Leaders Manual

TABLE

OF

CONTENTS

A. PHILOSOPHY AND OBJECTIVES 1. HISTORY AND PHILOSOPHY............................................................ 3 2. GENERAL STATEMENT OF PURPOSE................................................ 3 3. PROGRAM OBJECTIVES................................................................. 3 a) safety............................................................................ 3 b) enjoyment..................................................................... 3 c) socialization.................................................................. 4 d) living skills.................................................................... 4 e) normalization................................................................ 5 4. LEADERSHIP PHILOSOPHY AND STYLE............................................ 5 a) communicating meaningfully........................................ 5 b) helping.......................................................................... 6 c) calling things by their right names................................ 6 d) your own feelings......................................................... 6 e) decision making and choice......................................... 7 f) co-leading..................................................................... 8 g) principal leaders........................................................... 8 5. DEFINITIONS................................................................................. 9 a) developmental disabilities ........................................... 9 b) dual diagnosis.............................................................. 9 B. POLICIES AND PROCEDURES........................................................... 9 1. PRE-TRIP BRIEFING...................................................................... 9 2. CONDUCT.................................................................................... 10 a) participant conduct...................................................... 10 b) leader’s conduct........................................................... 11 3. PARTICIPANT LEAVING TRIP............................................................ 11 4. MEDICATION..................................................................................12 5. MEDICAL EMERGENCIES.................................................................15 a) accident resulting in injury............................................ 15 b) illness............................................................................ 15 c) accident/illness report................................................... 16 6. SPECIAL CONCERNS WHEN WORKING WITH THE ELDERLY................. 16 7. SWIMMING POLICY.........................................................................19 8. INSURANCE COVERAGE..................................................................19 a) accident coverage for trip participants..........................19 b) leader’s accident/illness insurance coverage............... 20 c) liability and liability insurance........................................20 C. SUPPORT PHONE................................................................................ 21 D. TRIP LOGISTICS...................................................................................22 1. PICK-UP AND DROP-OFF PROCEDURES........................................... 22 2. ACTIVITY PLANNING....................................................................... 23 3. CHECK-IN CALLS...........................................................................24

4. GROUP TRAVEL.............................................................................24 5. HOTEL PROCEDURES.....................................................................24 6. RESTAURANTS AND CLUBS............................................................. 25 7. TRANSPORTATION PROCEDURES..................................................... 26 a) van transportation......................................................... 26 b) air travel ....................................................................... 27 c) cruises...........................................................................28 E. FINANCES............................................................................................. 28 1. MANAGING FUNDS.........................................................................29 a) asking for discounts...................................................... 29 b) tax-exemption............................................................... 29 c) creative money-saving.................................................. 29 2. APPROPRIATE USES OF SPROUT FUNDS......................................... 30 3. RECORD KEEPING........................................................................ 30 F. SAFETY................................................................................................. 30 1. GENERAL POLICY.......................................................................... 30 2. SPECIFIC POLICIES....................................................................... 31 G. FIRST AID............................................................................................. 31 1. EMERGENCY REQUIRING URGENT CARE.......................................... 32 2. EPILEPSY, SEIZURES..................................................................... 33 3. DIABETES.................................................................................... 34 4. PROBLEMS CAUSED BY HEAT......................................................... 35 5. DIETARY RESPONSES TO COMMON AILMENTS................................ 36 6. ASTHMA ..................................................................................... 36 7. ALLERGIC REACTIONS.................................................................. 36 8. PAIN RELIEF WITHOUT MEDICATION................................................ 37 9. UNIVERSAL PRECAUTIONS............................................................ 37 H. EVALUATIONS.................................................................................... 38 I. PROCEDURES AFTER THE TRIP....................................................... 39 Copyright © 1988, Sprout 270 W 96th St, 2nd Floor New York, NY 10025 First Revision, June 1992 Second Revision, June 1994 Third Revision, June 1996 Fourth Revision, June 1997 Fiftth Revision, June 1998 Sixth Revision, June 2002 Seventh Revision, May 2005 Eighth Revision, March 2012

All rights reserved, including the right of reproduction in whole or in part in any form whatsoever.

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A. PHILOSOPHY AND OBJECTIVES 1. HISTORY AND PHILOSOPHY Sprout is a private, non-profit organization dedicated to helping people with disabilities grow through recreational, educational and leisure activities. Founded in 1979, Sprout believes in the therapeutic value of fun and the enjoyment and comfort of a small group setting. Sprout activities enable participants to become aware of their abilities as well as personal limitations imposed by themselves and society while encouraging them to overcome these limitations. The result is greater self-confidence and personal gratification.

2. GENERAL STATEMENT

OF

PURPOSE

Our primary goal is to give participants the opportunity to experience and enjoy recreational, educational and leisure activities. With our network of resources and dedicated leaders, Sprout opens up fascinating new worlds to people with disabilities.

At the same time, we hope to present new challenges to increase self esteem, mobility, and socialization. All participants are encouraged to take an active role in the planning and implementing of activities. Through group outings, each participant will gain insights that can be applied to his or her everyday life.

Additionally, Sprout strives to help participants acquire the skills and confidence necessary to initiate activities on their own.

3. PROGRAM OBJECTIVES In our desire to provide a recreational experience of high quality for people with developmental disabilities we have focused on the aspects which we feel are important to the overall success of the experience. a) Safety We believe that an important part of personal responsibility is an active regard for one’s own safety and the safety of those around you. We also acknowledge that on an outdoor program a certain degree of risk is inevitable. Our aim is to combine the benefits of travel and recreation with certain safety policies and procedures. We encourage an attitude toward safety that will benefit the group as a whole, and still allow for adventure and personal challenges. b) Enjoyment Participants come on Sprout trips to have a good time. We don’t ask you as a leader to be a 24-hour social director or a born entertainer. However when a participant is in a new, difficult, or unexpected situation, a relaxed, lighthearted attitude by the leader can be helpful and greatly appreciated.

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We at Sprout believe in the importance of the leaders joining in on the fun with the participants. It is a special feeling for the participants to have the leaders enjoying their vacation with them. For some leaders it is difficult to relax from all the responsibilities related to a trip and just have a good time. Some find it difficult to find a balance with teaching skills/modifying behavior and fun. Our guideline is: When the instruction is interfering with their good time, cut back on the instruction. c) Socialization Encourage each participant to socialize. Support them in turning to each other and to outsiders. Remain available if they need an opinion or advice, and step in when needed.

For the most part, we encourage learning by doing. As a leader you should be concerned with creating a comfortable and trusting atmosphere for the participants to become aware of their interpersonal resources and to use them with confidence. d) Living Skills While we recognize the importance of fun as a therapeutic tool, we also realize that recreation as a learning experience is not sufficient. It is not enough to offer the participant a safe and enjoyable experience. We encourage participants to do things for themselves, to take care of their own needs, and to realize their maximum potential.

There is no simple formula which can be used to describe or to create an effective learning experience. Methods that work well for some do not work at all for others. The effectiveness of instruction is dependent both upon what is taught and how it is taught.

The following are suggestions to promote successful learning experiences:

1. The natural environment: Whenever possible, teach skills in the environment in which they are normally used.

2. Skill reduction: Skills which seem very simple may be too complex for a participant to learn all at once. Complex skills should be broken down into smaller components.

3. Modeling: Often a participant will have no concept of the way a learning task should be performed unless he can watch someone else perform it.

4. Manual guidance: Once the participant has seen the task performed and has some concept of how to perform it, you can help him complete the task successfully by guiding him through it.

5. Motivation: A participant who is motivated will concentrate better, and work more intensely than a participant who is not motivated.

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e) Normalization Normalization is a goal that Sprout strives to achieve during each activity. Sprout attempts to offer the participants a vacation that would be acceptable to any adult. The manner in which leaders treat participants and the age-appropriate activities that participants are encouraged to undertake help to change the general public’s view of people with developmental disabilities.

The participants’ self image is also greatly enhanced when they are treated as adults. In essence, normalization challenges you, as a leader, to enhance both the skills and the societal image of the participants. A large factor in achieving this goal for you is to provide the necessary emotional, informational and physical support.

The maximum physical and social integration of our participants into all aspects of community life are the fundamental goals of the normalization process.

4. LEADERSHIP PHILOSOPHY AND STYLE There have been volumes written about leadership styles, whether it be autocratic, laissezfaire, democratic, the leader as parent, or the Zen of leadership. From our perspective it comes down to a time and a place for each style, with flexibility and sensitivity as the key words. No single style by itself will work all the time and we cannot tell you the “best” approach. In simply assigning you a trip we express our belief that you are capable of fulfilling your responsibilities within your own personal style.

If there were a “Sprout leadership style,” it would involve an attitude of caring and respect for each participant and the group as a whole. It includes creating a supportive environment where participants can struggle with new interpersonal and technical situations. It involves, wherever possible, respecting the choices that participants make as to how they want their trip to be organized.

A participant’s appreciation of his or her trip is often directly related to the amount of attention and interaction given by the leaders. Interaction with each participant is vital and is expected from all leaders. Leaders should also be attentive to shy and introverted participants and encourage them to share and take part in group activities. a) Communicating Meaningfully

When communicating with Sprout participants it is important that the leader should always be mindful of the principle of normalization. We must avoid the common tendency to deal with disabled people as if they were children and as if they could not hear or understand us.

