TABLE OF CONTENTS

A. PHILOSOPHY AND OBJECTIVES1. HISTORY AND PHILOSOPHY............................................................ 32. GENERAL STATEMENT OF PURPOSE................................................ 33. PROGRAM OBJECTIVES................................................................. 3

a) safety............................................................................ 3b) enjoyment..................................................................... 3c) socialization.................................................................. 4d) living skills.................................................................... 4e) normalization................................................................ 5

4. LEADERSHIP PHILOSOPHY AND STYLE............................................ 5a) communicating meaningfully........................................ 5b) helping.......................................................................... 6c) calling things by their right names................................ 6d) your own feelings......................................................... 6e) decision making and choice......................................... 7f) co-leading..................................................................... 8g) principal leaders........................................................... 8

5. DEFINITIONS................................................................................. 9a) developmental disabilities ........................................... 9b) dual diagnosis.............................................................. 9

B. POLICIES AND PROCEDURES........................................................... 91. PRE-TRIP BRIEFING...................................................................... 92. CONDUCT.................................................................................... 10

a) participant conduct...................................................... 10b) leader’s conduct........................................................... 11

3. PARTICIPANT LEAVING TRIP............................................................ 114. MEDICATION..................................................................................125. MEDICAL EMERGENCIES.................................................................15

a) accident resulting in injury............................................ 15b) illness............................................................................15c) accident/illness report................................................... 16

6. SPECIAL CONCERNS WHEN WORKING WITH THE ELDERLY................. 167. SWIMMING POLICY.........................................................................198. INSURANCE COVERAGE..................................................................19

a) accident coverage for trip participants..........................19b) leader’s accident/illness insurance coverage............... 20c) liability and liability insurance........................................20

C. SUPPORT PHONE................................................................................ 21D. TRIP LOGISTICS...................................................................................22

1. PICK-UP AND DROP-OFF PROCEDURES........................................... 222. ACTIVITY PLANNING....................................................................... 233. CHECK-IN CALLS...........................................................................24

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4. GROUP TRAVEL.............................................................................245. HOTEL PROCEDURES.....................................................................246. RESTAURANTS AND CLUBS............................................................. 257. TRANSPORTATION PROCEDURES..................................................... 26

a) van transportation......................................................... 26b) air travel .......................................................................27c) cruises...........................................................................28

E. FINANCES............................................................................................. 281. MANAGING FUNDS.........................................................................29

a) asking for discounts......................................................29b) tax-exemption............................................................... 29c) creative money-saving.................................................. 29

2. APPROPRIATE USES OF SPROUT FUNDS......................................... 303. RECORD KEEPING........................................................................ 30

F. SAFETY................................................................................................. 301. GENERAL POLICY.......................................................................... 302. SPECIFIC POLICIES....................................................................... 31

G. FIRST AID............................................................................................. 311. EMERGENCY REQUIRING URGENT CARE.......................................... 322. EPILEPSY, SEIZURES..................................................................... 333. DIABETES.................................................................................... 344. PROBLEMS CAUSED BY HEAT......................................................... 355. DIETARY RESPONSES TO COMMON AILMENTS................................ 366. ASTHMA ..................................................................................... 367. ALLERGIC REACTIONS.................................................................. 368. PAIN RELIEF WITHOUT MEDICATION................................................ 379. UNIVERSAL PRECAUTIONS............................................................ 37

H. EVALUATIONS.................................................................................... 38I. PROCEDURES AFTER THE TRIP....................................................... 39

Copyright © 1988, Sprout270 W 96th St, 2nd Floor New York, NY 10025First Revision, June 1992Second Revision, June 1994Third Revision, June 1996Fourth Revision, June 1997Fiftth Revision, June 1998Sixth Revision, June 2002Seventh Revision, May 2005Eighth Revision, March 2012All rights reserved, including the right of reproduction in whole or in part in any form whatsoever.

A. PHILOSOPHY AND OBJECTIVES

1. HISTORY AND PHILOSOPHYSprout is a private, non-profit organizationdedicated to helping people with disabilitiesgrow through recreational, educational andleisure activities. Founded in 1979, Sproutbelieves in the therapeutic value of fun andthe enjoyment and comfort of a small groupsetting. Sprout activities enable participantsto become aware of their abilities as well aspersonal limitations imposed by themselvesand society while encouraging them toovercome these limitations. The result isgreater self-confidence and personalgratification.

2. GENERAL STATEMENT OF PURPOSEOur primary goal is to give participants the opportunity to experience and enjoyrecreational, educational and leisure activities. With our network of resources anddedicated 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 theplanning and implementing of activities. Through group outings, each participant will gaininsights that can be applied to his or her everyday life.Additionally, Sprout strives to help participants acquire the skills and confidencenecessary to initiate activities on their own.

3. PROGRAM OBJECTIVES

In our desire to provide a recreational experience of high quality for people withdevelopmental disabilities we have focused on the aspects which we feel are importantto the overall success of the experience.

a) SafetyWe believe that an important part of personal responsibility is an active regard for one’sown safety and the safety of those around you. We also acknowledge that on an outdoorprogram a certain degree of risk is inevitable. Our aim is to combine the benefits of traveland recreation with certain safety policies and procedures. We encourage an attitudetoward safety that will benefit the group as a whole, and still allow for adventure andpersonal challenges.

b) EnjoymentParticipants come on Sprout trips to have a good time. We don’t ask you as a leader tobe a 24-hour social director or a born entertainer. However when a participant is in anew, difficult, or unexpected situation, a relaxed, lighthearted attitude by the leader canbe helpful and greatly appreciated.

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We at Sprout believe in the importance of the leaders joining in on the fun with theparticipants. It is a special feeling for the participants to have the leaders enjoying theirvacation with them. For some leaders it is difficult to relax from all the responsibilitiesrelated to a trip and just have a good time. Some find it difficult to find a balance withteaching skills/modifying behavior and fun. Our guideline is: When the instruction isinterfering with their good time, cut back on the instruction.

c) SocializationEncourage each participant tosocialize. Support them in turning toeach other and to outsiders. Remainavailable if they need an opinion oradvice, and step in when needed.For the most part, we encouragelearning by doing. As a leader youshould be concerned with creating acomfortable and trusting atmospherefor the participants to become awareof their interpersonal resources andto use them with confidence.

d) Living SkillsWhile we recognize the importance of fun as a therapeutic tool, we also realize thatrecreation as a learning experience is not sufficient. It is not enough to offer theparticipant a safe and enjoyable experience. We encourage participants to do things forthemselves, 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 effectivelearning experience. Methods that work well for some do not work at all for others. Theeffectiveness 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) NormalizationNormalization is a goal that Sprout strives to achieve during each activity. Sproutattempts to offer the participants a vacation that would be acceptable to any adult. Themanner in which leaders treat participants and the age-appropriate activities thatparticipants are encouraged to undertake help to change the general public’s view ofpeople with developmental disabilities. The participants’ self image is also greatly enhanced when they are treated as adults. Inessence, normalization challenges you, as a leader, to enhance both the skills and thesocietal image of the participants. A large factor in achieving this goal for you is toprovide the necessary emotional, informational and physical support.The maximum physical and social integration of our participants into all aspects ofcommunity life are the fundamental goals of the normalization process.

