PIVOTPoint WNC Policies & Procedures

Policies & Procedures Manual

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Policies and Procedures 1.

Mission Statement ➢ Program Intended Outcomes ➢ Program Goals for Instruction ➢ Program Enhancement Plan ➢ Manner of service delivery, suggested interventions, number of sessions, content, and flow

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Job Description ➢ Application ➢ Letters of Recommendation ➢ Resume and Certifications ➢ Background Screening ➢ Training Period ➢ Expectations ➢ Dress Code ➢ Program Evaluation ➢ Scheduling and Meetings ➢ General Outing Curriculum ➢ Our Core Values ➢ Feedback System ➢ Cultural and Individual Differences Training ➢ Harassment ➢ Alcohol and Drug Policy ➢ Prohibition of Firearms and Weapons ➢ Medical Training Requirements ● Recertification Reimbursement ● CPR for Our Clients ➢ Responsibility of Levels ● Lead Instructor ● Support Instructor ● Program Director ● Executive Director ➢ Technical Skills & Equipment Training ➢ Teaching Skills ➢ Interpersonal Skills

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Client ➢ Initial Client Assessment ➢ Waiver and Photo Release

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Assessment of Learning Outcomes and Levels of Program Natural Versus Artificial Consequences Adequate Water, Nutrition, and Clothing HIPAA Compliance No Shows and Noncompliance Plan for Parental Involvement Visitation to Private Homes Non-discrimination policy Investigation Reporting Consequences

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Pre-Trek Policies and Procedures ➢ First Aid Kit Check and Car Check ➢ Instructor Debrief ➢ Instructor-to-Participant Ratios ➢ Weather and Terrain Check ➢ Appropriate Equipment, Clothing, and Footwear

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During-Trek Policies and Procedures ➢ Incident Reports ➢ Health Care and Dispensing Medication ➢ Behavioral Management/Physical Restraint ➢ First Aid Protocols ➢ Forest Service Regulations and Permitted Land ➢ 7 Principles of Leave No Trace ➢ Abuse Reporting ➢ Detox Symptoms ➢ Knife/Tool/Other Safety ➢ Lightning Protocol

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Safety and Emergency Action Plan (EAP) ➢ Emergency On-Call Chain of Command ➢ Medical Emergencies ➢ Evacuation Procedures ➢ Safety Hazards ➢ Self-harm and Suicide Protocol ➢ Lost-Person Protocol ➢ Program Specific Wilderness Medicine Practices

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Vehicle Operations/Safety and Procedures

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Insured Drivers List and Eligibility Requirements Operating Company Vehicles Pre-Trip Checks Client Transport and Passenger Safety Accident Procedures Overnight Events

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Confidentiality and Record Retention

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COVID Protocols

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Policies and Procedures 1. Mission Statement: PIVOTPoint WNC provides mindfulness-centered, therapeutic wilderness experiences to those recovering from substance use disorder promoting connection, compassion, and character. ➢ Program Intended Outcomes ● Engaging participants in a series of engaging scenarios designed to mitigate the effects of stressors generally associated with substance use and misuse. ● Clients will reduce specific problem behaviors presented at referral and targeted in individual service plans. ● Clients will demonstrate improvement in targeted skills identified in the individual service plan. ● As related to adjudicated and court-involved clients, participants will have no new complaints after an offense date after the admission date to PIVOTPoint WNC. ● Clients will reduce current substance use, will avoid future or expanded substance use, and will increase pro-social interaction resulting in increased positive outcomes and reduced recidivism. ➢ Program Goals for Instruction ● PIVOTPoint WNC uses hands-on, tangible and practical activities implemented in the natural environment to challenge, instruct, and provide opportunities for participants to practice pro-social, interpersonal, problem-solving, communication and self-regulation skills. ● Clients generally will experience an increase in self-awareness, leading to an increased recognition of behavioral consequences and available choices. ● Clients will have a higher level of accountability both to self and others. ● Clients will learn healthier coping strategies leading to an increased environmental control.

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● Clients are provided tangible evidence of success, thereby correcting negative self-conceptions and leading to a more positive self-concept. ● Clients learn creative problem-solving, communication and cooperation skills. ● Through therapeutic adventure, clients facilitate realistic appraisal of individual strengths, weaknesses, and self-imposed limitations. This ultimately leads to better decision-making abilities. ➢ Program Enhancement Plan ● PIVOTPoint will incorporate FIT Assessments to help track the therapeutic alliance with clients in order to intervene with clients who aren’t feeling heard and seen as well as to track when clients are feeling especially heard and seen by staff to best meet our clients. ● PIVOTPoint staff will consistently be working on staff manuals that incorporate all levels of training needed to best serve clients. ● PIVOTPoint groups are based out of evidence-based practices and curriculum. ➢ Manner of service delivery, suggested interventions, number of sessions, content, and flow ● PIVOTPoint meets clients at a central location or picks them up from their residences if transportation is an issue. ● The program duration varies depending upon the specific contract. ● Interventions are based upon program curriculum, parent, therapist, and client goals and are revised and expanded upon as the relationship develops with the client. ● Interventions and group facilitation is informed by Gestalt principles, mindfulness-based practices, motivational interviewing, community resilience model, and cognitive behavioral therapy among others.