If the participant you are speaking to does not understand you or you do not understand him, you should change your communication style. This may mean slower speech - not childish phrases - and you may have to speak more clearly rather than louder.

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A childish voice can also introduce an affected pity that is much resented by most disabled people. It’s an element that enters the voice and yet does not do anything to lift self-esteem or to establish a meaningful rapport between you and the participant. In all aspects of our interaction we strive to getting past the disability.

The tendency to talk to participants in a childish manner is often matched by conversation with childish content. Conversational content should be of an adult nature.

Many participants are very aware of and interested in adult topics such as discussions of current affairs, sporting events, science, interpersonal relationships, philosophy and politics.

It is important to be patient while you are having a conversation with the participants.

There is a great tendency to want to finish a sentence for a participant and guess at what he is trying to say. This is not a good idea unless it is something that the person has asked you to do. Although it may speed up conversation, it denies the participant the right of his own communication, even though it may be slower and require some deciphering. b) Helping It is a quite common mistake to extend help to participants beyond the degree required.

There is a fine distinction between useful assistance and overdoing it. Generally speaking, the participants should be allowed to function as independently as possible, unless they specifically ask for help or it is apparent that they are getting into difficulty because of their limitations. Then they should be offered help and assistance. Questions like “Do you need any help ordering from the menu?” are always appropriate. Assistance should be spontaneous when a person is approaching a questionable safety situation. When assisting participants with showering, dressing or other bathroom needs, a leader should only help participants of the same sex as the leader. c) Refer to the Person First The name of a physical or mental disability may be important, but the name of the person is infinitely more important.

Try to discipline yourself to say, “John Johnson is a person with developmental disabilities,” rather than, “He’s a developmentally disabled person named John Johnson.”

Likewise, the term “a person with developmental disabilities” is preferred to “a developmentally disabled person.” They are “people” first who happen to have a disability. d) Your Own Feelings

Understand from the beginning that no person attempting to assist the disabled will meet joyous and uniform success with every endeavor. Anyone who leads trips will have many

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enjoyable and special moments with the participants, but may also be faced with periods of frustration and disappointment which can leave one with mixed feelings. It is not unusualto feel the need to sort out your original expectations and the sometimes conflicting reality of experience.

Leaders must face the fact that not all contacts with the participants will be enjoyable.

People with disabilities can be just as difficult as non-disabled persons. Personality conflicts may arise. One should recognize, without guilt, that experiences of this kind may occur. There are no guarantees of success, but everyone owes it to themselves to try.

Kidding and fun can often lighten helping moments. When the kidding is directed at yourself, rather than the participants, you can relieve the strain from many situations.

e) Decision Making and Choice

Sprout considers the inclusion of the participants in the decision-making process to be very important and leaders should attempt to offer the participants choices whenever possible.

By providing our participants with the opportunity to make choices we are giving them autonomy, respect and self-control. Presenting choices may cause discussions and disagreements but if looked at as part of a learning experience it may seem worth the extra work. Choices can be presented in a low key manner without becoming too stressful.

Leaders must seek input regarding participants’ interests, likes and dislikes. Offer choices in a reasonable manner by avoiding too many options and asking closed questions with yes or no answers. If possible, the participants should be included in decisions regarding restaurants, activities and if appropriate rooming preferences. Care should be taken with the manner in which options are presented to the participants. Participants may perceive a possible activity option as a promise to do the offered activity at a later time. For example, asking a group on the last day of the trip if they would like to go whale watching or to an amusement park could lead to problems.

There should be good communication and consensus among the leaders about what choices should be offered to the participants before actually offering the participants a choice. Leaders should strive to make participants realize that decisions,that will effect the group, are not made in isolation. It is appropriate, if the leaders feel comfortable, to offer participants the opportunity to choose different activities by splitting the group. (See Section D. 4. Group Travel for more information on splitting a group.)

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While inclusion of the participants in the decision-making process is encouraged, many decisions will need to be made solely by the leaders, for example, decisions regarding budget, logistics, emergency situations, etc. We recommend a consensus approach to decision making. In a consensus, an agreement is reached through a process of gathering information and viewpoints, and discussing the various proposals. The goal is to reach a decision with which all three leaders can agree. Leaders can proceed with an action without having total agreement, but those not in agreement must consent. A consensus requires a great deal of patience and flexibility, providing leaders with the opportunity and the responsibility to share their thoughts and feelings. f) Co-Leading Each leader assigned to a trip is considered an important member of the team. Even though one leader may have more experience than another, all leaders have a say in the decision-making. A more experienced leader may be looked to for advice concerning a delicate situation. However, all leaders should have the chance to be heard.

A successful leadership team takes time and energy. We suggest setting aside specific time during the trip, usually at night, for the leaders to get together and discuss the aspects of the trip, such as: how the trip is developing, how each leader feels, planning appropriate activities, concerns with participant behaviors, budgetary concerns, and sharing responsibilities. It is important that the team works well together, and each leader does his or her share of the work in order to assure a safe, enjoyable trip for the participants.

It is important to realize that even experienced leaders can make mistakes or bad judgement decisions. If at anytime a leader feels another leader has made a poor judgement decision, he/she should not hesitate to speak out. The leadership team is designed to be able to look at a situation from three sides and ideally work out the best possible solution for any particular set of circumstances. Of course, if the co-leadership team finds itself in disagreement on how to handle a situation, the support phone should be called to seek further advice. g) Primary Leaders Certain leaders are assigned by the Leadership Department to be Primary Leaders.

These leaders are experienced and have a leadership style in line with Sprout’s philosophy and policies and have displayed outstanding leadership skills in a variety of situations. Primary Leaders are responsible for training new leaders as to the logistics of

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running a trip and also for passing on their skills and knowledge of Sprout philosophy and style. Primary Leaders should be considered as mentors rather than “bosses” and used as an experienced resource. They are not in charge of the trip, nor do they expect to do all the work and make all the decisions; they should actively look for input from other leaders.

5. DEFINITIONS a) Developmental Disabilities Developmental Disabilities is the term that covers a wide range of disabilities which affect an individual’s mental and/or physical development. Autism, Down syndrome, Asperger’s, and intellectual disability all fall under the category of developmental disabilities. The majority of the participants we work with are people who are intellectually disabled. The following is the definition of intellectual disability outlined by the AAMR (1992): Intellectual Disability (formerly referred to as “mental retardation”) refers to substantial limitations in present functioning. It is characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure and work. Intellectual Disability manifests before age 18.

The three key elements in this definition are: 1. Low intellectual functioning.

2. Deficiency in adaptive behavior.

3. Acquisition before age 18. b) Dual Diagnosis A person who has a developmental disability and a psychiatric condition is said to be dual diagnosed. Some of the participants on Sprout trips will have a dual diagnosis.

Leaders should be aware that these participants may exhibit some manifestations of psychiatric illnesses. Sprout does not work with any participant that exhibits behaviors that are dangerous to him/herself or others. Participants on Sprout trips are required to be in a behaviorally stable condition. If there is a concern with the behavior of any participant contact the office via the support phone.

B. POLICIES & PROCEDURES 1. PRE-TRIP BRIEFING Each leader team will meet prior to the trip departure to cover the following: participant information forms, trip/activity information, medication information, leaders’ and budget notebook, leader evaluation forms, ID cards, directions & maps, and related equipment.

An office staff member will be present to assist in any way.

Review of participant records is useful only in a general way as an assessment. What a

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particular participant did one, five, or twenty years ago may have no connection to his or her present self. Participants’ behaviors can change when they are faced with the new environment like the one they are confronted with on a Sprout vacation. In addition to histories provided by the agency, participants may have evaluations from previous trips

by Sprout leaders which are often a more accurate guide to how a participant will behave on a trip. It is important to bear in mind when reading any evaluation that it is subjective; each leader - participant relationship is unique.

The following information should be drawn from the participant’s personal file: a) Medical limitations - Included under this are: allergies, seizures, physical disabilities, dietary restrictions, intellectual limitations, safety precautions, and other types of assessments. b) Observed behaviors - These are evaluations and reports from leaders that had previous contact with the participant. They can give a good indication of the participant’s behavior while on a Sprout trip. Included under this section are: repetitive, disruptive or abusive behaviors; reinforcers and programming success; cyclical behaviors; and objects or individuals to which the participant responds positively or negatively.

2. CONDUCT a) Participant Conduct As a leader you should be aware that Sprout reserves the right to expel from a trip any participant that is exhibiting behavior that is endangering to himself or others. This type of behavior cannot be accepted on our trips, and it should be reported to the Director of Leadership immediately. Participants that demand, for whatever reason, the constant attention of one leader to the exclusion of the rest of the group may cause a safety problem. This situation should be reported to the attention of the director.

The Sprout staff will decide, after reviewing the leaders’ input, whether a participant will be allowed to travel with Sprout again. Leaders should not, under any circumstance, tell the participant, the participant’s family or agency contact whether a disruptive participant will or will not be allowed to travel with Sprout again.

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b) Leaders’ Conduct You, as a leader, are assigned to lead a trip for the group’s benefit. Any behavior on your part that negatively affects the safety of the group is not allowed and will not be tolerated.

