Presentation created by Texas A&M University System Risk Manager Henry Judah 04/26/2011

 Why Review Summer Camp Programs?  System Audit Findings  Outline System Risk Management Survey Process  Explore Findings From Survey › The Good › The Bad › The Ugly  Review Regulating Entities of Camp Programs in the State of Texas  Recommended Best Practices  System Summer Camp GL and Accident Medical  Session Summary

 Involves the care of minors  Increased attention-Reputational and Legal Risks Are Higher › Serving as surrogate parents while in our care › Emotional reaction when children involved › Increased likelihood of media attention › Increased desire to “place blame” and “punish”  Risks Associated With Children › Sexual molestation › Injury and/or death › Missing › Mental Harm

Camp Administration

 Camp administration lacks university-wide procedures and oversight. Management could not provide a comprehensive list of current camps. We identified at least 17 camps that were held on the campus in fiscal year Camps held on the University’s campus host kindergarten through college-age participants. Without procedures and oversight for camps, the risk of injuries and potential liabilities is increased

 Overall, the controls established over Athletic Department operations at Nameless University are effective in providing reasonable assurance resources are used efficiently and effectively and in compliance with laws, policies, regulations, and University rules except in the area of cash receipts. Significant improvements are needed in the Department’s cash receipting procedures. Opportunities for improvement were also identified in the areas of sports camp administration and the affiliation agreement with the ????? Club

 Of the four university-sponsored camps reviewed, two lacked documented approvals on file; one did not have a signed agreement or contract; one did not have waiver of liability forms and emergency medical release forms for participants; and one could not verify that background checks for camp personnel or volunteers occurred.  Camps were not monitored to ensure that the third-Party sponsor had adequate insurance coverage for the camp, that background checks were completed on camp personnel, and that emergency medical information was obtained

 No University rule or comprehensive written operating procedures have been developed to provide standardization and guidance to the administration of university-sponsored camps. As a result, certain safety processes within these camps require improvement to better ensure the safety of camp participants (especially youths). For instance, although background checks or screenings recently began on University employees, no similar checks are being performed on non-University personnel or volunteers prior to working at the camps. In addition, camp documentation is decentralized at the responsible department and standardized Forms are not always used making it difficult to ensure all documents are completed, signed, and retained.

 Of the seven camps tested for proper safety documentation one camp did not retain any participant safety documentation. Of the 102 camp participants tested in the remaining six camps, seven percent (7%) did not have a properly completed or signed medical release form and eight percent (8%) did not have a properly completed or signed waiver  The University rules and procedures do not address camps held by University departments or employees. Without guidance, a camp may be held that is incongruent with the University’s mission or without the knowledge and approval of the administration. Adequate insurance for the camp may not be obtained. In addition, adequate participant information may not be obtained, for example release, waiver, and authorization for medical treatment. Without guidance, or approval, the University could be exposed to both reputational and legal risks

 Survey sent to Members  Replies received  Summary of findings documented  Trends and inconsistencies noted  Translate finding into best practices recommendations across the System

The Good The Bad The Ugly

 All members with camp programs have an application process  Some have an online registration process while others have a paper process  Recognition for the need to complete background checks

 Different levels of authority for final approval  Not all Members complete a risk assessment form (and for those who do, some online, others paper form)  Camp directors are not required for all camps  No standardized criteria for who should serve as camp director and/or counselor  Differences in who conducts the background checks (HR or UPD)

 Storage location and retention schedules of background checks vary  Guidelines for transporting minors vary from Member to Member  Amount of time for review of waivers by parents is inconsistent  Waiver storage location and retention schedules vary Member to Member  Procedure manuals are used by some but not all Members

 Inconsistent background checks relating to who, how often etc.  Differences in criteria used to evaluate background checks  Medicine distribution is treated differently by Members  Camper to counselor ratios vary for both day and night activities

 Texas Administrative Code Texas Administrative Code  TITLE 25 HEALTH SERVICES TITLE 25  PART 1 DEPARTMENT OF STATE HEALTH SERVICES PART 1  CHAPTER 265 GENERAL SANITATION SUBCHAPTER B TEXAS YOUTH CAMPS SAFETY AND HEALTH CHAPTER 265 SUBCHAPTER B  Rule Medical and Nursing Care Rule

 The Texas Department of State Health Services is the principal authority on matters relating to health and safety conditions at youth camps in Texas. All youth camps must obtain a license prior to operating. Any youth camp may be inspected during operation to determine compliance with the Youth Camp Act and the Youth Camp Rules. Youth Camp ActYouth Camp Rules › To determine if an operation is a youth camp, the operation must meet the following criteria: › A facility or property, other than a facility required to be licensed by the Department of Family and Protective Services that:  has the general characteristics of a day camp, resident camp, or travel camp;  is used for recreational, athletic, religious, or educational activities;  accommodates at least five minors who attend or temporarily reside at the camp for all or part of at least four consecutive days; and  is not a facility or program operated by or on the campus of an institution of higher education or a private or independent institution of higher education as those terms are defined by the Education Code, §61.003, that is regularly inspected by one or more local governmental entities for compliance with health and safety standards. › A youth camp provides supervision, instruction, and recreation, utilizing a variety of activities primarily in an outdoor, natural environment, for children who are apart from their parents or legal guardians. › A youth camp operates only during school vacation periods, and not more than 120 days per calendar year; and › A youth camp accepts a camper for a minimum of four consecutive days for more than four hours per day.  Sec EXEMPTION. This chapter does not apply to a facility or program operated by or on the campus of an institution of higher education or a private or independent institution of higher education as those terms are defined by Section , Education Code, that is regularly inspected by one or more local governmental entities for compliance with health and safety standards.

