they relate to those causes of death should not be entrusted with your children. 

In too many schools and programs (and with accrediting agencies) we see lofty pronouncements in policy statements about standards that are kept.  Then we also discover staff are not rigorously held accountable for those standards.  We regard those approaches to policy -- especially where safety is involved -- as disingenuous and endangering the lives of their students. 

Policy statements need to put into words the standards of conduct that that the school or program, and its owners, governing board members, and managers will take responsibility for enforcing 100% of the time with an expectation of 100% compliance.  Where individual discretion on the part of a staff member is to be allowed, that is what the policy should state.

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. 

In addition, we expect all schools and programs to comply with all governmental safety requirements, with respect to both physical plant issues and student client procedure issues.  It is contrary to our guideline for faith based programs to take advantage of exemptions from regulation based upon being a religious organization and/or first amendment rights.

Our bulleted guidelines for safety for all programs accommodating clients and students with emotional and behavioral issues, are as follows, in addition to  matters pertaining to safety incorporated within other guidelines areas:

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 behavior change 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

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 3-17-09

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