Planning for - and minimizing the impact of - undisclosed medical/psychological conditions
Introduction: It's common for outdoor programs to experience "undisclosed medical / psychological conditions," where a participant (or parent) will withhold information in the medical form / application to participate. We will never know the full extent of these undisclosed conditions, as we only learn about SOME of them. However, based on many years of experience working with a wide variety of programs, we have identified the following strategies to minimize the impact that this issue has on outdoor programs.
Philosophy: First and foremost, we don't see medical evaluation as a tool aimed at ruling participants out / screening them off of a program, though of course a certain number of participants will likely end up not participating as a result of the assessment. We see the primary purpose of medical evaluation as helping to gain the essential information needed to appropriately support students to succeed. This could include using the information on the form to make sure they've signed up for the best program, in the right location, paired with the best program leaders, etc. It could also be used to make sure that the leaders (and office staff) are equipped with strategies they need to help the student succeed during the program, such as what kind of food or equipment will be packed, or what strategies help a student overcome their personal challenges.
Recommendations: We recommend the following steps to help minimize the likelihood (and the impact) of undisclosed conditions.
1 - Establish clear, written policies and procedures for how medical/psychological conditions will be assessed, including what kind of conditions can't be accommodated on a program. These policies and procedures should be developed in consultation with a physician advisor, and regularly reviewed/refined. Consider formalizing written "essential eligibility criteria" (EEC’s) for each trip. If you use EEC's, they must be applied fairly and evenly to everyone, not just those who present with conditions, and review the EEC’s with your HR / Legal / Program team.
2 - At the same time you have clear policies and procedures, we recommend also integrating critical thinking and flexibility into your approach. Remember that you are not seeking out ways to exclude, your primary purpose is to find the right ways to include. This means finding the right way to say "yes" rather than starting from a place of "no." Learn to say “no, you can’t go on a certain trip now, but you will be able to go ife X, Y, or Z is achieved / demonstrated.” For example, once a student has demonstrated that they are stable and consistent on a psychotropic med for a reasonable amount of time, etc.
3 - Be meticulous about only asking for information that is useful, and that you will actually use to make meaningful decisions. It does not do you any good to collect information that you won’t / don’t know how to use, and you may be more at risk for collecting information that you fail to meaningfully utilize.
4 - Educate participants (and parents, if serving minors) about the purpose of your medical evaluation process, and how the information will be used. Also, advise them about the importance of being open and transparent. The information they share (or withhold) can affect the wellbeing of the entire group, especially if an undisclosed condition creates an abrupt change to the itinerary, an evacuation from the field, or affects the ratio of leaders to participants, for example. Consider highlighting that undisclosed medical conditions that are discovered in the field may warrant removal from the program, and may also incur evacuation costs to participants/families. We recommend being open and direct about the fact that some conditions will necessitate additional assessment, such as follow-up questions or conversations with doctors.
5 - Create policies and training for how to respond when an undisclosed condition arises during a program / in the field. Depending on this circumstances, this does not automatically mean removal from the program, but may require re-evaluating the students' fitness for the program.
De-Stigmatizing Mental Health: While parents, students, and leaders don't hesitate to report or openly discuss medical conditions like a recently sprained ankle or high fever, our society places more of a stigma around openly disclosing and discussing mental health issues. As mental health becomes more of a widespread and increasingly understood (common) issue, we now see programs such as Mental Health First Aid becoming equally widespread across the country. We recommend that the school be proactive about educating parents and students about your approach to medical evaluation, that your goal is to appropriately include rather than exclude, and that being transparent about mental health concerns is the best way to help students succeed. This can help to de-stigmatize mental health issues and promote more transparency by parents and participants.
Summary: Undisclosed conditions are a common issue in the outdoor industry, and we are certain that they will never completely cease to be an issue. However, rather than being caught off guard by them, we recommend being proactive and appropriately responsive when they do arise, and grounding your approach to medical evaluation (not “screening”) in your program's mission and culture.
DIsclaimer: This blog is not offering specific legal advice for your program. State laws vary and we recommend that you take this blog as general information, not specific guidance for your program. Consult with local attorneys and physician / counseling advisors to fine tune an approach to these issues that works best for your program.