2. Job Description ➢ Application ● An application will be provided and kept on file for each guide and employee. If any changes to a guide’s criminal status happen during employment then they are to relay that information to the Program

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Director immediately. Failure to do so could result in disciplinary action and ultimately termination on a case-by-case basis. ➢ Letters of Recommendation ● All guides/employees of PIVOTPoint WNC will provide recommendations to persue. ➢ Resume and Certifications ● Guides must carry a current WFA/WFR certification in addition to having a current adult/child CPR certification in their personnel file. ● Guides must have a current resume in their personnel file. ● At all times one of the two staff on shift must have active WFR and adult/child CPR. ● JCPC will be informed of any changes in licensure or certification immediately. ➢ Background Screening ● Applicants will need to complete a ClearChecks background checks upon hiring and annually thereafter. ➢ Training Period ● The training period for all guides will involve one observed unpaid trek, two paid support-facilitated treks, and one paid as support lead-facilitated trek (observed by trainer/facilitator). ● Trainings, certifications, and feedback will be tracked for each contractor, volunteer, intern, and staff member via the staff manuals and staff process tracking spreadsheet. ➢ Expectations ● All guides are expected to: ● Keep appropriate boundaries with clients as detailed in the Support Training Manual. ● Keep a professional appearance. ● Be punctual to every mandatory meeting and outing. ● Follow all policies and procedures. ● Properly document before and after every trek. ➢ Dress Code

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● Independent Contractors and Staff need to wear activity appropriate clothing that’s mindful of potential client history of trauma and body image issues. Participants need to wear activity appropriate clothing. This includes close-toed shoes. ➢ Program Evaluation ● Field evaluations will be completed using the Field Evaluation form quarterly. ● Staff Manuals and the staff process tracking spreadsheet will be utilized to constantly evaluate and give feedback to staff as well as to have them complete all appropriate training as they are promoted through the levels. ➢ Scheduling and Meetings ● Guides are expected to attend a mandatory contractor meeting every month. ● Guides are expected to check in with the Program Director four days before a committed trek date. ➢ General Outing Curriculum ● Each outing should consist of an initial checkin consisting of getting a good feel for the group dynamics, what everyone is bringing to the trek today, and including a meditation or grounding exercise of some sort to set the tone for the day. Throughout the day, every moment can be an opportunity to check in and process what might be coming up for everyone, use your intuition and facilitation experience to dive into those moments with curiosity and explore through mindfulness what everyone’s experience individually and collectively may be. There should be between 3-5 groups during each trek, sometimes more depending on the group and what comes up throughout the day. Everything from a tough uphill, a tricky rapid, initial fear of climbing, a tiff with another client, or a calm quiet lake can be an invitation to process and deepen the experience. Each outing will be 4-8 hours in length including transportation. Facilitator is in charge of that, not the clients. ➢ Our Core Values ● Intentionality (honesty, integrity, accountability, fairness, equity) ● Growth-oriented (community, organization, individuals)

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● Team-oriented (all stars, captain, coach) ➢ Feedback System ● Guides will give each other feedback after each outing and the Program Director, Executive Director, and lead guides will give each support staff feedback three times throughout their time being support staff on the expectations detailed in the staff training manual. The Program Director and Executive Director will give feedback three times to lead guides as well before they are able to transition to master on the expectations detailed in the staff training manual. ➢ Cultural and Individual Differences Training ● Guides will have access to Clinical First Responder Training/Mental Health First Aid, Equity Training, as well as Motivational Interviewing levels 1 and 2. ➢ Harassment ● Sexual harassment is unwelcome conduct of a sexual nature that is persistent or offensive and interferes with an employee's job performance or creates an intimidating, hostile or offensive work environment. Sexual harassment is defined by the federal Equal Employment Opportunity Commission as unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when, for example: a) submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment, b) submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual, or c) such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile or offensive working environment.

Sexual harassment can be physical and psychological in nature. An aggregation of incidents can constitute sexual harassment even if one of the incidents considered on its own would not be harassing. Physical assaults of a sexual nature, such as rape, sexual battery, molestation or attempts to commit these assaults, and intentional physical conduct that is sexual in nature, such as touching, pinching, patting, grabbing, brushing against another employee's body or poking another employee's body.

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Unwelcome sexual advances, propositions or other sexual comments, such as sexually oriented gestures, noises, remarks, jokes, or comments about a person's sexuality or sexual experience. Preferential treatment or promises of preferential treatment to an employee for submitting to sexual conduct, including soliciting or attempting to solicit any employee to engage in sexual activity for compensation or reward. Subjecting, or threats of subjecting, an employee to unwelcome sexual attention or conduct or intentionally making performance of the employee's job more difficult because of that employee's sex. Sexual or discriminatory displays or publications anywhere in PIVOTPoint WNC's workplace by the PIVOTPoint WNC employees/contractors. ● Violations of the harassment policy will result in disciplinary action and potentially termination. ➢ Alcohol and Drug Policy ● Employees and contractors will not be permitted to use alcohol or drugs before or during any PIVOTPoint WNC experience. A mandatory drug screen will be required in the event of an accident happening while they are driving the vehicle. PIVOTPoint WNC has the right to drug test at any time at will. ● If the test comes back positive, they will be terminated. ➢ Prohibition of Firearms and Weapons ● PIVOTPoint WNC staff and facilitators will never use or be in possession of any firearm or other weapon while working with clients nor will there ever be a firearm or weapon at any site or in any transportation vehicle. ➢ Medical Training Requirements ● Guides will be notified and alerted of recertification dates and reimbursed after 20 facilitated treks following the training period. ● Current Adult and Child CPR is required. ● Current WFA or WFR is required. ➢ Responsibility of Levels ● Lead Guide ○ Read Full Time Lead Staff Appendix for description of roles and responsibilities for full time Lead Staff. Shift Lead Staff