Behaviors which negatively affect the safety of the group, as well as the reputation of Sprout include, but are not limited to, the following: 1. Not abiding by Sprout’s Alcohol Policy which states: Sprout leaders are not allowed to consume alcoholic beverages, at any time, while on a Sprout trip.

2. Engaging in any illegal activity.

3. Smoking in the vans or the hotel rooms.

4. Using Sprout vans for personal use.

5. Abandoning or leaving the group alone for any period of time.

6. The misappropriation, misuse, or theft of participants’, co-workers’, or group funds.

7. Using a cellphone while driving (including texting).

8. The rough treatment or abuse, either verbally or physically, of any participant or co-worker, regardless of provocation or circumstance.

9. Sprout does not accept the sexual harassment of any of its employees by another employee. Unwelcome sexual advances, sexual favors and other verbal or physical conduct of a sexual nature will not be tolerated.

10. Abuse and Neglect - Maltreatment, abuse or neglect of any participant is prohibited. Corporal punishment, verbal or psychological abuse, degradation, humiliation, or dehumanization of any kind is forbidden. Any leader involved in such activities will be reported to the proper authorities and will be discharged.

If any leader suspects that a co-leader has mistreated a participant, or has reason to believe that a participant is being mistreated at his/her home, the leader must immediately report this to the Leadership Department via support phone.

3. PARTICIPANT LEAVING TRIP As stated in the section regarding participant conduct, Sprout cannot work with participants who exhibit dangerous behaviors or who demand such attention from the leaders that the group’s safety or enjoyment of the trip is jeopardized. In addition, due to illness or injury a participant may not be able to stay with the group. In these situations it may become necessary to send a participant home early.

At the first sign of any problem behavior or illness the Sprout office or the person on call should be contacted via the support phone. Some behaviors may be defused before they get out of hand, others should be closely watched. Participants deserve the chance to change, so be sure to seek advice from the office as soon as you are concerned. Be sure to keep the office closely informed as to the development of the situation.

The decision to send a participant home can only be made by the office staff. All agency or parent contacts regarding this possibility will be made by the office only. If it is decided that a participant is to leave the trip, the office will provide you with instructions as to what to do with the departing participant’s share of the budget.

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4. MEDICATION The proper dispensation of medications on Sprout trips is of the utmost importance.

Medication helps our participants lead healthier and more normal lives by controlling seizures, preventing psychological outbursts or breakdowns and by regulating the heart and other organs. Improper dispensation can have serious effects.

A small percentage of participants on medication will be self-administering. In other words, they will carry their own medications and will take them on their own. The larger percentage of participants on medication, however, will rely on the leaders to distribute their medications at the specified times. If a participant arrives on his/her own and informs you of being self-medicating, there should be additional information sent with him/her (or sent to the Sprout office) to confirm this. If the person arrives with staff, find out the level of independence the person has in self-administering their medication (ie.

Should the participant be reminded at the prescribed times? Should they be witnessed taking their medication? Should the leaders hold on to the medications? Are they completely independent and in need of no supervision whatsoever?) If there is any confusion, call the Support Phone.

Sprout works with many different agencies and individuals who, while following the general principles of our medication policy, tend to have various idiosyncrasies. To make the task of distributing medications easier for leaders, Sprout’s medication policy requests that all agencies present medications to leaders on the day of the trip in the following manner: - All pills should be pre-packed by the agency in blister packs.

- Creams, lotions, inhalants, drops or liquid oral preparations should be presented in their original containers labeled correctly and legibly with labels that list the participant’s name, medication dosage, frequency, route or method of application, and time of dose.

- The agency should also provide you with check-off sheets that list the participant’s name, the day and date, the time of the dose and the type of medication. There should be space provided to place your initials whenever you dispense a medication.

- When meeting the participant a staff person from the participant’s agency or the participant’s guardian should also be present to answer any questions you may have regarding medications and should not leave until you are satisfied with the medications.

A. - IF THE MEDICATIONS HAVE BEEN PRESENTED TO THE LEADERS IN THE MANNER

REQUESTED BY PROCEDURE:

SPROUT,

PLEASE FOLLOW THE FOLLOWING

When picking up the participant: (1) Review all medications and information with a staff person from the participant’s agency or the participant’s guardian. Two leaders should check that the information on the medication check off sheet matches exactly the information on the blister packs you have been given. Check that you have been given sufficient medication for the entire trip. (The third leader should remain with the group and take care of their needs.)

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(2) If there is a problem, question the agency staff and if you are still unsure of medications contact the Sprout office or Support phone.

(3) One leader (assigned by the office) oversees the dispensing of medication.

Transcribe the participant’s name, the medication’s name, the dose to be given, the time at which it is to be given and the date on which it is to be given onto a Sprout Medication check off sheet. Have another leader check that you have done this correctly. This leader assigned by the office is responsible for ensuring that the correct participants receive the correct medications at the correct time. They do not necessarily have to give every medication.

Giving medications: (1) Two leaders should check the information on the blister pack or other medication container against the information on the medication check off sheet.

Two leaders should check that the correct medication is being given to the correct participant at the correct time on the correct date.

(2) As soon as possible after dispensing a medication the leader who dispensed the medication should sign the medication sheet.

B. - IF THE MEDICATIONS HAVE BEEN PRESENTED TO THE LEADERS IN A MANNER OTHER

THAN THAT REQUESTED BY

SPROUT

PLEASE FOLLOW THE FOLLOWING PROCEDURE:

When picking up the participants: (1) If a staff person or guardian is present, review all medications and information.

(2) If there are medication check off sheets, two leaders should check the medication bottles or packets against these sheets. Creams, lotions and drops should also be checked in the same manner.

(3) Check that you have been given sufficient medication for the entire trip.

(4) Pre-packet the first day’s medication and the medications for the morning of the second day into the envelopes provided by Sprout. Have another leader check that you have dispensed the correct dose and that you have written on the outside of the envelope the correct participant’s name, the correct dose, the correct time and the correct name of the medication. Do not seal the envelope until it has been checked by another leader.

(5) If there appears to be anything missing, contact the Sprout office or Support phone.

(6) If there are no prescriptions or medication check off sheets check the physical containers for medication doses, dates and times. Transcribe the participant’s name, the medications name, the dose to be given, the time at which it is to be given and the date on which it is to be given onto a Sprout Medication check off sheet. Have another leader check that you have done this correctly.

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During the morning of the second day: (1) The leader in charge of medications should use the Sprout medication sheets that had been filled in the previous day or the agency’s medication check-off sheet to pre-packet the entire week’s meds.

(2) Pre-packet medications into the envelopes provided by Sprout. Have another leader check that you have dispensed the correct dose and that you have written on the outside of the envelope the correct participant’s name, the correct dose, the correct time and the correct name of the medication. Do not seal the envelope until it has been checked by another leader.

(3) This pre-packeting should be done before any other activities.

During the trip: (1) The leader in charge of medications should have another leader check the medication envelopes as they are being distributed to the participants.

(2) As soon as possible after dispensing a medication, the leader who dispensed the medication should sign the medication sheet.

General Medication Guidelines:

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1) One leader (assigned by the office) oversees the dispensing of medication.

This leader is responsible for ensuring that the correct participants receive the correct medications at the correct time. The leader in charge of medications does not necessarily have to give every medication.

2) If there is any question concerning medication, contact the Sprout office.

3) Creams, lotions and drops cannot be prepackaged but should be checked before dispensing in the same manner as oral medications. Have another leader check against the available paper work that you are applying the correct amount of cream to the correct body part or the correct number of drops to the correct orifice. All medications should be noted on the medication check sheets and leaders need to initial the medication check off sheet for any cream, lotion or drops they give.

4) Leaders should wear gloves whenever applying creams.

5) If during distribution the participant claims that he/she is being given the wrong pill, number of pills, or any other discrepancy; heed the claim and check your work. If after checking, you still have a question contact the Support phone.

6) Keep beverages in the cooler and paper cups in the van at all times. No matter where you are the participants should have something to wash their meds down with.

7) Before leaving your hotel for the day, remember to bring all necessary medications.

8) If you receive the medications in such a state that you have no idea what a medication is, under no circumstance administer that medication. Contact the Sprout office or support phone.

9) If you are asked to give medications or prepare medications for which you have no training, for example, giving suppositories, drawing up insulin for an injection or preparing a solution for a nebulizer, contact the Sprout office or the Support phone.

10) If you realize that you have given someone the wrong medication, not enough/too much medication, or completely missed a distribution cycle, you must contact the Support phone for further instructions. All three leaders on a

trip will be required to fill out a medication incident form regardless of who made the error.

11) Leaders should never give a medication that has not been prescribed by a doctor without seeking permission from the person on call via the support phone. This includes all over-the-counter medications such as Tylenol, Dramamine, Peptobismol, etc. If a participant requests a medication saying he or she has it at home, still contact the person on call via the Support Phone.

(See the information on non-medication pain relief methods in the General Health Issues section.)

12) All problems and difficulties relating to a participant’s medication should be noted on the participant evaluation form. In this way Sprout will be able to deal accordingly with the agency/guardian in the future.