4. LEADERSHIP PHILOSOPHY AND STYLEThere have been volumes written aboutleadership styles, whether it be autocratic, laissez-faire, democratic, the leader as parent, or the Zenof leadership. From our perspective it comesdown to a time and a place for each style, withflexibility and sensitivity as the key words. Nosingle style by itself will work all the time and wecannot tell you the “best” approach. In simplyassigning you a trip we express our belief that youare capable of fulfilling your responsibilities withinyour own personal style.If there were a “Sprout leadership style,” it would involve an attitude of caring andrespect for each participant and the group as a whole. It includes creating a supportiveenvironment where participants can struggle with new interpersonal and technicalsituations. It involves, wherever possible, respecting the choices that participants makeas 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 ofattention and interaction given by the leaders. Interaction with each participant is vitaland is expected from all leaders. Leaders should also be attentive to shy and introvertedparticipants and encourage them to share and take part in group activities.

a) Communicating MeaningfullyWhen communicating with Sprout participants it is important that the leader shouldalways be mindful of the principle of normalization. We must avoid the common tendencyto deal with disabled people as if they were children and as if they could not hear orunderstand us.If the participant you are speaking to does not understand you or you do not understandhim, you should change your communication style. This may mean slower speech - notchildish 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 mostdisabled people. It’s an element that enters the voice and yet does not do anything to liftself-esteem or to establish a meaningful rapport between you and the participant. In allaspects of our interaction we strive to getting past the disability.The tendency to talk to participants in a childish manner is often matched byconversation 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 ofcurrent affairs, sporting events, science, interpersonal relationships, philosophy andpolitics.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 whathe is trying to say. This is not a good idea unless it is something that the person hasasked you to do. Although it may speed up conversation, it denies the participant theright of his own communication, even though it may be slower and require somedeciphering.

b) HelpingIt 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. Generallyspeaking, the participants should be allowed tofunction as independently as possible, unless theyspecifically ask for help or it is apparent that they aregetting into difficulty because of their limitations. Thenthey should be offered help and assistance. Questionslike “Do you need any help ordering from the menu?”are always appropriate. Assistance should bespontaneous when a person is approaching aquestionable safety situation. When assistingparticipants with showering, dressing or otherbathroom needs, a leader should only helpparticipants of the same sex as the leader.

c) Refer to the Person FirstThe name of a physical or mental disability may beimportant, but the name of the person is infinitelymore important.Try to discipline yourself to say, “John Johnson is a person with developmentaldisabilities,” rather than, “He’s a developmentally disabled person named John Johnson.”Likewise, the term “a person with developmental disabilities” is preferred to “adevelopmentally disabled person.” They are “people” first who happen to have adisability.

d) Your Own FeelingsUnderstand from the beginning that no person attempting to assist the disabled will meetjoyous 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 periodsof frustration and disappointment which can leave one with mixed feelings. It is notunusualto feel the need to sort out your original expectations and the sometimesconflicting 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. Personalityconflicts may arise. One should recognize, without guilt, that experiences of this kindmay occur. There are no guarantees of success, but everyone owes it to themselves totry.Kidding and fun can often lighten helping moments. When the kidding is directed atyourself, 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 bevery important and leaders should attempt to offer the participants choices wheneverpossible. By providing our participants with the opportunity to make choices we are giving themautonomy, respect and self-control. Presenting choices may cause discussions anddisagreements but if looked at as part of a learning experience it may seem worth theextra work. Choices can be presented in a low key manner without becoming toostressful. Leaders must seek input regarding participants’ interests, likes and dislikes. Offer choicesin a reasonable manner by avoiding too many options and asking closed questions withyes or no answers. If possible, the participants should be included in decisions regardingrestaurants, activities and if appropriate rooming preferences. Care should be taken withthe manner in which options are presented to the participants. Participants may perceivea possible activity option as a promise to do the offered activity at a later time. Forexample, asking a group on the last day of the trip if they would like to go whalewatching or to an amusement park could lead to problems. There should be good communication and consensus among the leaders about whatchoices should be offered to the participants before actually offering the participants achoice. Leaders should strive to make participants realize that decisions,that will effectthe group, are not made in isolation. It is appropriate, if the leaders feel comfortable, tooffer participants the opportunity to choose different activities by splitting the group. (SeeSection 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, manydecisions will need to be made solely by the leaders, for example, decisions regardingbudget, logistics, emergency situations, etc. We recommend a consensus approach

to decision making. In a consensus, an agreement is reached through a process ofgathering information and viewpoints, and discussing the various proposals. The goal isto reach a decision with which all three leaders can agree. Leaders can proceed with anaction without having total agreement, but those not in agreement must consent. Aconsensus requires a great deal of patience and flexibility, providing leaders with theopportunity and the responsibility to share their thoughts and feelings.

f) Co-LeadingEach leader assigned to a trip is considered an important member of the team. Eventhough one leader may have more experience than another, all leaders have a say in thedecision-making. A moreexperienced leader may belooked to for advice concerninga delicate situation. However, allleaders should have the chanceto be heard. A successful leadership teamtakes time and energy. Wesuggest setting aside specifictime during the trip, usually atnight, for the leaders to gettogether and discuss theaspects of the trip, such as: howthe trip is developing, how eachleader feels, planningappropriate activities, concerns with participant behaviors, budgetary concerns, andsharing responsibilities. It is important that the team works well together, and each leaderdoes his or her share of the work in order to assure a safe, enjoyable trip for theparticipants.It is important to realize that even experienced leaders can make mistakes or badjudgement decisions. If at anytime a leader feels another leader has made a poorjudgement decision, he/she should not hesitate to speak out. The leadership team isdesigned to be able to look at a situation from three sides and ideally work out the bestpossible solution for any particular set of circumstances. Of course, if the co-leadershipteam finds itself in disagreement on how to handle a situation, the support phone shouldbe called to seek further advice.

g) Primary LeadersCertain leaders are assigned by the Leadership Department to be Primary Leaders. These leaders are experienced and have a leadership style in line with Sprout’sphilosophy and policies and have displayed outstanding leadership skills in a variety ofsituations. 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 philosophyand style. Primary Leaders should be considered as mentors rather than “bosses” andused as an experienced resource. They are not in charge of the trip, nor do they expectto do all the work and make all the decisions; they should actively look for input from other leaders.