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description of roles and responsibilities include, but are not limited to the following: Demonstrates consistent understanding and application of Motivational Interviewing Level 2.

Demonstrates consistent understanding and application of CFR: Along with improving their therapeutic skill set, staff will feel supported, empowered, and prepared—factors that enhance performance and improve staff retention. CFR Certified training also prepares staff to more effectively handle day-to-day treatment issues and to respond to the inevitable crises that occur.

Demonstrates Wilderness First Responder practical skills to maintain confidence and make critical medical decisions in a wilderness setting.

Demonstrates working knowledge of NCI+ Prevention course: development of communication skills, relationship building, skills needed to identify escalating behaviors, and understanding clients.

Consistently demonstrates working knowledge of weather apps and utilizing it to make both a plan and an alternative plan for the outing.

Consistently demonstrates effective, timely, and clear communication with program staff and referral source regarding weather, gear, and outing details.

Communicates with Program Director and program staff 4 days before each outing and includes Program Director on all communication with clients and program staff.

Can demonstrate set up and knock down of all gear and consistently returns gear in its original location and with consistent organization. “Leave it the way you found it”.

Consistently puts iPad where it belongs and demonstrates proficient working knowledge of relevant apps, documentation, and organization with the device.

Consistently delegates with clarity, context, and guidance.

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○ Demonstrates working knowledge of all items in the med kit and utilizes that knowledge appropriately both in the field and in practice scenarios. ○ Reviews and incorporates previous outing’s client notes into outing planning and facilitation. ○ Effectively communicates scope of intentions and expectations for the day with support staff/volunteers/interns. Additionally offers space for the facilitation team in order to most effectively show up for clients. ○ Ensures that volunteers and interns are aware of their expectations for the day, the 5 inappropriate areas of sharing, and active listening vs. advice giving. ○ Consistently shows up to outings fed, rested, and grounded for the day. ○ Consistently applies knowledge about each client from their intake paperwork to best serve that client. ○ Consistently and appropriately asks clients about asthma, seizures, and diabetes before entering the vehicle. ○ Maintains boundaries and client expectations during transportation. ○ Group facilitation expectations ○ Consistently facilitates 3-5 groups per outing. ○ Intro group begins with foundation of what you’re coming out there with and establishes tone and safety for the day. ○ Main group carries momentum of initial tone and expectations for the day and incorporates active listening, motivational interviewing skills, concise/targeted question format, and repacks what was unpacked with the clients. ○ Consistently utilizes nature and metaphor to highlight and leverage the client experience to encourage being present in the moment and build self-awareness. ○ Consistently utilizes meditation resources at least once per outing. ○ Consistently offers space for summary/conclusion of each outing experience and “closes” experience through SMART goal setting,

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metaphoric release of things that aren’t serving you, gratitude, and/or formal intentional reflection. ○ Consistently approaches clients with congruence, unconditional positive regard, and empathy. This can be noted through relationships and rapport formed with each client. ○ Consistently and appropriately utilizes tone of voice with clients. ○ Consistently evaluates the needs of clients and responds effectively. ○ Can demonstrate how and when to administer Narcan and identify substance withdrawal signs and symptoms. ○ Demonstrates working knowledge of all emergency protocols. ○ Demonstrates familiarity with experiential game resource lists and when and with whom to use them. ○ Demonstrates ability and familiarity with populations with whom we work and how to facilitate therapeutic adventure in a variety of scenarios. ○ Consistently provides detailed individualized outing debriefs incorporating support staff’s notes and perspective and relays all relevant information in a timely manner. Is available to provide follow up conversation and reflection to the leadership team as needed. ○ Completed all required reading and discussed with the Program Director. ○ Demonstrates working knowledge of needs vs. wants and Glassner’s needs model. ○ Demonstrates working knowledge of nonviolent communication training. ○ Consistently practices appropriate self-care. ○ Exhibits proficient knowledge of the stages of change and uses that knowledge to inform delivery, reception, and execution of feedback. ● Expectations for support guide are:

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○ Recognize the potential risk factors and warning signs for a range of mental health problems, including: depression, anxiety/trauma, psychosis and psychotic disorders, substance use disorders, and self-injury. ○ Use a 5-step action plan to help an individual in crisis connect with appropriate professional help. ○ Interpret the prevalence of various mental health disorders in the U.S. and the need for reduced negative attitudes in their communities. ○ Apply knowledge of the appropriate professional, peer, social, and self-help resources available to help someone with a mental health challenge treat and manage it and achieve recovery. ○ Recognize and consistently exhibit compassion for marginalized and underserved populations. ○ Consistently exhibits a working knowledge of motivational interviewing. ○ Knows all trails that we’re permitted to go on. ○ Can utilize FIT app. ○ Can utilize weather apps and has a consistent track record of using them. ○ Consistently checks client gear before entering the vehicle. ○ Consistently shows up in appropriate attire and with the appropriate personal gear for the day. ○ Consistently turning in completely filled out client pre and post trek tracking into the correct folder. ○ Consistently holds healthy and professional boundaries with clients both emotionally, physically, and in the car. ○ Consistently does not talk about the 5 areas of inappropriate sharing with staff. Can effectively redirect and hold boundaries when clients bring them up. ○ Demonstrates ability of safety planning and appropriate redirection of topics outside of our scope of practice when in the field if the opportunity arises.

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Demonstrates ability to build rapport with clients.

Demonstrates ability to utilize the SAT phone.

Demonstrates working knowledge of all policies and procedures.

Demonstrates a working knowledge of leading the back of a hike.

Demonstrates a working knowledge of knots, tarp set up, and fire striking. ○ Consistently teaches and demonstrates Leave No Trace Principles. ○ Consistently holds boundaries around inappropriate inhalants in the woods before clients get into the vehicle. ○ Consistently asks clients if they have all of their personal gear when exiting the vehicle. ○ Consistently cleans and sanitizes vehicle. ○ Consistently shuts garage door and gate. ○ Consistently throws away trash and alerts Matt of any towels left in the garage. ○ Has read all required readings. ○ Consistently demonstrates working knowledge of active listening and holding space in the field. ● Program Director: marketing and client development oversight; logistics coordinator; administrative director; personnel oversight, evaluation, and training.

3. Client ➢ Initial Client Assessment ● It’s the responsibility of the Program Director to update lead guides on all medical and psychological information pertinent to the clients before each outing. ➢ Waiver and Photo Release ● It’s the responsibility of the Program Director to ensure that all waivers, releases, and intake paperwork are completed properly and thoroughly. ➢ Assessment of Learning Outcomes and Levels of Program ● PIVOTPoint WNC implements FIT Assessments. Guides should have each participant complete this before and after each trek.

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● PIVOTPoint implements pre and post trek tracking forms based on our outcomes. ● PIVOTPoint implements FIT assessments to track the therapeutic alliance with staff and clients. ● Client tracking weekly and creation and adherence to Individualized Service Plans will also track level of program and outcomes. ➢ Natural Versus Artificial Consequences ● Due to the duration of a standard outing, clients are responsible for their own water and snacks in addition to eating lunch before the outing. ➢ Adequate Water, Nutrition, and Clothing ● It is the responsibility of the guide running the trek to instruct clients on proper clothing and footwear and to advise for water activities and inform of terrain. PIVOTPoint WNC clients are responsible for bringing appropriate clothing and adequate water on treks. ● Snacks may be provided by guides as available; but clients are responsible for eating pre-trek and bringing any/all food and snacks for the day. ➢ HIPAA Compliance ● All client personal information, disclosures, and information gathered via client assessment sheet or on a trek is not to be shared or communicated with anyone except the Executive Director and Program Director.

Non-compliance in this may result in termination. ● Guides are not allowed to be “friends” or “followed” by clients on social media or to socialize with them outside of PIVOTPoint outings. ➢ No Shows and Noncompliance ● PIVOTPoint WNC will appropriately log all no shows and noncompliance, alert families of clients, and/or counselors of referring agencies. ● After two noncompliant activities, PIVOTPoint will consider termination. ➢ Plan for Parental Involvement ● Parents of DJJ referred youth will be consulted on Individual Service Plans along with court counselors and will be developed within 30 days of intake. Communication will continue throughout the program. Staff will

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be available 30 minutes prior to the start of outings and 30 minutes after outings planned drop off times for parental communication and involvement. ➢ Visitation to Private Homes ● Staff will communicate with parents of youth requiring individualized pickup and drop-off. Pick up will be at a time that allows the facilitator to arrive at Carrier Park 30 minutes prior to outing start time. ➢ Non-discrimination Policy ● PIVOTPoint doesn’t discriminate or refer to programs or individuals who discriminate based on race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation. ➢ Investigation Reporting ● PIVOTPoint will report all ethical, disciplinary, investigation of conduct, and any abuse or neglect by program staff to DPS consultant within 5 days of the incident. PIVOTPoint will also continuously update DPS on the process of the investigation. ➢ Consequences ● PIVOTPoint does not use any humiliation, verbal or physical abuse or intimidation, fear or physical pain in practice or as consequences. Natural consequences that mother nature provides are the only form of consequences that PIVOTPoint involves. ● If a PIVOTPoint staff is suspected of abuse or neglect then they will undergo an investigation and will be suspended from all outings until the investigation is complete. ● DSS will be informed immediately of any abuse or neglect by PIVOTPoint staff and juveniles will be transferred to a different staff member. ● DPS consultant will be updated immediately with any progress on the investigation.