5. MEDICAL EMERGENCIES A leader’s primary responsibility is for the physical well-being of the group. Making sure that safety and health guidelines are followed and that group members develop an attitude of respect for these guidelines is by far the best way to approach this responsibility. Accidents and illnesses do occur. Leaders need to do what they can to prevent them, but must also be prepared to react immediately and effectively should they occur. Secondarily, with accidents or illnesses, leaders must complete the accompanying paperwork that documents the accident/illness and treatments given in order that Sprout may have a complete picture to provide to any party in need of this information. During a medical emergency, leaders should make all attempts to record pertinent information, i.e., name and phone number of attending physicians, witnesses, etc. a) Accident Resulting in Injury In the event of an accident it is imperative that you remain calm, trust your common sense and first aid knowledge, and act quickly. Your main concerns should be: a) Preventing further damage to the victim or anyone else. b) Getting necessary medical help c) Informing Sprout that an accident has occurred d) Completing the necessary paperwork.

For further information, see the First Aid Instruction in the section entitled General Health Issues Relating to Sprout Trips. b) Illnesses It is not uncommon for a participant to become ill to some degree during the course of a trip. New eating habits can lend themselves to a variety of intestinal disorders.

Experiencing new places and new people can put one’s physical system to the test. As the leader it is your responsibility to monitor the health of your group. Many illnesses can be prevented, but if they occur it is your responsibility to provide or obtain treatment.

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Use your common sense as well as the ill participant’s desires to determine whether or not a doctor should be seen. Use the support phone to update Sprout’s Leadership Department and to discuss how to proceed. When in doubt about the severity of an illness, it is best to err on the side of safety and get the participant checked by a doctor.

Any persistent illness should be checked by a doctor.

It is essential that you be aware of any special medical considerations of your group members (epilepsy, diabetes, allergies, etc.). It is also essential to be aware of any medications being taken by group members. This information is on the participant’s health forms and should be brought to the hospital/clinic if a doctor’s visit is necessary. c) Accident/Illness Report The Accident/Illness Report is a critical element in the handling of any accident or illness.

It is our official record of what transpired. It is essential that this form be filled out by the leader for any injury or illness whether or not a doctor was seen.

6. SPECIAL CONCERNS

WHEN

WORKING ELDERLY PARTICIPANTS

Each year Sprout serves an increasing number of elderly participants. Due to the effects of aging, these participants demand special consideration and attention.

a) Picking up the group Leaders should check that elderly participant’s who need them have the following; dentures with proper cleaning and adhesive supplies, hearing aids with spare batteries, glasses and incontinence devices.

Leaders should inquire about the participants level of mobility as well as any other special needs they may have such as dietary needs, hygiene needs, physical restrictions, etc. b) Activity planning When planning activities it should be considered that elderly participants may not be able to keep pace with the young and may have difficulty doing activities that demand excessive walking, standing, or any other physical activity. Accessibility is of the utmost importance; avoid high inclines (upper level theaters, stadiums, loading planks on boats),

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extensive walking, or exceptionally long waits. Planning activities requires special consideration when dealing with elderly participants, and becomes extremely difficult when dealing with a group with mixed ages. Splitting the group is one solution. (See the Group Travel section Part D 4 regarding group splitting.)

Elderly participants may also have different interests that should be considered when planning activities. Activities that may cater to the interests of an elderly group and allow for their slower pace may include plays, light theater, big band music, shopping in an airconditioned mall or a scenic drive or train ride.

Extra time is necessary for almost all activities when dealing with elderly participants.

Mornings require more than the usual amount of work, and the day’s activities should be planned accordingly. A large amount of time should be allocated between activities in order to allow for longer than average travel periods. c) Sensory Deficits

Poor sight and hearing are common among the elderly population. Participants with sensory deficits present leaders with many safety concerns. Leaders need to be very aware of the physical environment when dealing with people with sensory deficits.

Crossing or walking near roads or in parking lots can be dangerous for people with hearing or vision loss. Uneven surfaces such as grass, gutters or even rugs in hotel rooms can make walking difficult for people with vision loss. Hotel rooms should be made safe by removing throw rugs and other obstacles or impediments. Be aware of those participants who have hearing loss and make sure they hear and understand all safety instructions. d) Mobility Concerns Elderly people are prone to falls due to sensory loss and decreased coordination.

Healing time is greatly lengthened in the elderly so falls can be particularly devastating.

The first priority when dealing with an elderly person’s mobility is fall prevention.

All vans will be equipped with footstools which assist in entering and exiting. It is absolutely imperative to exercise caution with the elderly while loading and unloading the vans. It is necessary to secure the footstool on steady terrain, keeping one foot on the stool to insure balance. It is necessary to have two leaders present and attentive when loading and unloading elderly participants. The third leader should be with the participants after they leave the van and ensure they are safe. It is common that elderly people may become dizzy when moving from a sitting to a standing position. Front seats should be reserved for the elderly.

Both trains and boats present the elderly with a moving surface to walk on. Elderly participants should remain seated at all times when on boats or trains unless accompanied by a leader.

When checking into a hotel, the rooms on the ground floor should be occupied by the elderly participants whenever possible. Elderly participants should be given extra attention whenever they are walking up or down steps, stepping over gutters or other obstructions and when sitting down or getting up from tables at a restaurant.

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Extra attention should be given to the elderlywhile showering or bathing. The leader should assist with the entering and exiting of the tub or shower. Place a non-slip mat on the shower floor if one is available. Use bath mats to ensure the participants have a dry, non-slipperyfloor to step out of the bath on to. Give the elderly participants assistance with dressing if needed. e) Dietary Needs It is common for elderly participants to use dentures. It is important to check that the participants have their dentures with proper cleaning and adhesive supplies when picking up the group. Check that the participants are wearing their dentures when going out for meals. Participants who wear dentures may need to be encouraged to eat softer foods.

Always be aware of the participant’s dietary restrictions. f) Hygiene Needs It is common for the elderly to suffer from incontinence. Many elderly participants will use some form of incontinence pads or underwear. Check that the participants who use incontinence pads have a sufficient supply when you are picking them up.

When leaving for an activity on any given day, an extra set of clothing is recommended for those with incontinence. Participants who wear incontinence devices should be checked regularly and assisted if necessary by leaders to change into dry, clean pads or underwear.

Proximity to bathrooms should be taken into consideration when planning activities. Long van rides should be punctuated by frequent bathroom stops. g) Medical Concerns Symptoms that may not seem serious in the young can be signs of a problem in the elderly. The elderly are more susceptible to infection, so cuts and scrapes should be tended to and watched. Shortness of breath is a prominent sign of a heart attack; in the elderly it arises more than chest pain. Confusion is also a sign of heart trouble.

Excessive sweating, nausea, and dizziness can have more severe connotations for the elderly. Vomiting and diarrhea can lead more quickly to dehydration in the elderly. If a participant is displaying any of these symptoms, a call to the support phone should be made, and a trip to a local hospital may be necessary.

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7. SWIMMING POLICY Pools, lakes, and beaches are very dangerous environments. Because sitting by the pool-side is equated with relaxation and swimming is considered such a fun and playful activity, it is all too easy to forget the inherent danger.

Remember: Water can Kill!! Therefore the strict adherence to the following swimming policies are mandatory for the safety of our participants: A: NO LIFEGUARD PRESENT: Participants may go into water that is no more than waist deep. AT A POOL (no waves, clear water), participants may swim in waist-deep water. IN OCEANS AND LAKES (waves, murky water) participants are restricted to wading in only to the level of their hips. THERE MUST BE TWO LEADERS PRESENT, one of which must be in the water with them at all times, the other must be watching those participants not swimming but in the general area. The leader in the water should position him/herself at the deepest point that participants may swim to.

B: LIFEGUARD PRESENT: Participants may swim according to their abilities.

TWO LEADERS MUST BE PRESENT, one of which must be in the water at all times, the other must be watching those participants not swimming but in the general area. In addition, the leaders must notify the lifeguard that the group is disabled and should also point out to the lifeguard exactly which participants will be in the water.

If the choice is available, always opt for the swimming location with a lifeguard.

8. INSURANCE COVERAGE Insurance coverage is vital to any recreation program. This coverage is held by the organization and its trip participants for financial protection in the event of an accident, illness, and/or liability. You need to be familiar with the accident and illness coverage for the trip participants and the leaders, and with the liability insurance for leaders. a) Accident Coverage for Trip Participants Every Sprout participant has accident coverage. This is for accidents only. Sickness and transportation are not covered. Coverage is subject to the following limitations: $500.00 medical expenses due to an accident, including $100.00 dental expenses due to an accident to sound teeth.

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b) Leader’s Accident/Illness Insurance Coverage Injured or sick leaders are covered by Workers’ Compensation. In order to insure coverage, Sprout needs to file a claim with the Workers’ Compensation Board within 10 days of the incident. Follow the following procedure any time you become sick or injured while on a trip: 1. Call the support phone. Be prepared to give details on the accident/illness (time, date, how it happened, etc.) and the name, address, and phone number of doctor or hospital visited if you needed to receive medical attention.

2. When you receive medical attention, tell the attending physician that you are covered

by Workers’ Compensation.

3. Get receipts for any money you spend.

4. Complete an Accident/Illness Report on yourself and return it to the Director of Leadership at the end of your trip. c) Liability and Liability Insurance Liability is based on the principle of negligence. Negligence is the failure to act as a reasonably prudent person would act under the circumstances. Negligence is conduct which falls below the standards established by law for the protection of others against unreasonable risks. If one is aware of hazards and makes an effort to avoid them, liability is minimized.