5. DEFINITIONSa) 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 ofdevelopmental disabilities. The majority of the participants we work with are people whoare intellectually disabled. The following is the definition of intellectual disability outlinedby the AAMR (1992):

Intellectual Disability (formerly referred to as “mental retardation”) refers tosubstantial limitations in present functioning. It is characterized by significantly sub-average intellectual functioning, existing concurrently with related limitations in two ormore of the following applicable adaptive skill areas: communication, self-care, homeliving, social skills, community use, self-direction, health and safety, functionalacademics, 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 DiagnosisA person who has a developmental disability and a psychiatric condition is said to bedual diagnosed. Some of the participants on Sprout trips will have a dual diagnosis.Leaders should be aware that these participants may exhibit some manifestations ofpsychiatric illnesses. Sprout does not work with any participant that exhibits behaviorsthat are dangerous to him/herself or others. Participants on Sprout trips are required tobe in a behaviorally stable condition. If there is a concern with the behavior of anyparticipant contact the office via the support phone.

B. POLICIES & PROCEDURES1. PRE-TRIP BRIEFING

Each leader team will meet prior to the trip departure to cover the following: participantinformation forms, trip/activity information, medication information, leaders’ and budgetnotebook, 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 orher present self. Participants’ behaviors can change when they are faced with the newenvironment like the one they are confronted with on a Sprout vacation. In addition tohistories provided by the agency, participants may have evaluations from previous tripsby Sprout leaders which are often a more accurate guide to how a participant will behaveon 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, physicaldisabilities, dietary restrictions, intellectual limitations, safety precautions, and other typesof assessments.

b) Observed behaviors - These are evaluations and reports from leaders thathad previous contact with the participant. They can give a good indication of theparticipant’s behavior while on a Sprout trip. Included under this section are: repetitive,disruptive or abusive behaviors; reinforcers and programming success; cyclicalbehaviors; and objects or individuals to which the participant responds positively ornegatively.

2. CONDUCTa) Participant Conduct

As a leader you should be aware that Sprout reserves the right to expel from a trip anyparticipant that is exhibiting behavior that is endangering to himself or others. This typeof behavior cannot be accepted on our trips, and it should be reported to the Director ofLeadership immediately. Participants that demand, for whatever reason, the constantattention of one leader to the exclusion of the rest of the group may cause a safetyproblem. This situation should be reported to the attention of the director.The Sprout staff will decide, after reviewing the leaders’ input, whether a participant willbe allowed to travel with Sprout again. Leaders should not, under any circumstance, tellthe participant, the participant’s family or agency contact whether a disruptive participantwill or will not be allowed to travel with Sprout again.

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b) Leaders’ ConductYou, as a leader, are assigned to lead a trip for the group’s benefit. Any behavior on yourpart 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 ofSprout 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 tobelieve that a participant is being mistreated at his/her home, the leader mustimmediately report this to the Leadership Department via support phone.

3. PARTICIPANT LEAVING TRIPAs stated in the section regarding participant conduct, Sprout cannot work withparticipants who exhibit dangerous behaviors or who demand such attention from theleaders that the group’s safety or enjoyment of the trip is jeopardized. In addition, due toillness or injury a participant may not be able to stay with the group. In these situations itmay 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 callshould be contacted via the support phone. Some behaviors may be defused before theyget out of hand, others should be closely watched. Participants deserve the chance tochange, so be sure to seek advice from the office as soon as you are concerned. Besure 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 agencyor parent contacts regarding this possibility will be made by the office only. If it is decidedthat a participant is to leave the trip, the office will provide you with instructions as towhat 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 controllingseizures, preventing psychological outbursts or breakdowns and by regulating the heartand other organs. Improper dispensation can have serious effects.A small percentage of participants on medication will be self-administering. In otherwords, they will carry their own medications and will take them on their own. The largerpercentage of participants on medication, however, will rely on the leaders to distributetheir medications at the specified times. If a participant arrives on his/her own andinforms you of being self-medicating, there should be additional information sent withhim/her (or sent to the Sprout office) to confirm this. If the person arrives with staff, findout 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 witnessedtaking their medication? Should the leaders hold on to the medications? Are theycompletely independent and in need of no supervision whatsoever?) If there is anyconfusion, call the Support Phone.Sprout works with many different agencies and individuals who, while following thegeneral principles of our medication policy, tend to have various idiosyncrasies. To makethe task of distributing medications easier for leaders, Sprout’s medication policyrequests that all agencies present medications to leaders on the day of the trip in thefollowing 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 youdispense 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 MANNERREQUESTED BY SPROUT, PLEASE FOLLOW THE FOLLOWINGPROCEDURE:

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 thatthe 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 dispensedthe medication should sign the medication sheet.

B. - IF THE MEDICATIONS HAVE BEEN PRESENTED TO THE LEADERS IN A MANNER OTHERTHAN 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 ormedication check off sheets check thephysical containers for medication doses,dates and times. Transcribe the participant’sname, the medications name, the dose to begiven, the time at which it is to be given andthe date on which it is to be given onto aSprout Medication check off sheet. Haveanother leader check that you have donethis 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: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 15

trip will be required to fill out a medication incident form regardless of who madethe 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 EMERGENCIESA leader’s primary responsibility is for the physical well-being of the group. Making surethat safety and health guidelines are followed and that group members develop anattitude of respect for these guidelines is by far the best way to approach thisresponsibility. Accidents and illnesses do occur. Leaders need to do what they can toprevent them, but must also be prepared to react immediately and effectively should theyoccur. Secondarily, with accidents or illnesses, leaders must complete the accompanyingpaperwork that documents the accident/illness and treatments given in order that Sproutmay have a complete picture to provide to any party in need of this information. During amedical 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 InjuryIn the event of an accident it is imperative that youremain calm, trust your common sense and first aidknowledge, and act quickly. Your main concernsshould be:a) Preventing further damage to the victim or anyone

else. b) Getting necessary medical helpc) Informing Sprout that an accident has occurred d) Completing the necessary paperwork.