4. Pre-Trek Policies and Procedures

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➢ Med Kit Check and Vehicle Pre-Trip google form should be filled out pre-trek every trek ➢ Instructor debrief on pertinent medical and psychological information ➢ Instructor-to-Participant Ratios ● 2:10 at most at all times ➢ Weather and Terrain Check ● Guides should ensure that the weather and terrain are appropriate for the participants. ➢ Appropriate Equipment, Clothing, and Footwear for all Treks ● Backpack ● Waterproof shoes/shoes that can get wet ● Change of socks ● Water and snacks ● Layers: windbreaker, base layer, rain gear, etc. ● ONLY water activities: ONLY closed-toes shoes; NO boots or sandals; NO cotton clothing if possible

5. During-Trek Policies and Procedures ➢ Incident Reports ● Incident Reports will be provided and should be filled out for any/all; ○ Field-Related Incidents ○ Minor or Major Injuries ○ Illnesses ○ Evacuations ○ Behavioral Incidents ⇻ Adverse Reactions ⇻ Psychiatric Episodes ⇻ Anger, Impulsivity, Aggressive Behavior ○ Suicide/Self-Harm Reporting ○ If a client goes missing for more than 15 minutes. ○ Car Accident ● Incident reports should be filled out by the staff member, Program Director, and client involved in the incident.

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➢ Health Care and Dispensing Medication ● PIVOTPoint WNC staff and facilitators are expected to work within the parameters of their WFR certification. They will not dispense medication unless it is to mitigate life threatening situations under the confines of their WFR certification. ➢ Behavioral Management/Physical Restraint ● All facilitators will utilize their CFR training to pre-emptively establish rapport through effective nonviolent communication and appropriate behavioral modeling. ● PIVOTPoint WNC staff are not permitted to utilize physical restraint. ➢ First Aid Protocols ● First Aid Protocols should be followed per WFR/WFA instruction unless otherwise stated in PIVOTPoint WNC Policies and Procedures. ➢ Forest Service Regulations and Permitted Land ● Pisgah (NSFS): We are permitted to operate in Black Balsam Knob Area (access to Flat Laurel Creek Trail, Tennent Mountain access via Ivestor Gap Trail/Art Loeb Spur Train, Shining Rock Wilderness via Ivestor Gap Trail, and Sams Knob). We are also permitted for Graveyard Fields, John Rock Trail Loop, Looking Glass Rock, Big East Fork Trail, Pinnacle Park Trail, Catawba Falls, and Twin Falls (from Pisgah Horse Stables area or access via Avery Creek Falls trailhead on FSR 477). ● DuPont: We are permitted to utilize any of the land in DuPont State Park. ● Conservation Lands: We are permitted to utilize any of the land in conservation lands. ● Green River Game Lands ● Guides will lead therapeutic adventure outings in-line with and in the service of all applicable Priority Use permit stipulations. ● It is the guide’s responsibility to utilize LNT principles, land stewardship, and to sustain our mutually beneficial relationship with these lands by being respectful. ➢ 7 Principles of Leave No Trace ● plan ahead and prepare, ● travel and camp on durable surfaces,

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● dispose of waste properly, ● leave what you find, ● minimize campfire impacts, ● respect wildlife, ● be considerate of other visitors. ➢ Abuse Reporting ● Any disclosure of physical abuse should be reported to the Executive Director and Program Director immediately. It is not your job to speak to staff at the client’s program about the disclosure. ➢ Detox Symptoms: Detox symptoms should be reported to the Executive Director and then the Program Director immediately. Always call 911 in case of an emergency. Clients can experience physical and emotional withdrawal symptoms.

Withdrawal from alcohol or tranquilizers is the most dangerous, producing seizures, strokes, heart attacks, delirium tremens, and/or resulting in death.

Withdrawal from opiates like heroin and oxycontin may be extremely uncomfortable but are not dangerous unless combined with other drugs. Risk factor with opiates increases if there are multiple relapses within a short period of time so check client history. ● Acute Withdrawal ○ Alcohol: Intoxication looks like difficulty walking, slurred speech, lowered inhibitions, low blood pressure, or smelling of alcohol.

Mild to moderate withdrawal looks like tremors, nausea, anxiety, sweats, and sleep disturbances. Severe withdrawal looks like delirium tremens, visual/tactile/auditory hallucinations, seizure, vomiting, diarrhea, and death. ○ Tranquilizers/Depressants: (benzodiazepines i.e. valium, xanax, ativan, klonopin, and non-benzodiazepines i.e. barbiturates and rohypnol): Intoxication looks like difficulty walking, slurred speech, sedation, unusual eye movements, low blood pressure, drooling, and lowered inhibitions. Mild to moderate withdrawal looks like anxiety, sleep disturbances, hypersensitivity to noise/light/touch, perceptual disturbance, feelings of unreality, memory impairment, aches and pains, and palpitations. Severe