You, as a leader with Sprout, are covered by our liability policy. All leaders are protected against liability lawsuits which may be fixed against them. Be aware that our liability insurance will not protect you if you are engaging in any illegal activity or are breaking any specific Sprout policies while on a trip.

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C. SUPPORT PHONE Sprout provides a year-round, 24-hour support line for all our trips. We are available to assist you in handling difficulties that may arise.

The toll-free Support Phone numbers are:

1.) 888-222-9769 2.) 888-400-5542

Please Note: Most phones will accept these toll-free numbers. Some phones will accept only the 800 number, and others will accept neither. If one number does not work, try the other.

If you can not access the toll free numbers, Call COLLECT: 212-222-9769 The support phone should be used for: 1.) Emergency situations: i.e., accidents, illnesses, lost participant.

2.) Problems with a particular participant: uncontrollable or abusive behavior, an outsider’s view of an approach you are taking or plan to take.

3.) Personal problems: co-leading problems, leadership advice, etc.

4.) If a leader is running late for any Sprout activity.

5.) All medication concerns and problems.

6.) Problems at pick up or drop off points, for example, a participant not showing up for an extended trip.

7.) Problems with hotel bookings for example, not enough beds for the participants or leaders.

The support phone is an emergency line to be used only by leaders on trips.

Do not give the support number to friends, parents or any relative/guardian/counselor of the participants. Do not give them any number other than the main Sprout number, 212-222-9575.

SUPPORT PHONE PROCEDURE: 1.) During business hours (Monday - Friday, 10:00 am - 6:00 pm) a Sprout staff person will answer the phone.

2.) During non-business hours (6:00 pm - 10:00 am, Monday - Friday and all day Saturday, Sunday, and holidays), the emergency phone numbers will be forwarded to staff cell phones.

3.) If you reach a cell phone voicemail, leave a detailed message including your name, trip location, phone number (and hotel room number) where you can be reached, and a very brief description of why you are calling.

4.) If you need to speak with someone immediately and only reached voicemail on the first Support Phone number, try the second and then third Support numbers (listed above) If the support system is busy or you can’t get through for some reason within a reasonable amount of time and the problem is pressing, refer to the emergency numbers for Sprout staff located in your leader’s notebook.

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D. TRIP LOGISTICS

1. PICK-UP AND DROP-OFF PROCEDURES

Sprout organizes vacations for two different types of groups. The vacations advertised in the Sprout brochure are open to participants signing up individually. Sprout also organizes trips for agencies as part of the Custom Trip Program. These custom trips are for members of the contracted agency and are not open for participants signing up individually.

For vacations working with individual participants, normally a single meeting place will be designated by the trip planner, usually the New York International Hostel where the Sprout office is located. It is important to get to the meeting point early as many participants come on their own and arrive before the designated time.

For agency vacations, pick up will be at the residence, institution or other designated location. If you are running late, check in with the support phone staff so that the information may be relayed to waiting participants.

A leader will meet the guardian/counselor of each participant being dropped off at the meeting location. Leaders should seek information about the following: a) Spending money: How much each day? Can the participant hold his own money? b) Rooming requests: Does the participant have any preference for rooming? c) Problems and special needs: Is there anything we should be aware of?

Ask if the participant has any problem behaviors and ways to avoid them?

Does the participant have any special way of doing things, such as taking medications? d) Information regarding the drop off location and time will be given to the guardian/counselor.

Leaders should not accept checks as payment for the trip at the pick up location. Please have the counselor or guardian mail payment to the office.

The van will be used as the official check-in point. When the participant arrives he/she should board immediately and his/her name should be checked off the attendance list which should be located at the entrance of the van. The attendance list will bear the name of each participant and the name and relationship of each person scheduled to pick them up.

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When dropping participants off at the end of a trip, plan your return trip to arrive at the drop off point at the set time. Again, if you are running late, call the support phone. There should be no reason for a drop off earlier than that planned for the trip. While it is important to make certain considerations for traffic, it is more important not to cut the vacation short. If a leader feels there is a legitimate reason for dropping the group off earlier than planned they must first obtain approval from support phone staff.

At the drop off location no

participant should leave the

group until the person picking him up arrives.

The participant will then be presented to their guardian/counselor and their name checked off the attendance list.

Left over medication, spending money and baggage will be returned at this time.

The leader who is presenting the participant must record the name of the agency staff person doing the pick-up. If a leader has any question as to the legitimacy of the person doing the pick-up, identification should be asked for. If the person picking up a participant does not present proper identification or is not the same person agreed upon at the meeting location the Sprout office or support system must be notified. In this case, approval must be received from the Sprout office staff before discharging the participant.

2. ACTIVITY PLANNING All leaders on a trip are responsible for gathering information and planning daily activities. It is important to get to work on this immediately as it will be an important part of the participant’s appreciation of the trip. Included in each leader’s information packet on every trip will be a few “must do” activities along with a suggested list of activities and attractions in the area. Some will be tried and true by previous groups, others will be new and untested. In addition to this list, leaders are encouraged to seek out other new activities in the area, taking advantage of whatever local information and materials may be available (i.e., local newspapers, tourist guides, hotel staff, chambers of commerce, etc.).

Phone calls to prospective activities should be made to gather information such as: the availability of the activity, the cost, the need for reservations, and to request special discounts. Considerations for planning any activity include: the energy level/physical limitations of the participants, the weather outlook, the expense, age-appropriateness, the amount of time required to engage in activity as well as how meals may be worked in or around the activity.

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3. CHECK-IN CALLS

Check-in calls are made by the leaders to let the office know how the trip is going for the participants and leaders. Check-in calls should be made every third day to the office during normal business hours (10 am - 6 pm M-F). If the third day is a Saturday, call on Friday, if it is a Sunday, call on Monday.

Check-in calls should be made to the office on the toll-free number 888-222-9575.

4. GROUP TRAVEL

Enthralled by a trip’s many interesting distractions, participants can possibly wander away from the group. There are certain precautions that can be taken to prevent people from getting lost, as well as procedures to assist them in “getting found” should they become separated.

Prior to entering a crowded and potentially confusing situation such as a bustling town, amusement park or fair, distribute the Sprout participant identification cards to each participant. Explain to each participant that if he is separated from the group he should present himself to a person working at the site and show the card. When on the grounds, the leaders should pick out a high-visibility landmark that should be designated as a place to meet should anyone get separated from the group.

Dividing the group up into subgroups, with a leader assigned to each group, will ease travel through crowded areas. The leaders should agree on a meeting time and place for the sub groups to regroup.

If you realize a participant is missing; remain calm. Figure out exactly who is missing. Is he the only one? When and where were they seen last?

Keep the group together. Do not send other participants to look for the lost participant. If a leader can be freed, have him or her do a search of the area. Decide on a specific time and place for the leader who is searching to reunite with the group and co-leaders. The next step should be to notify security at the site. At this point the support phone should be called.

5. HOTEL PROCEDURES

Prior to checking-in to the hotel, one leader should be designated as the main liaison to deal with the hotel management. The liaison should be responsible for check-in, checkout, taking care of financial dealings with the hotel, telling the hotel to turn all participants’

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phones off except for making room-to room-calls, as well as notifying the management as to any problems with the accommodations. Ideally, during check-in, two sets of keys should be obtained for each room, one for the participants to hold, and one for the leaders to hold onto.

Room assignments are either predetermined by the agency, or the leader can ask the participants who they would like to room with. Each participant must have his/her own bed. Only participants of the same sex should room together unless an agency has given their permission for a mixed rooming assignment. Once room assignments have been made, the leaders should assign themselves specific participants’ rooms to be responsible for the following items: 1) Removing all matches distributed by the cleaning staff on a daily basis 2) Helping the participants settle-in, including: a) Overseeing participants in the unpacking of their suitcases and the placing of clothing in drawers and on hangers. b) Demonstrating how to operate sinks, showers, TV, locks, windows, etc.

3) Overseeing hygiene needs and initialing items on hygiene checklist.

4) Showing participants where the leaders’ room is located.

If there is a swimming pool at the hotel, the leaders must make it crystal clear that participants are only allowed to go to the pool with two leaders at prearranged times.

If there is a coffee shop, restaurant, game room, etc. at the hotel, the leaders may show participants how to get to these locations if they feel comfortable with the participant’s level of navigational skills.

All participants should be advised that smoking in the rooms is not allowed on Sprout trips.

6. RESTAURANTS & CLUBS

A leader should always check out a club or restaurant before a decision is made to bring in a group. The leader should be looking at the appropriateness of the establishment, the menu, the price, and to determine whether or not the atmosphere is suitable. If it is appropriate, a leader should let the club or restaurant know that a group of people with disabilities is coming so that they may prepare.

Participants should be encouraged to order from the menu themselves, however help is usually needed. Participants must also be made aware of the budgetary limitations if they are to order from the menu themselves.

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7. TRANSPORTATION PROCEDURES a) Van Transportation Leaders are responsible for the safe and legal operation of any van used on a Sprout trip. This includes maintaining safe and legal road speeds, and performing safe and legal road maneuvers.