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 Minimize the number of external camps on the premises if possible (it is understood this may not be practicable by some Members)  For external camps, maintain the same processes, expectations and guidelines as internal camps  Integrate the approval process as closely as possible with internal camp application process  Hold external camps to the same degree of care as internal camps

 Develop online camp application, review and approval process  Incorporate camps procedures and policies online (likely a secured website)

 A camp shall have written personnel policies and practices for both campers and staff. Supervisors shall be informed of these policies and practices prior to assuming responsibility for campers

 Complete a risk assessment form for each camp  Involve System Risk Management When Appropriate

 Every camp should have a camp director appointed who is an employee  Develop and maintain a set of “qualifications” for camp director position

 Every camp should have a program director appointed who is preferably an employee  Develop and maintain a set of “qualifications” for program director

 Every camp should have a set of qualifications for camp staff members and consideration should be given to specialty qualifications for special camp activities  Status of permanent employee vs. contract employee as it relates to liability esc/titles

 All personnel associated with all camps should have a background check completed  State Records Retention Schedule Employment Selection Records Includes notes of interviews with candidates; audio and videotapes of job interviews; background, criminal history and previous injury checks; pre-employment physical examinations; polygraph examination results; and all other records that document the selection process. See for security clearances on hired applicants. › CFR (a) (State Agencies) › 29 CFR (State Universities) › CAUTION: Does not include criminal history checks. See item number

 Criminal conviction and sex offender background check requirements. The camp management shall have on file a record of any criminal conviction and a sex offender registration check for all adult staff members and all adult volunteers working at the camp before the staff member or volunteer has unsupervised contact with children at the camp. If the records are located off-site, a letter from the national or regional headquarters of the camp organization stating the names of individuals at the camp site for whom background checks have been conducted, shall be available at the camp site. All records of criminal convictions and written evaluations for a camp or camping organization shall be made available to department personnel within two business days upon request.  Youth camps are responsible for ensuring that criminal and sex offender background checks have been conducted for international staff obtained through the J-1 visa process, and that documentation of these checks are located with other staff background checks. Records of criminal convictions and sex offender status shall be obtained by ????

 (1) performing an annual criminal background check using a criminal history database for each adult staff member's and each adult volunteer's permanent residence. If the staff member or adult volunteer has a temporary or an educational residence, an annual criminal background check shall include searching under the permanent, temporary and educational address, as applicable. The criminal history database used for the criminal background check is to be based on the individual's residences, and may include state, national or international databases. Documentation of the search results, whether or not the results are positive, shall be maintained with the sex offender background documentation; and  (2) performing an annual background check using a sex offender registration database for each adult staff member's and each adult volunteer's permanent residence and educational residence if applicable, such as the TXDPS - Sex Offender Registry, which may be accessed at Texas Department of Public Safety - Crime Records Service. Documentation of the search results, whether or not the results are positive, shall be maintained with the criminal background documentation

 Camp participants should be given adequate time to seek legal counsel prior to signing the form.  Standard system waiver and release should be used  doc/WAIVER-INDEMN-MEDICALAUTH- OGCFORM doc doc/WAIVER-INDEMN-MEDICALAUTH- OGCFORM doc

 Each youth camp shall have at least one adult supervisor who is responsible for the supervision of no more than ten children in the camp. For any hazardous activity the supervisor(s) shall be in the immediate vicinity (within sight and/or hearing) of the campers. An "all camp" sedentary activity, not requiring physical activity, may require less supervision, and each camp shall establish its own guidelines, but not less than one adult supervisor to every 25 campers. The camp director shall not be included in the supervisor to camper ratio in camps serving over 50 campers at one time System Risk Management Recommendations

 At least 80 percent (100 percent for camps primarily serving persons with special needs) of the staff are eighteen years of age or older  All staff are at least sixteen years of age and at least two years older than the minors with whom they are working

 Clarify the Camp Policy about Privacy of Personal Health Information  The rule acknowledges that healthcare providers need access to information about the people for whom they provide direct care. But it raises a question about other people or entities. Determine your camp's current way of handling protected health information (PHI). Remember to consider: › Who receives completed health forms and who has access to those forms before camp starts? › About what health concerns are kitchen staff typically informed? Why are they told? Specifically who is told - just the head cook or the entire kitchen staff? Could that pool of people be more limited without jeopardizing safety? › What health challenges are shared with cabin staff? › Who in the specialized areas of camp - waterfront, ropes course, horseback riding, tripping, etc. - are told about health challenges? Why are they told?

 Under what circumstances does PHI leave camp? How is the privacy of that information monitored?  What individuals have access to all and any PHI? Who has limited access and how is that access limited?  When a person leaves camp - whether on a day trip or at the end of their camp session - how is their health history secured? Who makes decisions regarding the disposition of that information?  How does one gain access to PHI?  The Privacy Rule directs entities to define their policy and make that policy generally known to clients as well as implement "reasonable steps" to limit use of protected information within the entity and in regard to requests it may receive from other parties. Information must only be released to those with a clear "need to know

 Be certain to obtain required health history information  All drugs must be stored under lock. Prescription drugs must be dispensed only under directions of physician. Nonprescription drugs dispensed only under written health care procedures or signed instruction of parent/guardian.

 For external camps, the following insurance should be required:

 Policy Summary and Rate Sheet  Loss Frequency/Loss Payments  Camp Roster

 Take a pro-active approach to camp management  Develop established processes and publish to all relevant staff and employees  Network and leverage other Members for best practices ideas  Call System Risk Management with any questions