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withdrawal looks like depression, suicidal thoughts, agoraphobia, seizure, and death. ○ Opioids: (heroin, methadone, codeine, vicodin, percocet, oxycontin, morphine, etc.): Intoxication looks like sedation, pinpoint pupils, low blood pressure, slowed pulse, itching and scratching. Mild to moderate withdrawal looks like runny eyes and nose, sweating, yawning, restlessness, sleep disturbances, dilated pupils, nausea, weakness, goosebumps, aches, cramps, joint pain, vomiting, diarrhea, hot and cold flashes, fatigue, and drug-seeking behavior. There is no severe withdrawal. ○ Stimulants: (cocaine, methamphetamine, MDMA, dexedrine, etc.): Intoxication looks like agitation, irritability, dilated pupils, fine tremor, sweating, rapid speech and movement. Mild to moderate withdrawal looks like anxiety, agitation, depression, fatigue, extended sleep and increased appetite. Severe withdrawal looks like psychosis and suicidal thoughts. ● Post-Acute Withdrawal (usually lasts for two years) ○ Anxiety, depression, mood swings, irritability, tiredness, variable energy, low enthusiasm, variable concentration, and sleep disturbances. ➢ Knife/Tool/Other Safety: Guides and clients should follow all tool safety protocols. Clients can only use one tool at a time and must return the tool/knife to the guide before receiving another tool. Clients cannot pass a tool to another client. Guides should be aware of who has what tool at all times. Guides should be aware of which clients should not be holding tools (self-harm or suicide concerns). Clients should cut over a log or the ground but not over or towards themselves. Don’t allow cutting on rocks or other hard surfaces. Don’t split wood with knives. ➢ Lightning Protocol: Lightning is a very real threat on PIVOTPoint WNC Treks.

Guides should be aware of the weather at all times to ensure safety of themselves and the group by following all safety procedures and using their best judgment.

Teach your clients how to enter into a lightning drill prior to an emergency drill. Lightning tends to strike the tallest object in the area so PIVOTPoint’s

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protocol is to go to the lowest possible place and avoid being the highest or near the highest point of an area when lightning is a threat. Avoid rocks, trees, cracks, and crevices if possible. When among trees, seek an area in which there are many trees of comparable height. Position yourself midway between trees, away from tree trunks, limbs and root systems if possible. Role-modeling proper lightning drill is the responsibility of PIVOTPoint guides. Guides should begin moving towards lightning drill if lightning flashes and thunder have less than 30-40 seconds between them. 5 seconds equals 1 mile so when the lightning is within 15 seconds then guides should have everyone in the lightning drill.

Lightning drill involved spreading out 15 feet apart with everyone in sight.

Guides should be as far apart as possible with keeping clients in sight.

Remove metal objects and keep away from the body. Communication devices and knives should be stored away from the body. Place insulation such as a backpack or sweatshirt under yourself to insulate from ground current and reduce ability to conduct electricity. Keep your hands off the ground. Crouch or sit low and have feet together, knees bent, with arms resting on knees. The group should remain in lightning position until 15 minutes after the last count of 15 seconds between thunder and lightning.

6. Safety and Emergency Action Plan (EAP) ➢ Emergency On-Call Chain of Command ● Guides should ALWAYS call 911 first. ● Second call should be on call ● The on call will call DPS immediately in the event of an emergency involving a court-referred youth outing resulting in a serious injury to or death of a staff member, intern, contractor, juvenile, visitor, or volunteer. ○ DPS Western Area Office: 828-296-4742 ● Third call should be to the Executive Director 828-748-8424 ➢ Medical Emergencies ● Follow the emergency on-call chain of command procedure for emergencies ● When requesting non-emergency assistance or communicating a non-emergency related incident call on call

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● Documentation is KEY. Signs, symptoms, times, medications, details, etc.

We will provide SOAP notes in your med kits. ● Front Country medical access is anything that’s within two hours of hospital care. Backcountry medical access is anything more than two hours of hospital care. Decisions made by guides should reflect this knowledge and follow appropriate procedure. ● Within the front country; guides are expected to exercise standard first aid practices and only to provide first aid treatment within the bounds of their training (i.e. WFA, WFR, WAFA, EMT) except as indicated in PIVOTPoint WNC policies and procedures. ➢ Evacuation Procedures: Injured person(s) during outings will be immediately stabilized and cared for by on-site guides in accordance with the guide's wilderness medicine training (WFR/WFA/EMT). If it is deemed that a higher level of care is required, those affected who are able to move safely will be transported back to vehicle and taken to Mission Hospital in Asheville NC using evacuation routes listed in our EAP plan. Those injured parties who cannot be safely moved will be stabilized on site and await higher level emergency care. ➢ Safety Hazards ● Creek crossing protocol: clients MUST wear shoes when crossing creeks at all times. Guide running the trek should assist every participant in crossing the creek. ➢ Self-harm and Suicide Protocol ● Low Level of Concern: If a client expresses suicidal thoughts or self-harm thoughts but this is a regular occurance for them and they report a plan and high ability to keep themselves safe. A verbal safety pact should be agreed upon between staff and client and should be followed up on every hour until the trek is over and then should be reported to the Executive Director and Program Director. ● Mid Level of Concern: If a client expresses suicidal thoughts or self-harm thoughts and they feel unsure of their ability to keep themselves safe then a written safety pact should be made between the client and the staff and signed by the client saying that they can keep themselves safe for a certain agreed upon amount of time. Ex: If the client feels as though they