Passengers in the front seats must wear safety belts while the van is in motion.

Leaders that speed, drive recklessly or show disregard for the laws of the road will be assigned to future trips as non-drivers.

If an accident of any size occurs, leaders must notify the office via the Support Phone as soon as possible. In addition a police report should be obtained if at all possible.

POLICY REGARDING TICKETS: Drivers of the van are solely responsible for any and all parking tickets or moving violations. The office must be notified of any parking tickets or moving violation tickets that are received during the trip. It is a myth that out-of-state parking tickets are not valid - all parking tickets eventually make their way back to the office.

Any unpaid parking tickets that come back to the Sprout office will be charged to all three leaders of the particular trip on which the ticket was given. The fine including any and all additional late fees or penalties, will be split equally among the three leaders, regardless of who actually parked the van illegally.

Vans may not be parked in handicapped zones, however if there are participants that have physical limitations leaders may elect to use these zones for the loading and unloading of passengers.

Smoking in the van is prohibited for both leaders and participants.

When loading and unloading passengers from the van, leaders should be there to help the participants. The step stools should also be used to ease entry and exit of the vans.

Leaders should be aware that breaks need to be taken frequently during a drive for the participants to use the bathroom, stretch their legs, smoke cigarettes and have a drink or snack.

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Leaders are also responsible for maintaining the cleanliness of the vans. Garbage bags are included in each pre-trip briefing packet. As the vans will most likely be sent out on another trip the day after they are returned, it is important that garbage in the van be removed at the end of each trip.

Depending on the length of the trip and the number of participants, the van may be equipped with accessory luggage carriers. Leaders should be sure they understand the workings of the particular unit supplied to them before leaving on the trip. In general, be sure to frequently check any straps, connections and securing devices, especially during the first and last days of the trip when the carriers will be loaded with luggage. Storing luggage outside the van creates a more comfortable environment inside the van for the participants. If an accessory luggage carrier is supplied leaders must use it to stow as much of the luggage as possible.

b) Air Travel When air transportation is to be used, it is helpful to separate the group from the general mayhem of the terminal. Airports are very busy and it is important to keep close tabs on the whereabouts of everyone in the group. Find a spot where the group can gather their luggage and bags. Separate baggage to be checked from carry on bags. The use of colored ribbon, or colored tape attached to participants’ baggage will make identification easier at the baggage claim area. Only one or two leaders should be sent to take care of luggage check in and the securing of boarding passes. Leaders should hold on to all airline paperwork; participants should not be given their own tickets to hold. The remaining leaders can supervise the waiting group.

If it has not been previously arranged that the group be seated together, the leaders should work with either the people at the check-in counter or the flight attendants in order to get the group together. If it is impossible to be seated as a group, the leaders should be sure to intersperse themselves amongst the participants to be able to give support in the case that any participants become frightened or nervous during the flight.

On the return journey leaders should not make plans based on the arrival time of the flight, as with all Sprout trips, the trips is not over until all of the participants have been picked up. At times for various reasons this may add an extra hour or two at the airport.

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c) Cruises As with trips that stay in hotels, the leaders are responsible for helping the participants settle into their rooms and to help them get a feel for the whereabouts of dining rooms, recreation rooms, etc. The layout of cruise ships makes for a maze-like arrangement of the rooms and hallways and leaders may find it necessary to escort participants to and from their rooms.

Cruise ships are famous for the amounts of food they serve, usually boasting upwards of four meals a day. For this reason, many participants must be watched and counseled as to the consumption of appropriate amounts of food. Leaders may need to set certain limits for participants who have trouble dealing with the amount of food offered.

It must be stressed to participants that they are not to use the pool except in the presence and awareness of two leaders.

Sun protection and guarding from heat exhaustion are two key tasks that require full attention of the leaders. Leaders are responsible for making sure that sunscreen has been applied to each participant and that each participant drinks a sufficient amount of water each day.

E. FINANCES The accurate and economic management of the funds given to each trip is of paramount importance to the successful running of the trip.

At the beginning of each trip, one co-leader will be selected by the office to handle the group finances. The budget is based on a specific allotment for meals, entertainment, transportation and at times, money for a specific, pre-scheduled activity. The total sum, usually given in traveler’s checks along with some cash, can be considerable. It is vitally important that these funds be kept safe and that proper records be kept. Your leader’s notebook contains several forms which will help you keep track of the group’s funds. List all the traveler’s checks you have received and keep a running record of the checks you’ve cashed. This information is vital should your traveler’s checks become lost or stolen. If traveler’s checks are lost or stolen, notify the Sprout office immediately, and follow the instructions provided in your leader’s notebook to report the missing checks to American Express.

The leader in charge of the budget should keep the other leaders up to date regarding the group’s budget.

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1. MANAGING

FUNDS

At first sight, it may seem that the amount of money budgeted per person for each meal will leave people hungry. Don’t despair - nobody goes hungry on a Sprout trip and nearly every trip returns with a fair amount of money. To run a successful trip from an economic point of view, you should keep the following points in mind: a) Ask for discounts Most restaurants and attractions will extend a discount when asked. Generally, you will need to appeal to the manager of the business.

Asking for a discount can be done when you call for reservations or when you arrive at a prospective restaurant or activity. Prearranging a discount is usually more effective but is not necessarily always practical in terms of time/spontaneity.

Present to the manager that you are with a group of adults with developmental disabilities traveling with Sprout, a nonprofit organization, on a tight budget and that a discount would greatly help the participants enjoy their time on vacation.

You may also want to tell the manager that Sprout sends other groups to the area and a discount would encourage future groups to patronize the establishment.

Whether the discount is small or large, it is very important to make a note of the discount, the name of the establishment and the name of the manager in your leader’s notebook so that the office can thank them and the information may be passed on to future Sprout groups who are visiting the area. b) Tax-exemption Sprout is a tax-exempt organization in New York State. Any trip that will be staying in New York State will be given plenty of taxexempt forms which should be used everywhere the group is spending money. As long as you are in New York State and are presenting a tax-exempt form, no business may refuse to honor our tax-exempt status.

Also mentioning that Sprout is tax-exempt in other states can sometimes encourage a business owner or manager to give the group a discount.

c) Creative money saving During a trip you will have many opportunities, especially for meals, to save money.

Going out for pizza one night, or having a pizza party at your hotel can save the group a lot of money. Taking a break from eating at restaurants from time to time can make for a nice change and a well-planned picnic or barbeque lunch or dinner can come out to be far cheaper than sitting down at a restaurant. Please remember to share any ideas you have regarding money-saving tips with the Sprout office so that we may share them with 30 future groups.

2. APPROPRIATE

USES OF

SPROUT FUNDS.

The money given to the group is to be used solely for the running of the trip. Although the budget is presented in the form of X amount for meals, X amount for activities, X amount for transportation, do keep in mind that the actual spending of the money is somewhat flexible. Snack or drink breaks, buying postcards to be used as an activity, replacing first aid items and buying a kite for the group to use on the beach are all acceptable ways to use funds.

Funds should not be used to purchase souvenirs for the group. Participants should have their own spending money for such expenditures.

Likewise, groups funds are not to be used for Leader’s personal needs. Toiletries, cigarettes, and other personal items are solely the responsibility of the leaders to purchase for themselves.

If you must spend group funds to purchase, for example, spare underwear for a participant who has soiled him/herself, or medications or toiletries that were not sent with the participant, be sure to notify the Leadership Department. Keep an accurate record with receipts as Sprout will seek these funds for reimbursement from the participant’s agency.

If you have any questions about the appropriate use of funds while on a trip, please contact the office.

3. RECORD

KEEPING

In the leader’s notebook you will find appropriate sections to: keep a record of all traveler’s checks, expenditures, each day’s total, and a calculator to figure the final total expenses and the amount of funds to return to Sprout.

You must obtain and return receipts for each purchase you make with group funds. This includes all tolls, meals, activities, gas and miscellaneous expenditures.

F. SAFETY 1. GENERAL POLICY Sprout has an obligation to minimize the risk factor in the activities we sponsor. Since travel with people with developmental disabilities contains inherent risks, our task as an organization and yours, as our designated representative, is to: — Be aware of the risks involved in the activities you participate in.

— Be knowledgeable of the safety procedures needed to minimize these risks.

— Transfer this awareness and knowledge to participants.

— Make certain these procedures are followed.

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2. SPECIFIC POLICIES Van safety: The driver and the front passenger must wear seat belts. Seat belts are available for the other passengers, however it is not required that they use them. Be extra careful when closing the doors of the van. Check that none of the participants are in a precarious position. It is highly recommended that those in the first bench wear seat belts, as well as all the frail and elderly participants. (See Section D. 7. a) Van Transportation - for safety information relating to the driving of a van.)

Clothing: Often participants are unfamiliar with suitable clothing for specific activities, weather conditions and also the newness of living out of a suitcase. Personal preferences will vary, however, the underlying principles and the relevance to health and safety and appropriateness may need to be explained.

Beach: Follow the specific swimming policies outlined in this manual (see section B-7).

The group should have its own supply of sunscreen and use it frequently. Many participants have a tendency to burn, use every precaution - sunscreen, beach umbrellas and proper clothing. Also check each participant for reaction to the sun relating to their medication.