For further information, see the First Aid Instruction inthe section entitled General Health Issues Relating toSprout Trips.

b) IllnessesIt is not uncommon for a participant to become ill to some degree during the course of atrip. 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. Asthe leader it is your responsibility to monitor the health of your group. Many illnesses canbe 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 ornot a doctor should be seen. Use the support phone to update Sprout’s LeadershipDepartment and to discuss how to proceed. When in doubt about the severity of anillness, 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 groupmembers (epilepsy, diabetes, allergies, etc.). It is also essential to be aware of anymedications being taken by group members. This information is on the participant’shealth forms and should be brought to the hospital/clinic if a doctor’s visit is necessary.

c) Accident/Illness ReportThe 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 theleader for any injury or illness whether or not a doctor was seen.

6. SPECIAL CONCERNS WHEN WORKING ELDERLY PARTICIPANTSEach year Sprout serves an increasing number of elderly participants. Due to the effectsof aging, these participants demand special consideration and attention.

a) Picking up the groupLeaders 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 otherspecial needs they may have such as dietary needs, hygiene needs, physicalrestrictions, etc.

b) Activity planningWhen planning activities it should be considered that elderly participants may not be ableto keep pace with the young and may have difficulty doing activities that demandexcessive walking, standing, or any other physical activity. Accessibility is of the utmostimportance; avoid high inclines (upper level theaters, stadiums, loading planks on boats),

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extensive walking, or exceptionally long waits. Planning activities requires specialconsideration when dealing with elderly participants, and becomes extremely difficultwhen dealing with a group with mixed ages. Splitting the group is one solution. (See theGroup Travel section Part D 4 regarding group splitting.) Elderly participants may also have different interests that should be considered whenplanning activities. Activities that may cater to the interests of an elderly group and allowfor their slower pace may include plays, light theater, big band music, shopping in an air-conditioned 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 beplanned accordingly. A large amount of time should be allocated between activities inorder to allow for longer than average travel periods.

c) Sensory DeficitsPoor sight and hearing are common among the elderly population. Participants withsensory deficits present leaders with many safety concerns. Leaders need to be veryaware 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 withhearing or vision loss. Uneven surfaces such as grass, gutters or even rugs in hotelrooms can make walking difficult for people with vision loss. Hotel rooms should bemade safe by removing throw rugs and other obstacles or impediments. Be aware ofthose participants who have hearing loss and make sure they hear and understand allsafety instructions.

d) Mobility ConcernsElderly 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 isabsolutely imperative to exercise caution with the elderly while loading and unloading thevans. It is necessary to secure the footstool on steady terrain, keeping one foot on thestool to insure balance. It is necessary to have two leaders present and attentive whenloading and unloading elderly participants. The third leader should be with theparticipants after they leave the van and ensure they are safe. It is common that elderlypeople may become dizzy when moving from a sitting to a standing position. Front seatsshould be reserved for the elderly.Both trains and boats present the elderly with a moving surface to walk on. Elderlyparticipants should remain seated at all times when on boats or trains unlessaccompanied by a leader.When checking into a hotel, the rooms on the ground floor should be occupied by theelderly participants whenever possible. Elderly participants should be given extraattention whenever they are walking up or down steps, stepping over gutters or otherobstructions and when sitting down or getting up from tables at a restaurant.

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Extra attention should begiven to the elderlywhileshowering or bathing. Theleader should assist with theentering and exiting of the tubor shower. Place a non-slipmat on the shower floor if oneis available. Use bath mats toensure the participants have adry, non-slipperyfloor to stepout of the bath on to. Give theelderly participants assistancewith dressing if needed.

e) Dietary NeedsIt is common for elderly participants to use dentures. It is important to check that theparticipants have their dentures with proper cleaning and adhesive supplies when pickingup the group. Check that the participants are wearing their dentures when going out formeals. Participants who wear dentures may need to be encouraged to eat softer foods.Always be aware of the participant’s dietary restrictions.

f) Hygiene NeedsIt is common for the elderly to suffer from incontinence. Many elderly participants will usesome form of incontinence pads or underwear. Check that the participants who useincontinence 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 recommendedfor those with incontinence. Participants who wear incontinence devices should bechecked regularly and assisted if necessary by leaders to change into dry, clean pads orunderwear. Proximity to bathrooms should be taken into consideration when planning activities. Longvan rides should be punctuated by frequent bathroom stops.

g) Medical ConcernsSymptoms that may not seem serious in the young can be signs of a problem in theelderly. The elderly are more susceptible to infection, so cuts and scrapes should betended to and watched. Shortness of breath is a prominent sign of a heart attack; in theelderly 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 theelderly. Vomiting and diarrhea can lead more quickly to dehydration in the elderly. If aparticipant is displaying any of these symptoms, a call to the support phone should bemade, and a trip to a local hospital may be necessary.

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7. SWIMMING POLICY

Pools, lakes, and beaches are verydangerous environments. Becausesitting by the pool-side is equatedwith relaxation and swimming is

considered such a fun and playfulactivity, it is all too easy to forget the

inherent danger.

Remember: Water can Kill!! Therefore the strict adherence to the followingswimming 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 TWOLEADERS 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 willbe 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 theorganization 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 forthe 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 andtransportation are not covered. Coverage is subject to the following limitations: $500.00medical expenses due to an accident, including $100.00 dental expenses due to anaccident 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 insurecoverage, Sprout needs to file a claim with the Workers’ Compensation Board within 10days of the incident. Follow the following procedure any time you become sick or injuredwhile 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 hospitalvisited if you needed to receive medical attention. 2. When you receive medical attention, tell the attending physician that you are coveredby Workers’ Compensation. 3. Get receipts for any money you spend.4. Complete an Accident/Illness Report on yourself and return it to the Director ofLeadership 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 areasonably prudent person would act under the circumstances. Negligence is conductwhich falls below the standards established by law for the protection of others againstunreasonable risks. If one is aware of hazards and makes an effort to avoid them, liabilityis minimized.You, as a leader with Sprout, are covered by our liability policy. All leaders are protectedagainst liability lawsuits which may be fixed against them. Be aware that our liabilityinsurance will not protect you if you are engaging in any illegal activity or are breakingany specific Sprout policies while on a trip.

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C. SUPPORT PHONESprout provides a year-round, 24-hour support line for all our trips. We are available toassist 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 acceptonly the 800 number, and others will accept neither. If one number does not work, try theother.If you can not access the toll free numbers, Call COLLECT: 212-222-9769The 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, anoutsider’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 showingup 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 theparticipants. 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 areasonable amount of time and the problem is pressing, refer to the emergency numbersfor Sprout staff located in your leader’s notebook.