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can keep themselves safe until the end of the trek then staff would write “I will keep myself safe until I return to the house today.” and both will sign it. Ex 2: If the client feels as though they can only agree to keep themselves safe for an hour (any amount of time here) then that’s what you would write instead and both sign and then it’s the responsibility of PIVOTPoint WNC guide to set an alarm on their watch and check in after that amount of time has passed to write a new written contract. Once returned to the house it should be reported to the Executive Director and Program Director. If a client stops being about to commit to a period of time to keep themselves safe then they are moved to “High Level of Concern'' (see below). ● High Level of Concern: If a client is unwilling to commit to a period of time to keep themselves safe OR is actively self-harming/trying to commit suicide then guide should remain within arm’s length to mitigate any further or lasting bodily harm. If another guide is present, they should immediately call the Executive Director and Program Director. If the self-harm is serious enough then emergency services must be called. The Executive Director and Program Director should be alerted at every step and should help make the plan dependent on the circumstances and on communication with the client’s program manager/clinical director. ➢ Lost-Person Protocol ● Lost-Person Protocol should be activated after a client has been out of sight for 15 minutes. ● In this situation one guide and other clients should not hike any further away from the original point where they were noticed to be out of sight.

They should remain where they are for the original 15 minutes that the client is out of sight. Once that window has passed one guide should contact the Executive Director and Program Director. That guide should send SAT phone coordinates and receive confirmation. The other guide should search for the client for 45 additional minutes making it one hour after the client was originally noticed to be out of sight. If NOT found, the guide and group should return down the mountain to the vehicle. If the client is not found at the vehicle or along the way then emergency

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services should be contacted. The Executive Director and Program Director should be informed of any/all updates along the way. ➢ Program Specific Wilderness Medicine Practices ● Spine Assessment ○ PIVOTPoint WNC guides should NEVER clear a spine in the field. ● Reduction of a dislocation ○ PIVOTPoint WNC guides should NEVER reduce a dislocation in the field ● Prescription Medication Administration ○ PIVOTPoint WNC guides should check to see if any clients have epinephrine or allergies before every trip ○ PIVOTPoint WNC guides with WFR certifications should provide epinephrine from the first aid kid per their WFR instruction were a client’s airway to be obstructed by an allergic reaction (anaphylaxis). ● Cessation of CPR ○ PIVOTPoint WNC guides should not cease administering CPR until emergency services arrive. ● Wound Care ○ PIVOTPoint WNC guides should follow wound care procedures per their respective WFA/WFR certification instructions. ● Removal of Impaled Objects ○ PIVOTPoint WNC guides should NEVER remove an impaled object in the field. If the impaled object is keeping the client from moving then staff should remain where they are until emergency services arrive.

7. Vehicle Operations/Safety and Procedures ➢ Insured Drivers List and Eligibility Requirements ● Every driver of a company vehicle should be cleared with insurance before driving.

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● Must be at least 25 years old and have 3-5 years of driving experience. ● Can’t have any major violations over the past 5 years (racing, vehicular manslaughter, driving 25 or more over) ➢ Operating Company Vehicles ● Assessment and Training ● Drug and Alcohol Policy ○ All drivers are subject to random drug and alcohol screening.

Failure to comply with requests could result in disciplinary action up to and including termination. ➢ Pre-Trip Checks ● Drivers must fill out a vehicle pre-trip check form before every time driving a company vehicle. ● Drivers should check tire pressure, gas level, and all paint/windows of the car before driving. ➢ Client Transport and Passenger Safety ● Drivers must have a valid driver’s license in their possession at all times when operating company vehicles. ● Drivers are not allowed to use cell phones while driving including text messaging. ● All drivers responsible for the transportation of passengers must maintain first aid and CPR certifications. ● All drivers must adhere to all state, local, and federal laws regarding the operation of a motor vehicle including but not limited to speed postings, signs, and road conditions. ● Vehicles must be locked when unattended. ● Drivers will ensure that all passengers are wearing a seatbelt while the vehicle is in operation. If a passenger removes their seatbelt, the driver should pull the car over and stop and not continue driving until all passengers are in compliance. ● No smoking or eating in the vehicles at any time. ● Passengers must keep their arms and legs inside the vehicle at all times.

Passengers must not throw anything out of the vehicle.

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● Each vehicle must maintain a first aid kit, jumper cables, and necessary equipment to change a tire. ➢ Accident Procedures ● Mandatory drug screening after an accident from a designated facility. ● If other vehicles or property was involved or anyone was injured 911 should be called immediately. DO NOT ADMIT RESPONSIBILITY/FAULT. If the other vehicle is not occupied the driver must make an attempt to locate the owner and if unsuccessful must leave a note with all information necessary to contact. Ensure safety of all clients.

Call the Executive Director and the Program Director. Document the accident with pictures, list of damages, location, and any other pertinent information. ● If no other vehicles or property were involved then the driver should; ensure safety of all clients, and report the accident immediately to the Executive Director and Program Director. Driver should document all damages to the vehicle and property with pictures and written description.

If there was a domestic animal involved then the driver should attempt to call the owner before leaving the scene. If unable to contact the owner, the driver should contact the local humane society or animal control. ● In both instances; fill out an accident report form. ➢ Overnight Events ○ TBD

8. Confidentiality and Record Retention ● PIVOTPoint WNC will keep all staff and client records for 10 years. ● PIVOTPoint WNC’s staff, facilitators, independent contractors, and volunteers will all comply with HIPAA standards. A discretion against HIPAA compliance can result in investigation and termination.