New activities: Participants, due to their disability, naturally have difficulty with new activities. Give the guidance that is needed to participate safely. Check with the Sprout office staff if you have any questions relating to a specific activity.

Nutrition: It is the leaders’ responsibility to insure that participants consider basic nutritional requirements in the ordering of food. Participants should be encouraged to partake of a well rounded, balanced diet as opposed to seven consecutive meals of cheeseburgers. While you shouldn’t “force” participants, you can make other suggestions and point out certain nutritional guidelines that need to be followed for the prevention of illness.

Rest/fatigue: Fatigue can play a major role in the onset of illness. It is your responsibility to monitor your group for fatigue. Participants will vary in their physical condition and need for rest.

Again, a leader can’t force people to sleep but you can point out the necessity for rest and allocate rest times if fatigue levels warrant such measures.

Also plan activities accordingly.

Cleanliness: Leaders need to be concerned with establishing and overseeing basic guidelines for cleanliness in relation to the health of our participants.

G. FIRST AID First aid is defined as “the immediate care given to victims of injuries or sudden illness”.

It involves physical conditions, emotional states and the whole accident situation. It is important to remember that as a leader you are responsible not only to the primary victim but to the other group members as well.

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1. EMERGENCY REQUIRING URGENT CARE. In the event of a serious accident or emergency remain calm, trust your common sense and first aid knowledge, and follow the procedural steps outlined in the “medical emergency” section of this manual.

For less serious illness or injury, simply utilize your basic first aid skills and obtain help if the situation requires additional attention. Leaders should become familiar with the basic principles in emergency care as described below. This is a rough outline only. Do not treat it as a detailed guideline.

1) Do not move the victim. In an emergency requiring urgent care, do not move the victim unless there is immediate danger in the environment, and you cannot alter things to make it safe. If there is danger, get the victim and yourself to a safe place before you do anything else.

2) Find out if the person is conscious. Ask them, “Are you OK?” Check for breathing and heartbeat. Clear the airway, keep it open, and attempt to restore breathing only if you know how and if you have a resuscitation mask. If a participant’s heart or breathing has stopped and you do not know how to resuscitate him seek medical help immediately.

3) If the person is unconscious, roll him on to his left side into the recovery position. This will keep the airway open.

4) Help prevent shock. Have the victim lie down, while you maintain their normal body temperature. If it is hot, provide shade; if it is cold, provide protection from cold both under and over the victim.

5) Seek medical help. Do not leave the victim alone, have someone stay with him while others go for help.

6) Be supportive. Remain as calm and relaxed as possible. Be gentle and reassuring while fulfilling the above steps. Remember that this is an injured human being who needs to be tended to emotionally as well as physically.

7) Follow universal precautions. Many diseases can be transmitted by human body fluids. When dealing with someone who is injured, wear gloves and do not allow body fluids to come in contact with your skin or mucous membranes.

After dealing with the injured person, whether it is taking the person to a hospital or administering first aid yourself, contact Sprout’s Support Line. Be sure to contact our office before contacting parents or counselors. When the office is reached, we will decide on who should contact the participant’s contact person.

In addition, if there is ever any question about handling a particular emergency, consult the person on call on the support phone.

Complete the Accident/Illness Report, which is included in your trip packet, and return it to the program director at the end of the trip.

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2. EPILEPSY, SEIZURES. Epilepsy is a physical condition caused by sudden brief changes in how the brain works.

When brain cells are not working properly, a person’s consciousness, movements or actions may be changed for a short time. These physical changes are called epileptic seizures. Epilepsy is sometimes called a seizure disorder. It affects people in all nations and of all races.

There is no single thing that triggers a seizure, but it is common for people with epilepsy to have an “aura” prior to a seizure. Auras are a wide variety of feelings or impulses that tell a person with epilepsy that they are about to have a seizure. Aura’s are different for each person, but each person usually experiences their own unique aura. For example a person may always smell a certain smell prior to a seizure. If a participant tells a leader they are about to have a seizure the leader should take them seriously and have them lie down and follow the procedure outlined below.

If a participant has a series of seizures they, should be seen by a doctor. This could be an indication of a low drug level or a more serious neurological problem. If you have any concerns regarding a participant who is having a seizure, contact the Sprout office or the person on call via the support phone.

First aid for epilepsy is very simple: Keep the person safe until the seizure stops naturally by itself. These are the key things to remember: 1. Clear the area around the person of anything hard or sharp.

2. Loosen ties or anything around the neck that may make breathing difficult.

3. Put something flat and soft, like a folded jacket, under the head.

4. Don’t hold the person down or try to stop their movements. Do not try to force his mouth open with any hard implement or with fingers. It is not true that a person having a seizure can swallow his tongue. Efforts to hold the tongue down can injure teeth or jaw.

5. Don’t attempt artificial respiration. In the unlikely event that a person does not start breathing again after the seizure has stopped, call 911 immediately.

6. Stay with the person until the seizure ends naturally.

7. Keep calm and reassure other people who may be nearby.

8. After the seizure is over turn the person gently onto their left side. This will help keep the airway clear. (See the section on first aid for information regarding placing a person in the recovery position.)

9. Be friendly and reassuring as consciousness returns.

10. Have the person rest for a while as the person is usually in a state of confusion.

11. If a participant has a continuous series of seizures they will need medical assistance. If possible take the participant to an emergency room or call 911.

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3. DIABETES

Diabetes mellitus is a common disorder that effects a large number of people. It is a condition where the body has problems producing insulin and loses its ability to control the level of sugar in the blood. This is a serious condition that if poorly controlled or neglected can lead to blindness, kidney failure, liver failure, shock and death. Fortunately it is easily controlled and most people require very little medical attention for this condition.

Many participants on Sprout trips will be diagnosed as having diabetes mellitus.

There are two different types of diabetes, adult onset diabetes and juvenile onset diabetes. Juvenile onset diabetes, as suggested by the name, develops during the teenage years and is controlled by regular insulin injections. No Sprout leader who is untrained in the procedure would be required to administer or supervise an injection of any type. It may be necessary for a leader to remind a participant that it is time for their insulin. It is important that the participants receive their insulin at the prescribed time. Insulin normally needs to be refrigerated or kept cool, you should check with the person dropping off the participant. If you have any concerns about a participant using insulin or you are asked to assist the participant in any way with the administration of insulin contact the Sprout staff on call via the support phone.

Adult onset diabetes is more common and is easily controlled by either diet restrictions, oral medications or a combination of the two.

Generally participants will be taking Oral Hypoglycemic medications which control the blood sugar level. It is important that the participants receive these medications. Usually these are given half an hour before meals which will be indicated by the medication information that is given out on each trip. Medications are usually used in conjunction with dietary controls. People who are diabetic should be encouraged to limit their sugar intake. This is a tough thing to do on a Sprout trip, but many participants who are diabetic will understand what limits they should place on themselves. “Limiting sugar” does not mean “no sugar” and generally it won’t harm the participants if they occasionally have a sweet. If you know a participant is diabetic and is taking no notice of their dietary constraints and are consuming excessive sugar try to gauge how much they understand about diabetes and their condition. If they understand and are just acting inappropriately, try to reason with them. If you are having major problems getting them to control their diet contact the office or the Sprout staff on call via the support phone for further advice.

People who suffer from diabetes may occasionally suffer from a raised blood sugar level, Hyperglycemia, or from a low blood sugar level, Hypoglycemia. With both conditions a participant will exhibit signs and symptoms such as lethargy, tiredness, weakness, a rapid pulse, and in the late stages, confusion and unconsciousness. Both hyperglycemia and hypoglycemia should be treated in the same manner. Have the participant rest and give him or her a very sweet drink. After this you should take the participant to a hospital or to a medical practitioner for a check up. Contact the office or the support phone if you have any queries or problems.

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A common problem affecting people who suffer from diabetes is the development of leg and foot ulcers. These can start from small cuts to their feet or from blisters from poor fitting shoes. Participants with diabetes should wear shoes at all times. You should check to see if the participant you are responsible for knows about foot care. If they do not seem to have much knowledge about foot care you should try to check their feet once a day looking for small cuts or blisters. Dress the cuts or blisters as you normally would. If you notice that these cuts are increasing or not healing take the participant to a medical practitioner. Let the participant’s agency or guardian know about these cuts or blisters when you drop the group off.

4. POSSIBLE HEALTH PROBLEMS CAUSED

BY

HEAT

The majority of Sprout trips occur during the heat of summer. All leaders need to be aware of possible complications related to heat that should be avoided. Common problems related to heat include heat cramps, heat exhaustion and heat stroke.

Heat Cramps, the least severe condition, are painful muscle spasms, usually in the legs and abdomen. Have the person relax in a cool place, give lots of fluids and rest. Lightly stretch or massage muscles involved.

Heat Exhaustion, is a more severe condition which can include cool, moist, pale or flushed skin, headache, nausea, dizziness, weakness and exhaustion. Get the person to a cool place, loosen any tight clothing, and apply a wet cloth (wet with water at room temperature not cold water) to forehead, neck, and underarms. If the person is conscious give water at room temperature (not cold) to drink (slowly about 1 glass every 15 minutes). Let the person rest in a comfortable position, he/she should not resume normal activities this day.