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D. TRIP LOGISTICS1. PICK-UP AND DROP-OFF PROCEDURES

Sprout organizes vacations for two differenttypes of groups. The vacations advertised inthe Sprout brochure are open to participantssigning up individually. Sprout alsoorganizes trips for agencies as part of theCustom Trip Program. These custom tripsare for members of the contracted agencyand are not open for participants signing upindividually. For vacations working with individual participants, normally a single meeting place will bedesignated by the trip planner, usually the New York International Hostel where theSprout office is located. It is important to get to the meeting point early as manyparticipants come on their own and arrive before the designated time.For agency vacations, pick up will be at the residence, institution or other designatedlocation. If you are running late, check in with the support phone staff so that theinformation may be relayed to waiting participants.A leader will meet the guardian/counselor of each participant being dropped off at themeeting 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 aspayment for the trip at the pick uplocation. Please have the counselor orguardian mail payment to the office. The van will be used as the officialcheck-in point. When the participantarrives he/she should boardimmediately and his/her name shouldbe checked off the attendance listwhich should be located at the entranceof the van. The attendance list will bearthe name of each participant and thename and relationship of each personscheduled 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 thedrop off point at the set time. Again, if you are running late, call the support phone. Thereshould be no reason for a drop off earlier than that planned for the trip. While it isimportant to make certain considerations for traffic, it is more important not to cut thevacation short. If a leader feels there is a legitimate reason for dropping the groupoff earlier than planned they must first obtain approval from support phone staff.

At the drop off location noparticipant should leave the

group until the person pickinghim up arrives.

The participant will then be presented totheir guardian/counselor and their name checked off the attendance list. Left over medication, spending moneyand baggage will be returned at this time.

The leader who is presenting the participant must record the name of the agency staffperson doing the pick-up. If a leader has any question as to the legitimacy of the persondoing the pick-up, identification should be asked for. If the person picking up a participantdoes not present proper identification or is not the same person agreed upon at themeeting 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 PLANNINGAll leaders on a trip are responsible for gathering information and planning dailyactivities. It is important to get to work on this immediately as it will be an important partof the participant’s appreciation of the trip. Included in each leader’s information packeton every trip will be a few “must do” activities along with a suggested list of activities andattractions in the area. Some will be tried and true by previous groups, others will be newand untested. In addition to this list, leaders are encouraged to seek out other newactivities in the area, taking advantage of whatever local information and materials maybe 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: theavailability of the activity, the cost, the need for reservations, and to request specialdiscounts. Considerations for planning any activity include: the energy level/physicallimitations 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 inor around the activity.

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3. CHECK-IN CALLSCheck-in calls are made by the leaders to let the office know how the trip is going for theparticipants and leaders. Check-in calls should be made every third day to the officeduring normal business hours (10 am - 6 pm M-F). If the third day is a Saturday, call onFriday, 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 TRAVELEnthralled by a trip’s manyinteresting distractions, participantscan possibly wander away from thegroup. There are certainprecautions that can be taken toprevent people from getting lost, aswell as procedures to assist themin “getting found” should theybecome separated. Prior to entering a crowded andpotentially confusing situation suchas a bustling town, amusementpark or fair, distribute the Sproutparticipant identification cards toeach participant. Explain to eachparticipant that if he is separatedfrom the group he should presenthimself to a person working at the

site and show the card. When on the grounds, the leaders should pick out a high-visibilitylandmark that should be designated as a place to meet should anyone get separatedfrom the group.

Dividing the group up into subgroups, with a leader assigned to each group, will easetravel through crowded areas. The leaders should agree on a meeting time and place forthe sub groups to regroup.If you realize a participant is missing; remain calm. Figure out exactly who is missing. Ishe 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. Ifa leader can be freed, have him or her do a search of the area. Decide on a specific timeand place for the leader who is searching to reunite with the group and co-leaders. Thenext step should be to notify security at the site. At this point the support phone shouldbe called.

5. HOTEL PROCEDURESPrior to checking-in to the hotel, one leader should be designated as the main liaison todeal with the hotel management. The liaison should be responsible for check-in, check-out, 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 managementas 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 theparticipants who they would like to room with. Each participant must have his/her ownbed. Only participants of the same sex should room together unless an agency hasgiven their permission for a mixed rooming assignment. Once room assignments havebeen made, the leaders should assign themselves specific participants’ rooms to beresponsible for the following items:

1) Removing all matches distributed by thecleaning staff on a daily basis2) 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 initialingitems 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 thatparticipants 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 showparticipants how to get to these locations if they feel comfortable with the participant’slevel of navigational skills. All participants should be advised that smoking in the rooms is not allowed on Sprouttrips.

6. RESTAURANTS & CLUBSA leader should always check out a club or restaurant before a decision is made to bringin a group. The leader should be looking at the appropriateness of the establishment, themenu, the price, and to determine whether or not the atmosphere is suitable. If it isappropriate, a leader should let the club or restaurant know that a group of people withdisabilities is coming so that they may prepare. Participants should be encouraged to order from the menu themselves, however help isusually needed. Participants must also be made aware of the budgetary limitations if theyare to order from the menu themselves.

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7. TRANSPORTATION PROCEDURESa) Van Transportation

Leaders are responsible for the safe and legal operation of any van used on a Sprouttrip. This includes maintaining safe and legal road speeds, and performing safe and legalroad 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 beassigned to future trips as non-drivers.If an accident of any size occurs, leaders must notify the office via the SupportPhone as soon as possible. In addition a police report should be obtained if at allpossible.POLICY REGARDING TICKETS: Drivers of the van are solely responsible for any and allparking tickets or moving violations. The office must be notified of any parkingtickets or moving violation tickets that are received during the trip. It is a myth thatout-of-state parking tickets are not valid - all parking tickets eventually make their wayback to the office.Any unpaid parking tickets that come back to the Sprout office will be charged to all threeleaders of the particular trip on which the ticket was given. The fine including any and alladditional late fees or penalties, will be split equally among the three leaders, regardlessof who actually parked the van illegally.Vans may not be parked in handicapped zones, however if there are participants thathave physical limitations leaders may elect to use these zones for the loading andunloading 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 helpthe 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 theparticipants to use the bathroom, stretch their legs, smoke cigarettes and have a drink orsnack.

