General Rules for Crossings

• We do not permit use or possession of alcohol, drugs or tobacco products. Over-the-counter medications and prescriptions must have the specific permission of parents or physicians. All medication is held by appropriate treatment staff and self-administered by participants under staff supervision.
• Weapons or articles which staff perceives could be used as weapons, including personal knives, are not allowed.
• Participants may not leave, or work on plans to leave, the program without permission of staff.
• Participants must avoid behavior which endangers themselves or others, including staff; including violence or threats of violence, engaging in or encouraging risky behaviors, or failing to follow instructions which bear on safety issues.
• Participants are responsible for following the program's rules and for obeying staff members at all times.

Confidentiality & Disclosure

All client and family information given to Crossings Wilderness Expeditions is protected under federal and state regulations and cannot be disclosed without written consent unless otherwise indicated in the regulations. Generally, without such consent, staff members in the program may not say to a person outside of the program that a participant attends the program or disclose any information identifying a participant. Federal and state law and Crossings recognize the following exceptions:

• Information regarding imminent danger to self or others, criminal activity involving program or program personnel, or medical emergency.
• Information regarding suspected child abuse.
• Information about communicable diseases which have significant public health implications, including HIV/AIDS, is reported to Wrangell Public Health Department.

Disclosure of information may be allowed by court order under limited circumstances.

You may disclose personal information about yourself to whomever you wish, but it is not appropriate to do so about others without their consent. We ask that you not share names or personal information about Expedition participants or their families without their permission.

What a participant tells the Expedition staff in the field is confidential with respect to outside persons, but not with respect to their own families and case workers. One of the goals of the program is to rebuild trust in families by removing the barriers created by lies and secrets. That work is best done by encouraging and assisting adolescents to be open and candid with their families, and Crossings staff will so encourage and assist participants. Staff may make exceptions for especially sensitive information that should be discussed in the context of ongoing family therapy.

Informed consent.

Participants and their families will be informed about the nature of the care, procedures and treatment that he will receive, and the risks, side effects, and benefits of treatment procedures. Informed consent will be obtained from participants' parents or guardians during screening and intake procedures. A reasonable attempt will be made to obtain informed consent from participants at the earliest opportunity following admission. Information will be provided to parents and participants and will contain the following:

• The training or treatment to be undertaken, including the treatment philosophy, methods, and services available.
• Alternative training or treatment methods available, if any. Risks that may be involved in the training or treatment.

Dignity and Respect

Each participant's personal dignity shall be recognized and respected in the provision of all care and treatment.

Voluntary treatment

Participants are placed in treatment on the authority of their parents or guardians. Those parents or guardians are highly involved in the child's treatment from the initial contacts with Crossings. Some participants enter treatment willingly and others are brought into treatment against their will. Crossings staff are happy to assist families directly with the intake process and we can talk directly with you or your child with ideas and solutions if there are hesitations or concerns about attending the program.

While it is highly discouraged for participants to leave, and the exit process can take some time, those who indicate a desire to leave the program will be given the opportunity when it is safe and appropriate to do so. No one is kept in the program against their will.

Signed consent

A written, dated and signed informed consent form shall be obtained from the participant, the participant's family or the participant's legal guardian, as appropriate, for participation in any research program, for photographs or quotations that might be used by news media, or in promotional material for the Crossings program.

Treatment Planning

Individualized treatment includes an individual treatment plan. Participants are actively involved in creating this.

Clinical Records

Unless state law provides otherwise, it has been the judgment of the professional staff of the facility that due to the sensitivity of the information contained in the clinical record, it is in the best clinical interest of the participant and his parents that the participant have the right to have his clinical record reviewed and/or interpreted by the therapist or the Clinical Supervisor or his designee to provide appropriate information to the participant and his parents regarding his problem(s), treatment received, alternative forms of treatment available, progress in the facility, and recommendations for the future. All participants may request that the clinical record be released to appropriate agencies, their attorney, their physician, referral sources, or follow-up treatment resources.

Personal property

Participants are not allowed to bring personal property with them on Expedition, except for clothing as described in the Crossings equipment list. Approved items include eye glasses, an inexpensive camera, and basic toilet articles including a comb or brush and toothbrush. Soap, radios, wallets or purses, watches, make-up, jewelry, piercing, matches, lighters, and unnecessary or unsafe items of clothing are excluded. If discovered once the Expedition has left the program office, such items are taken and kept by staff. Participants may reclaim them at the end of the Expedition. Crossings will not be responsible for these items if found once the Expedition begins. A search during which the participant's clothing and bags are examined is the routine procedure. Parents are asked to pack their children's bags, to be attentive, and to inform Crossings of any possible contraband. Searches are sometimes unavoidable and unpleasant for participants and staff. They are conducted for the purpose of providing a drug-free and low-risk environment.