9. COVID Protocols ● Thermal temperatures taken and hands sanitized before entering the vehicle. While in the vehicle, masks should be properly worn, windows ¼

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of the way down for airflow, maximize distancing, and deep cleaned with anti-viral anti-bacterial cleaning solution after every trek. ● All PIVOTPoint WNC guides will be following state federal and healthcare professional guidelines for facilitator travel across state lines.

Guides will be required to be tested for COVID once a month; reimbursement for Range Urgent Care testing available on a case-by-case basis and to be discussed with the Program Director.

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Appendix A Full Time Lead Staff Roles & Responsibilities The Lead Staff is responsible for the overall execution and facilitation of PIVOTPoint WNC outings. They will report directly to Master Staff for task supervision and to the Program Director for leadership supervision. This description reflects the general guidelines, guardrails, and expectations of the position.

Other tasks and responsibilities will surface as time and organizational needs shift.

Position Structure This position is for 4 days/week at approximately 32 hours a week. Block Scheduling will be either Wednesday through Saturday or Monday, Wednesday, Thursday, Friday. During block scheduling there will be no more than 2 sequential outings for any 1 staff barring staffing needs and concerns for coverage. Staff will occasionally shift from one block to another depending on programmatic needs.

Key Responsibilities The Lead Staff will have two key sets of responsibilities: those carried out during days on the trail and those carried out on days off the trail.

Days spent on the trail The Lead Staff is responsible for leading the provision of constant safety, risk assessment, and therapeutic management of clients during outings. Comfort with each population with whom we work and the best practices in providing targeted, relevant therapeutic support is paramount. This Includes,but is not limited to: ●

● ●

Planning, developing, and delivering therapeutic processing under the direct support of Master Staff and with the supervisor of Program Director in conjunction with intake/assessment paperwork, additional referral documentation, and in alignment with the PIVOTPoint Program curriculum. Group facilitation will be based around the education, scaffolding, practice, and implementation of the following skills: effective and compassionate communication, prosocial behavior, active listening, inter- and intra-personal relationship building, problem-solving, and self-regulation skills.

Pre-trek review of activities for the day with co-staff (including back up plans, delegation of safety checks and client-related protocols, and perceived/anticipated client outcomes) Engage in consistent rapport building with clients, including serving as a mentor to clients in group facilitation through active client engagement throughout the duration of their programming

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●

Engage in consistent rapport building with Support Staff, including serving as a mentor in their ongoing training and development from Support to Lead Staff

Experience with the following is fundamental to our work – we will provide resources to assist in the development of this knowledge base: Cognitive Behavioral Therapy, Gestalt Therapy, Community Resilience Model, Motivational Interviewing, Acceptance Commitment Therapy, Mindfulness-Based Practices, and various psycho-ed and experiential education groups.

Lead Staff is responsible for final sign off and incorporation of Support Staff field notes and pre- and post-trek paperwork. While the primary responsibility of the Support Staff, your role requires more than proficient wilderness first aid and SAT phone skills. Lead Staff must have an up-to-date knowledge of PIVOTPoint WNC Policies & Procedures prior to, and throughout duration of employment. Availability for bi-monthly meetings is expected.

Days spent off the trail Administrative hours (defined as any time spent not on trail with clients) will comprise of peer-led workshops, client case studies, and extensive familiarity with the organization’s policies, practices, intentions, and goals. Assignments will be discussed and delegated on a case-by-case basis and in consideration of the strengths of each Lead Staff. We will create projected tasks for each team member and the organization as a whole and co-create accountability check points to track progress.

Organizational tasks may include, but are not limited to: ● ● ● ●

Client documentation upkeep and review, Regular check-ins regarding tasks, skills, feedback, and case conceptualizations with Master Staff and peer staff Monthly strategy plans for community outreach and engagement Administrative and logistical support as needed (permit updates; gear and maintenance oversight; client relationship management; etc)

This role requires: ●

● ●

●

A willingness to participate in staff meetings and trainings with authenticity and accountability, navigating the giving and receiving of feedback with respect and implementing feedback in a timely manner.

Excellent communication skills and accountability Training, knowledge, and/or experience facilitating groups informed by the therapeutic theories that PIVOTPoint WNC is informed by and is capable and invested in creating meaningful group topics Exemplary ability to work and communicate well with others in professional settings and with clients and families

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● ● ● ●

●

Practice self-care & resiliency and live and work in alignment with our values & mission Being “at home” in the woods; and being comfortable with any of the following: paddling, climbing, mountain biking, and camping Possess the ability to hold healthy therapeutic boundaries Someone who demonstrates a commitment to their own growth and development regarding emotional regulation, grounding and core value alignment. Whether through personal therapy, group work, experiential courses, etc.

Themselves and can speak from a peer-delivered services perspective about the value of therapeutic work

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I have read, understood, and will adhere to all of these Policies and Procedures. Furthermore, I understand that the information and parameters set forth herein may evolve and shift as the organization evolves and shifts. At such time, updated and amended Policies and Procedures documents will be provided for review, comprehension, and adherence.

_________________________________ Signature

______________________________ Date

_________________________________ Printed Name

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