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Leaders are also responsible for maintaining the cleanliness of the vans. Garbage bagsare included in each pre-trip briefing packet. As the vans will most likely be sent out onanother trip the day after they are returned, it is important that garbage in the van beremoved at the end of each trip.Depending on the length of the trip and the number of participants, the van may beequipped with accessory luggage carriers. Leaders should be sure they understand theworkings of the particular unit supplied to them before leaving on the trip. In general, besure to frequently check any straps, connections and securing devices, especially duringthe first and last days of the trip when the carriers will be loaded with luggage. Storingluggage outside the van creates a more comfortable environment inside the van for theparticipants. If an accessory luggage carrier is supplied leaders must use it to stow asmuch of the luggage as possible.

b) Air Travel When air transportation is to be used, it is helpful to separate the group from the generalmayhem of the terminal. Airports are very busy and it is important to keep close tabs onthe whereabouts of everyone in the group. Find a spot where the group can gather theirluggage and bags. Separate baggage to be checked from carry on bags. The use ofcolored ribbon, or colored tape attached to participants’ baggage will make identificationeasier at the baggage claim area. Only one or two leaders should be sent to take care ofluggage check in and the securing of boarding passes. Leaders should hold on to allairline paperwork; participants should not be given their own tickets to hold. Theremaining leaders can supervise the waiting group. If it has not been previously arranged that the group be seated together, the leadersshould work with either the people at the check-in counter or the flight attendants in orderto get the group together. If it is impossible to be seated as a group, the leaders shouldbe sure to intersperse themselves amongst the participants to be able to give support inthe 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 theflight, as with all Sprout trips, the trips is not over until all of the participants have beenpicked up. At times for various reasons this may add an extra hour or two at the airport.

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c) CruisesAs with trips that stay in hotels, the leaders are responsible for helping the participantssettle 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 ofthe rooms and hallways and leaders may find it necessary to escort participants to andfrom their rooms. Cruise ships are famous for the amounts of food they serve, usually boasting upwards offour meals a day. For this reason, many participants must be watched and counseled asto the consumption of appropriate amounts of food. Leaders may need to set certainlimits 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 thepresence and awareness of two leaders.Sun protection and guarding from heat exhaustion are two key tasks that require fullattention of the leaders. Leaders are responsible for making sure that sunscreen hasbeen applied to each participant and that each participant drinks a sufficient amount ofwater each day.

E. FINANCESThe accurate and economic management of the funds given to each trip is of paramountimportance to the successful running of the trip.At the beginning of each trip, one co-leader will be selected by the office to handle thegroup 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 vitallyimportant that these funds be kept safe and that proper records be kept. Your leader’snotebook contains several forms which will help you keep track of the group’s funds. Listall the traveler’s checks you havereceived and keep a runningrecord of the checks you’vecashed. This information is vitalshould your traveler’s checksbecome lost or stolen. Iftraveler’s checks are lost orstolen, notify the Sprout officeimmediately, and follow theinstructions provided in yourleader’s notebook to report themissing checks to AmericanExpress. The leader in charge of thebudget 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 mealwill leave people hungry. Don’t despair - nobody goes hungry on a Sprout trip and nearlyevery trip returns with a fair amount of money. To run a successful trip from an economicpoint of view, you should keep the following points in mind:

a) Ask for discountsMost restaurants and attractions will extend a discount when asked. Generally, you willneed 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 aprospective restaurant or activity. Prearranging a discount is usually more effective but isnot necessarily always practical in terms of time/spontaneity. Present to the manager that you are with a group of adults with developmentaldisabilities traveling with Sprout, a nonprofit organization, on a tight budget andthat 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 areaand 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 thediscount, the name of the establishment and the name of the manager in your leader’snotebook so that the office can thank them and the information may be passed on tofuture Sprout groups who are visiting the area.

b) Tax-exemptionSprout is a tax-exempt organization in NewYork State. Any trip that will be staying inNew York State will be given plenty of tax-exempt forms which should be usedeverywhere the group is spending money. Aslong as you are in New York State and arepresenting a tax-exempt form, no businessmay refuse to honor our tax-exempt status.Also mentioning that Sprout is tax-exempt inother states can sometimes encourage abusiness owner or manager to give the groupa discount.

c) Creative money savingDuring 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 alot of money. Taking a break from eating at restaurants from time to time can make for anice change and a well-planned picnic or barbeque lunch or dinner can come out to befar cheaper than sitting down at a restaurant. Please remember to share any ideas youhave regarding money-saving tips with the Sprout office so that we may share them withfuture groups. 30

2. APPROPRIATE USES OF SPROUT FUNDS.The money given to the group is to be used solely for the running of the trip. Althoughthe budget is presented in the form of X amount for meals, X amount for activities, Xamount for transportation, do keep in mind that the actual spending of the money issomewhat 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 allacceptable ways to use funds. Funds should not be used to purchase souvenirs for the group. Participants should havetheir 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 topurchase for themselves. If you must spend group funds to purchase, for example, spare underwear for aparticipant who has soiled him/herself, or medications or toiletries that were not sent withthe participant, be sure to notify the Leadership Department. Keep an accurate recordwith receipts as Sprout will seek these funds for reimbursement from the participant’sagency. If you have any questions about the appropriate use of funds while on a trip, pleasecontact the office.

3. RECORD KEEPINGIn the leader’s notebook you will find appropriate sections to: keep a record of alltraveler’s checks, expenditures, eachday’s total, and a calculator to figurethe final total expenses and the amount offunds to return to Sprout.You must obtain and return receiptsfor each purchase you make withgroup funds. This includes all tolls,meals, activities, gas andmiscellaneous expenditures.

F. SAFETY1. GENERAL POLICY

Sprout has an obligation to minimize the risk factor in the activities we sponsor. Sincetravel with people with developmental disabilities contains inherent risks, our task as anorganization 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 POLICIESVan safety: The driver and the front passenger must wear seat belts. Seat belts areavailable for the other passengers, however it is not required that they use them. Beextra careful when closing the doors of the van. Check that none of the participants arein a precarious position. It is highly recommended that those in the first bench wear seatbelts, as well as all the frail and elderly participants. (See Section D. 7. a) VanTransportation - 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. Personalpreferences will vary, however, the underlying principles and the relevance to health andsafety 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. Manyparticipants have a tendency to burn, use every precaution - sunscreen, beach umbrellasand proper clothing. Also check each participant for reaction to the sun relating to theirmedication.New activities: Participants, due to their disability, naturally have difficulty with newactivities. Give the guidance that is needed to participate safely. Check with the Sproutoffice staff if you have any questions relating to a specific activity. Nutrition: It is the leaders’ responsibility to insure that participants consider basicnutritional requirements in the ordering of food. Participants should be encouraged topartake of a well rounded, balanced diet as opposed to seven consecutive meals ofcheeseburgers. While you shouldn’t “force” participants, you can make other suggestionsand point out certain nutritional guidelines that need to be followed for the prevention ofillness.