Communication

It is not possible for parents to communicate with their child during the Expedition. Parents are encouraged to write to their child during the Expedition and send their correspondence to the program office. The letters will normally be delivered to the participants the night or morning before the final graduation.

Privacy

Each participant's personal privacy shall be ensured and protected within the constraints of the individual treatment plan, the outdoor environment, and the participant's own behavior. The Crossings treatment philosophy includes personal solitude, and time alone is usually plentiful. Participants are expected to set up their own shelter in an area assigned by the field staff. Shelters are tarps or tents. The types of shelter and camp assignments are chosen to allow for line-of-sight supervision by the staff. Privacy for dressing, cleansing, elimination, and self-care is largely determined by the participant's own efforts.

Religious freedom

Crossings cannot provide access to religious services, religious leaders, or to the standard community religious resources of each participant's choice. Students are encouraged to consider the spiritual aspects of the wilderness setting, recovery, and their lives. They are free to discuss any aspect of their own religion and values. They are free to engage in personal religious activities. When treatment services focus on spiritual matters, it is without bias for or against any religion or denomination. It is not intrusive.

Self-determination

Participants are not allowed to set their own rules, consequences, or conditions of work and play. Crossings students have behavior, mental, and substance abuse problems. They may lack internal standards of behavior. They often fail to persevere, exercise self control, and conform at minimal levels to social standards. For this sub set of adolescents, it is appropriate to provide external constraints upon their behavior.

Work

Participants will not have the opportunity to work for remuneration. They exert substantial physical energy to hike, paddle, collect firewood, cook, erect shelters, and exercise. Those activities are required to keep up with the group, take care of themselves, and assist others. Some Expeditions involve contributing 1-2 days of service work such as trail maintenance or trash cleanup.

Complaint procedures

Crossings has an established complaint procedure which is available to participants and families upon request.

Staff

The Crossings program will provide an adequate number of competent, qualified, and experienced professional staff to supervise and implement the treatment plan. Participants and their families will be informed about the professional staff members responsible for participant care, their professional status and their staff relationships. The Crossings program provides continuing training for all staff members and specific orientation for all new staff members in the principles of confidentiality and participant rights.

Family Visits, Letters, and Outside Contact

Visits from family members are not possible during the Expedition.

Contact with medical personnel is limited to emergency situations clearly requiring medical treatment. This is at the discretion of qualified staff rather than participants. Participants are free to request medical attention and are encouraged to fully inform staff of any medical problems or concerns they may be experiencing.

Medical Policy

Parents are responsible for accurately completing the medical history of the application form, and for getting a physical examination by a physician who reports his/her findings on the medical examination form included in the application materials. When the history or examination reveals conditions that might entail risk to the client or other participants in a trek, Crossings staff, with possible review by our consulting physician, will review the record and make a recommendation as to admission and any conditions for participation.

Any applicant who has a history of diabetes, seizures, or head trauma requires a minimum of one week notification prior to admission. This allows our staff adequate time to speak with the child's physician regarding the medical condition in question and the management of said condition in the field.

When a program participant is in need of medications of any kind, the following guidelines must be adhered to:

1. A written order signed by a physician is required before any medication can be given to any participant.
• Medications prescribed for one participant shall not be used by another participant.
• Normally, participants will self?administer their medications. However, Crossings staff will retain physical possession of the medication supply and administration directions and will supervise the taking of them.
• It is not possible to keep prescription medications in a locked, stationary container; they will be kept by the trip director in his/her backpack or on his/her person for safekeeping. With the exception of winter months, it is not possible to refrigerate medications. Applicants taking refrigerated medications must find a medically acceptable substitute not requiring refrigeration or attend another program that has refrigeration available.
2. Individual records will be kept for any prescription drugs taken by participants, including the prescribing physician's name, a description of the medication and dosage, method of administration, verification in writing by treatment staff that the medication was taken and the times and dates given, and any adverse reactions to the medication.
3. At the end of each trek, staff will return all medications to the parent(s) or guardian(s) of the participant. In the case of any medication with potential for abuse, staff will count the medication; tally the records of use during the trek and make sure all the medication is accounted for; seal the medication before sending it home; and inform the parent or guardian as to the quantities used on the trek.