Heat Stroke the most severe condition, occurs when the body is overwhelmed by heat and stops functioning. Signals include hot, red, dry skin, changes in consciousness, rapid weak pulse, shallow breathing. Get the person to a cool place, loosen any tight clothing, and apply a wet cloth (with cool not cold water) to forehead, neck, and underarms. If the person is conscious give cool (not cold) water to drink (slowly - about 1 glass every 15 minutes). Let the person rest in a comfortable position, he/she should not resume normal activities this day. If the person refuses water, vomits or a change in consciousness occurs get the person to an EMERGENCY ROOM immediately. Keep him/her comfortable and sponge with warm water until medical assistance is available.

When there is excessive heat, pay extra attention to the participants for the above signals. To avoid these conditions, please make sure everyone has plenty of fluids to drink, and takes it easy in the heat. Try to do indoor air conditioned activities. Do not do any energetic outdoor activities. Do not plan to be outdoors for an extended (over 1 hour) amount of time. Everyone should wear hats with visors and sun block. Be aware of how the participants are dressed: clothing should be of a light fabric and a light color.

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5. DIETARY RESPONSES

TO

COMMON AILMENTS

The change in a participant’s diet on a Sprout trip can result in diarrhea or constipation.

Both conditions are uncomfortable and if they persist can have serious consequences for a person’s health. If a participant, particularly an elderly participant experiences diarrhea or constipation for longer than 2 days, leaders should contact the office or the person on call via the support phone as the participant may need to be seen by a doctor.

Most diarrhea and constipation can be cured by a change in dietary practices. Generally for diarrhea it is good to offer the participant low fibre foods such as white rice, white bread or spaghetti while avoiding salads and fruit. For constipation high fibre foods such as fruits, vegetables and cereals are good to eat, while rice and junk foods should be avoided. For all gastric complaints dairy products should be avoided. Fluid intake should be kept high for people with both diarrhea and constipation, water being the optimum choice.

6. ASTHMA

Asthma is a common condition effecting many people in the United States. Asthma is a condition which effects the bronchial tubes causing them to obstruct. It can be caused by physical activity, emotional excitement or it can occur spontaneously. A severe asthma attack can lead to unconsciousness and death.

Most asthma sufferers regularly use inhalants to reverse the effects of an asthma attack.

The participants may be supplied with an inhalant by their agencies or guardians as part of their medications. Most inhalants can also be used if a participant is having an asthma attack. Leaders should carry the inhalers with them at all times. Check that the participants know how to use their inhalers.

If a participant has an asthma attack, have them sit quietly in a well ventilated place. An asthma attack is a frightening experience for the asthma sufferer. Fear can exacerbate an asthma attack, so it is important to stay with the participant and reassure them that they are going to be alright. They should use the inhaler immediately. If there is no relief after 3-4 minutes they should use it again. If there is no relief after using the inhaler a third time, medical assistance should be sought immediately.

7. ALLERGIC

REACTIONS

Many Sprout participants may be allergic to certain foods or drugs - be sure to check each person’s medical record for specific allergies on the first day of the trip. Allergies to bee stings, milk, caffeine or types of material such as nylon are common but people can be allergic to just about anything. Leaders should make every effort possible to prevent the participant from coming in contact with their specific allergen.

Allergic reactions vary greatly in intensity from skin irritation and watering eyes to problems with breathing. If a participant does have an allergic reaction leaders should seek medical assistance and contact the person on call via the support phone.

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8. PAIN

RELIEF WITHOUT MEDICATION

The Sprout medication policy states that leaders should not give any medication that has not been prescribed by a doctor without seeking permission from the person on call via the support phone. This includes all over the counter medications such as Tylenol, Dramamine, Peptobismol, etc. If a participant requests a medication saying he/she has it at home, still contact the person on call via the Support Phone.

Most people can wait for Dramamine or Peptobismol, but someone in pain needs relief quickly. For headaches, relocate the person to an environment that is as free as possible of stimulation. Ideally have the participant lie down on their bed with their eyes closed. A wet cloth to the forehead can also offer some relief. Depending on the severity of the headache one leader should stay with the participant.

Muscular pain is best relieved by getting the participant in pain to stop using the effected muscles. Ask the participant to sit or lie down if possible. Warm cloths to the effected muscles can also offer relief.

9. UNIVERSAL PRECAUTIONS Occasionally a participant may be a hepatitis carrier or may possibly be infected with HIV. These are common diseases that anybody who works closely with people in the human services field should be aware of. HIV, Hepatitis and other diseases are spread via human body fluids. Health care professionals are using Universal Precautions to protect themselves and others from the spread of these diseases.

Universal Precautions involve the prevention of body fluids from any person, whether they are known to be infected or not, from coming in contact with your eyes, mouth, nose or cuts and breaks in the skin. For Sprout leaders, this means putting on a pair of gloves whenever dealing with a participant’s body fluids. Masks and safety glasses will not be necessary for the amount and the nature of the body fluids that Sprout leaders deal with. Preventing the participants from sharing personal items such as eating utensils, toothbrushes, razors, etc. is a good practice to follow.

It is important not to stigmatize participants who are known Hepatitis B or HIV carriers.

They can participate in all activities and should not be excluded from the group at any time. The key to universal precautions is that all people, including leaders and members of the public may be carriers and should be treated in the same manner.

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H. EVALUATIONS 1. PARTICIPANT

EVALUATION

Leaders’ evaluations of participants are extremely valuable in that they are used to give future leaders working with these participants a bit of advance understanding of the individuals. In addition, the information leaders supply is often used in considering whether or not participants with problem behaviors are suitable for future involvement with the program. In evaluating the participant there are several areas that will yield important information concerning the direction of the therapeutic recreation program.

These include attention span, the ability to interact, social and physical abilities, fine and large motor skills, reactions to stress, unusual behaviors, problem-solving abilities and relevant reinforcers.

Specific areas to observe relating to evaluations are the following: 1. Social skills: How the participant interacted with leaders, the other participants and outsiders.

2. Activity: The participant’s appreciation, understanding and participation in specific activities.

3. Mobility: The participant’s difficulty/ease with traveling in the van, walking, etc,.

4. Behavior: General demeanor and any positive or negative behaviors.

2. LEADERSHIP EVALUATION Leaders will also be asked to evaluate themselves and their co-leaders. These evaluations are valuable in order to assign balanced and compatible co-leading teams for future trips. To ensure confidentiality, evaluations will only be reviewed by members of the Leadership Department. All leaders will be invited to meet with a member of the Leadership Department to receive feedback and discuss their performance as a leader.

3. RESTAURANT, ACTIVITY AND ACCOMMODATION EVALUATION To help us plan better quality vacations Sprout also requests that leaders evaluate restaurants, activities and accommodations. For restaurants and activities, leaders should note the quality of the service, the cost, any discounts offered, address, phone numbers and appropriateness for future groups. Accommodations should be evaluated for their comfort, safety, management and proximity to various activities.

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H. EVALUATIONS 1. PARTICIPANT

EVALUATION

Leaders’ evaluations of participants are extremely valuable in that they are used to give future leaders working with these participants a bit of advance understanding of the individuals. In addition, the information leaders supply is often used in considering whether or not participants with problem behaviors are suitable for future involvement with the program. In evaluating the participant there are several areas that will yield important information concerning the direction of the therapeutic recreation program. These include attention span, the ability to interact, social and physical abilities, fine and large motor skills, reactions to stress, unusual behaviors, problem-solving abilities and relevant reinforcers.

Specific areas to observe relating to evaluations are the following: 1. Social skills: How the participant interacted with leaders, the other participants and outsiders.

2. Activity: The participant’s appreciation, understanding an participation in specific activities.

3. Mobility: The participant’s difficulty/ease with traveling in the van, walking, etc,.

4. Behavior: General demeanor and any positive or negative behaviors.

2. LEADERSHIP EVALUATION

Leaders will also be asked to evaluate themselves and their co-leaders. These evaluations are valuable in order to assign balanced and compatible co-leading teams for future trips. To ensure confidentiality, evaluations will only be reviewed by members of the Leadership Department. All leaders will be invited to meet with a member of the Leadership Department to receive feedback and discuss their performance as a leader.

3. RESTAURANT, ACTIVITY AND ACCOMMODATION EVALUATION

To help us plan better quality vacations Sprout also requests that leaders evaluate restaurants, activities and accommodations. For restaurants and activities, leaders should note the quality of the service, the cost, any discounts offered, address, phone numbers and appropriateness for future groups. Accommodations should be evaluated for their comfort, safety, management and proximity to various activities.

After all participants have been released to their specific drop-off people/care-takers, leaders are responsible for returning the various equipment and paperwork to the office.

I. PROCEDURES AFTER THE TRIP

After all participants have been released to their specific drop-off people/care-takers, leaders are responsible for returning the various equipment and paperwork to the office.

1. Return all Sprout equipment (cooler, games, luggage rack, road kit, first aid kit) to the office or other prearranged location as specified in the pre-trip briefing or as communicated to the group while on the road.

2. Information packets, including completed budget sheets, returning funds, any accident/illness reports, leader notebooks and trip evaluation forms must be returned to the office within one week of the trip’s end or prior to your next trip, whichever comes first.

3. Your stipend will be mailed to you after all information is reviewed.

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