Rest/fatigue: Fatigue can play a majorrole in the onset of illness. It is yourresponsibility to monitor your group forfatigue. Participants will vary in theirphysical condition and need for rest.Again, a leader can’t force people tosleep but you can point out thenecessity for rest and allocate rest timesif fatigue levels warrant such measures.Also plan activities accordingly.Cleanliness: Leaders need to beconcerned with establishing andoverseeing basic guidelines forcleanliness in relation to the health ofour participants.

G. FIRST AIDFirst 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 isimportant to remember that as a leader you are responsible not only to the primary victimbut 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 senseand first aid knowledge, and follow the procedural steps outlined in the “medicalemergency” section of this manual. For less serious illness or injury, simply utilize your basic first aid skills and obtain help ifthe situation requires additional attention. Leaders should become familiar with the basicprinciples in emergency care as described below. This is a rough outline only. Do nottreat 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 normalbody 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 notallow body fluids to come in contact with your skin or mucous membranes.

After dealing with the injured person, whetherit is taking the person to a hospital oradministering first aid yourself, contactSprout’s Support Line. Be sure to contact ouroffice before contacting parents orcounselors. When the office is reached, wewill decide on who should contact theparticipant’s contact person.In addition, if there is ever any questionabout handling a particular emergency,consult the person on call on the supportphone.Complete the Accident/Illness Report, whichis included in your trip packet, and return it tothe 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 oractions may be changed for a short time. These physical changes are called epilepticseizures. Epilepsy is sometimes called a seizure disorder. It affects people in all nationsand of all races.There is no single thing that triggers a seizure, but it is common for people with epilepsyto have an “aura” prior to a seizure. Auras are a wide variety of feelings or impulses thattell a person with epilepsy that they are about to have a seizure. Aura’s are different foreach person, but each person usually experiences their own unique aura. For example aperson may always smell a certain smell prior to a seizure. If a participant tells a leaderthey are about to have a seizure the leader should take them seriously and have them liedown and follow the procedure outlined below. If a participant has a series of seizures they, should be seen by a doctor. This could bean indication of a low drug level or a more serious neurological problem. If you have anyconcerns regarding a participant who is having a seizure, contact the Sprout office or theperson on call via the support phone. First aid for epilepsy is very simple: Keep the person safe until the seizure stops naturallyby 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 forcehis 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. Thiswill help keep the airway clear. (See thesection on first aid for informationregarding placing a person in the recoveryposition.)

9. Be friendly and reassuring asconsciousness returns.

10. Have the person rest for awhile 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. DIABETESDiabetes mellitus is a common disorder that effects a large number of people. It is acondition where the body has problems producing insulin and loses its ability to controlthe level of sugar in the blood. This is a serious condition that if poorly controlled orneglected can lead to blindness, kidney failure, liver failure, shock and death. Fortunatelyit is easily controlled and most people require very little medical attention for thiscondition. Many participants on Sprout trips will bediagnosed as having diabetes mellitus.There are two different types of diabetes,adult onset diabetes and juvenile onsetdiabetes. Juvenile onset diabetes, assuggested by the name, develops duringthe teenage years and is controlled byregular insulin injections. No Sprout leaderwho is untrained in the procedure would berequired to administer or supervise aninjection of any type. It may be necessaryfor a leader to remind a participant that it istime for their insulin. It is important that theparticipants receive their insulin at theprescribed time. Insulin normally needs to be refrigerated or kept cool, you should checkwith the person dropping off the participant. If you have any concerns about aparticipant using insulin or you are asked to assist the participant in any way withthe 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 theblood sugar level. It is important that the participants receive these medications. Usuallythese are given half an hour before meals which will be indicated by the medicationinformation that is given out on each trip. Medications are usually used in conjunctionwith dietary controls. People who are diabetic should be encouraged to limit their sugarintake. This is a tough thing to do on a Sprout trip, but many participants who are diabeticwill understand what limits they should place on themselves. “Limiting sugar” does notmean “no sugar” and generally it won’t harm the participants if they occasionally have asweet. If you know a participant is diabetic and is taking no notice of their dietaryconstraints and are consuming excessive sugar try to gauge how much they understandabout 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 theirdiet 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 aparticipant will exhibit signs and symptoms such as lethargy, tiredness, weakness, arapid pulse, and in the late stages, confusion and unconsciousness. Both hyperglycemiaand hypoglycemia should be treated in the same manner. Have the participant rest andgive him or her a very sweet drink. After this you should take the participant to a hospitalor to a medical practitioner for a check up. Contact the office or the support phone if youhave any queries or problems.

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

4. POSSIBLE HEALTH PROBLEMS CAUSED BY HEATThe majority of Sprout trips occur during the heat of summer. All leaders need to beaware of possible complications related to heat that should be avoided. Commonproblems related to heat include heat cramps, heat exhaustion and heat stroke. Heat Cramps, the least severe condition, are painful muscle spasms, usually in the legsand abdomen. Have the person relax in a cool place, give lots of fluids and rest. Lightlystretch or massage muscles involved. Heat Exhaustion, is a more severe condition which can include cool, moist, pale orflushed skin, headache, nausea, dizziness, weakness and exhaustion. Get the person toa 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 isconscious give water at roomtemperature (not cold) to drink (slowly -about 1 glass every 15 minutes). Let theperson rest in a comfortable position,he/she should not resume normalactivities this day. Heat Stroke the most severe condition,occurs when the body is overwhelmed byheat and stops functioning. Signalsinclude 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, vomitsor a change in consciousness occurs get the person to an EMERGENCY ROOMimmediately. Keep him/her comfortable and sponge with warm water until medicalassistance is available. When there is excessive heat, pay extra attention to the participants for the abovesignals. To avoid these conditions, please make sure everyone has plenty of fluids todrink, and takes it easy in the heat. Try to do indoor air conditioned activities. Do not doany 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 howthe participants are dressed: clothing should be of a light fabric and a light color.

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5. DIETARY RESPONSES TO COMMON AILMENTSThe 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 fora person’s health. If a participant, particularly an elderly participant experiences diarrheaor constipation for longer than 2 days, leaders should contact the office or the person oncall 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. Generallyfor diarrhea it is good to offer the participant low fibre foods such as white rice, whitebread or spaghetti while avoiding salads and fruit. For constipation high fibre foods suchas fruits, vegetables and cereals are good to eat, while rice and junk foods should beavoided. For all gastric complaints dairy products should be avoided. Fluid intake shouldbe kept high for people with both diarrheaand constipation, water being the optimumchoice.

6. ASTHMAAsthma is a common condition effectingmany people in the United States. Asthma isa condition which effects the bronchial tubescausing them to obstruct. It can be causedby physical activity, emotional excitement orit can occur spontaneously. A severeasthma attack can lead to unconsciousnessand 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 partof their medications. Most inhalants can also be used if a participant is having an asthmaattack. Leaders should carry the inhalers with them at all times. Check that theparticipants know how to use their inhalers. If a participant has an asthma attack, have them sit quietly in a well ventilated place. Anasthma attack is a frightening experience for the asthma sufferer. Fear can exacerbatean asthma attack, so it is important to stay with the participant and reassure them thatthey are going to be alright. They should use the inhaler immediately. If there is no reliefafter 3-4 minutes they should use it again. If there is no relief after using the inhaler athird time, medical assistance should be sought immediately.

7. ALLERGIC REACTIONSMany Sprout participants may be allergic to certain foods or drugs - be sure to checkeach person’s medical record for specific allergies on the first day of the trip. Allergies tobee stings, milk, caffeine or types of material such as nylon are common but people canbe allergic to just about anything. Leaders should make every effort possible to preventthe participant from coming in contact with their specific allergen. Allergic reactions vary greatly in intensity from skin irritation and watering eyes toproblems with breathing. If a participant does have an allergic reaction leaders shouldseek medical assistance and contact the person on call via the support phone.

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8. PAIN RELIEF WITHOUT MEDICATIONThe Sprout medication policy states that leaders should not give any medication thathas not been prescribed by a doctor without seeking permission from the person oncall via the support phone. This includes all over the counter medications such asTylenol, Dramamine, Peptobismol, etc. If a participant requests a medication sayinghe/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 needsrelief quickly. For headaches, relocate the person to an environment that is as free aspossible of stimulation. Ideally have the participant lie down on their bed with theireyes closed. A wet cloth to the forehead can also offer some relief. Depending on theseverity of the headache one leader should stay with the participant.Muscular pain is best relieved by getting the participant in pain to stop using theeffected muscles. Ask the participant to sit or lie down if possible. Warm cloths to theeffected muscles can also offer relief.

9. UNIVERSAL PRECAUTIONSOccasionally a participant may be ahepatitis carrier or may possibly beinfected with HIV. These are commondiseases that anybody who worksclosely with people in the humanservices field should be aware of. HIV,Hepatitis and other diseases arespread via human body fluids. Healthcare professionals are using UniversalPrecautions to protect themselvesand others from the spread of thesediseases. Universal Precautions involve the

prevention of body fluids from any person, whether they are known to be infected ornot, from coming in contact with your eyes, mouth, nose or cuts and breaks in theskin. For Sprout leaders, this means putting on a pair of gloves whenever dealing witha participant’s body fluids. Masks and safety glasses will not be necessary for theamount and the nature of the body fluids that Sprout leaders deal with. Preventing theparticipants 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 anytime. The key to universal precautions is that all people, including leaders andmembers of the public may be carriers and should be treated in the same manner.

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H. EVALUATIONS1. PARTICIPANT EVALUATION

Leaders’ evaluations of participants are extremely valuable in that they are usedto give future leaders working with these participants a bit of advance understanding ofthe individuals. In addition, the information leaders supply is often used in consideringwhether or not participants with problem behaviors are suitable for future involvementwith the program. In evaluating the participant there are several areas that will yieldimportant information concerning the direction of the therapeutic recreation program.These include attention span, the ability to interact, social and physical abilities, fine andlarge motor skills, reactions to stress, unusual behaviors, problem-solving abilities andrelevant 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 EVALUATIONLeaders will also be asked to evaluate themselves and their co-leaders. Theseevaluations are valuable in order to assign balanced and compatible co-leading teamsfor future trips. To ensure confidentiality, evaluations will only be reviewed by members ofthe Leadership Department. All leaders will be invited to meet with a member of theLeadership Department to receive feedback and discuss their performance as a leader.

3. RESTAURANT, ACTIVITY AND ACCOMMODATION EVALUATIONTo help us plan better quality vacations Sprout alsorequests that leaders evaluate restaurants, activitiesand accommodations. For restaurants andactivities, leaders should note the quality of theservice, the cost, any discounts offered, address,phone numbers and appropriateness for futuregroups. Accommodations should be evaluated fortheir comfort, safety, management and proximity tovarious activities.

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H. EVALUATIONS1. PARTICIPANT EVALUATION

Leaders’ evaluations of participants are extremely valuable in that they are usedto give future leaders working with these participants a bit of advance understanding ofthe individuals. In addition, the information leaders supply is often used in consideringwhether or not participants with problem behaviors are suitable for future involvement withthe program. In evaluating the participant there are several areas that will yield importantinformation concerning the direction of the therapeutic recreation program. These includeattention span, the ability to interact, social and physical abilities, fine and large motorskills, reactions to stress, unusual behaviors, problem-solving abilities and relevantreinforcers. Specific areas to observe relating to evaluations are the following:

1. Social skills: How the participant interacted with leaders, the otherparticipants and outsiders.

2. Activity: The participant’s appreciation, understanding an participation inspecific 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 EVALUATIONLeaders will also be asked to evaluate themselves and their co-leaders. Theseevaluations are valuable in order to assign balanced and compatible co-leading teams forfuture trips. To ensure confidentiality, evaluations will only be reviewed by members of theLeadership Department. All leaders will be invited to meet with a member of theLeadership Department to receive feedback and discuss their performance as a leader.

3. RESTAURANT, ACTIVITY AND ACCOMMODATION EVALUATIONTo help us plan better quality vacations Sprout also requests that leaders evaluaterestaurants, activities and accommodations. For restaurants and activities, leaders shouldnote the quality of the service, the cost, any discounts offered, address, phone numbersand appropriateness for future groups. Accommodations should be evaluated for theircomfort, 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 TRIPAfter 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 theoffice or other prearranged location as specified in the pre-trip briefing or ascommunicated 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, whichevercomes first. 3. Your stipend will be mailed to you after all information is reviewed.

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