(Also see HILLCREST policy on “Professional Boundaries”.)

INTRODUCTION
By its very nature, residential care and treatment with children and adolescents involves intense interpersonal dynamics and some intensely intimate aspects of the lives of students. The nature of our work can contribute to and result in complicated emotions and strong personal feelings and/or relationships between staff and students. The familiarity that develops between staff and students also contributes to a relationship that may be so comfortable at times that feelings and responses may be, in fact, personal instead of professional.

These feelings and relationships, if understood, acknowledged and managed well, can have positive, beneficial, therapeutic impacts on students without causing harm to any student or staff. However, if misunderstood, unacknowledged or poorly managed, they have the potential to cause serious harm to students and/or staff. Therefore, the challenge is:
1) to understand, acknowledge and manage feelings and behaviors appropriately and professionally;
2) to develop staff-student relationships that are professional, therapeutic, and in the best interests of HEC students.

The role modeling of professional boundaries by all staff, regardless of role or function, promotes mutual respect and a culture of respect. It helps to insure proper care and treatment for students, and protects staff employment status, liability vulnerability and reputation. (Also see HEC policy on “Boundaries”.)

The following policy statement is intended to define the expectations and obligations of Hillcrest staff, both current and former, with regard to personal versus professional contact and/or relationships with current and/or former Hillcrest students.

POLICY STATEMENT

Hillcrest Educational Centers, as a licensed and accredited behavioral health agency, has an obligation to ensure that professional boundaries between students and staff are respected and maintained. Both experience and best practices have clearly demonstrated over time that maintaining these professional boundaries is essential to insure proper and effective care and treatment for students, regardless of the personal feelings, either positive or negative, any staff may have toward any student. Hillcrest, therefore, must reserve the right to limit and/or disapprove what is, or may be, inappropriate or unauthorized contact between current and/or former HEC staff and current and/or former HEC students, and/or any relations and/or contacts that are contraindicated by virtue of student or staff characteristics.

Regardless of their role or position, almost all Hillcrest staff come to know and have contact with students as part of their professional function and because of their Hillcrest employment. During the course of employment, it is natural and normal for each of us to have a range of feelings and reactions to the students, both positive and negative. It is natural for us to “like” some students more than others, just as it is natural for students to “like” some staff more than others. As Hillcrest staff, however, good practice and professional standards of conduct require us to treat and deal with all students in an unbiased, equal and professional manner, regardless of our personal feelings about them or our reactions to them. Therefore, the agency has both the right and the responsibility to develop and to enforce these standards for staff conduct with students.

All contacts and relationships between staff and students, current and/or former, must be strictly professional in nature and function, regardless of the employment status of the staff (i.e., currently or formerly employed by HEC) or the placement status of the student (i.e., current or former student). This, in fact, is the only way to insure that staff – student contact and relationships are appropriate and therapeutic in nature.

There are four basic conditions to which this policy applies.
1) The staff is currently employed at HEC. The student is currently in HEC care.
2) The staff is currently employed at HEC. The student has been discharged or transferred from HEC care.
3) The staff is no longer employed at HEC. The student is still in HEC care.
4) The staff is no longer employed at HEC. The student has been discharged or transferred from HEC care.

The essence of this policy is a clear differentiation and boundary between personal and professional contacts and relationships between staff and students, whether current or former. This differentiation and this boundary are consistent with HEC expectations, and with ethical codes and standards for all helping professions.

1) The relationships and/or contacts (i.e., communication by mail, telephone, email, etc.; in person meetings; etc.) between current and/or former HEC staff, and current and/or former HEC students are exclusively professional. They are guided and bound by the HEC Code of Ethics, HEC Policy and Procedures, and by the staff member’s current or former role and job description.

2) It is neither appropriate nor acceptable for any current or former student to have a current or former staff member’s home telephone number, home mailing address, email or “instant messenger” address, or any other personal or demographic information that allows or encourages personal versus professional contact. If a staff member becomes aware that a current or former student has such personal information about any staff, including themselves, they are required to immediately report this fact to their immediate or former supervisor, or to an HEC administrator.

3) Former Hillcrest staff shall have no contact with current or former HEC students unless the contact has been authorized by HEC administration.

4) Any and all desired contacts and/or relationships between current and/or former HEC staff and current and/or former HEC students that are outside the parameters of the staff member’s role and/or job description, and which therefore might constitute personal relationship or contact, must be discussed in advance with the campus Program Director and/or the agency Executive Vice President or CEO and be determined by them to be in the best interest of the current or former student. Such desired relationships and/or contacts may only be conducted with the knowledge and approval of the campus Program Director and/or the agency Executive Vice President or CEO.

Any such relationship and/or contacts between current and/or former HEC staff and current and/or former HEC students that are not approved in advance will be considered to be in violation of HEC policies, procedures and professional ethics. Such an unapproved relationship and/or contact will be cause for disciplinary action for a current employee who engages in such action, up to and including termination from employment. Legal or administrative action or referral may be initiated against former employees who violate this policy or when there is reason to believe this policy has been violated.

Former employees who choose not to respect and follow these policies and procedures will receive negative references to future, prospective employers and/or helping agencies (e.g., foster care or adoption agencies) checking HEC references.

Similarly, during any form of contact with a student’s family, guardian, or advocate, or with any representative an outside agency, staff are expected to act in a professional manner. For example, at no time during a professional contact may staff violate professional boundaries, form personal relationship or share personal information.

Finally, if there is any evidence or reason to believe that inappropriate and/or illegal contact between a current or former staff and a current or former student may have occurred, relevant social service and/or law enforcement agencies shall be notified.

WHEN FORMER STUDENTS CALL A CAMPUS
It is not possible to detail all possible scenarios or conditions related to former students calling, writing to, or making an unplanned visit to a campus. It is essential, therefore, that Supervisors use their best professional judgment about how to manage such contacts. The following guidelines should be used to guide such management decisions.

Calls:
1) The person answering the telephone should transfer the call to the Supervisor.
Calls from former students should not be transferred to other students, direct care staff or to Teams.
2) Most students who call a campus do so with benign intentions. They are usually attempting to maintain connections with people with whom they had meaningful relationships. Students may also call because they are troubled, are in trouble or are seeking affirmation or reassurance in some way. Therefore, whoever converses with a former student should be cordial and professional. The call should not be treated as “social call”. The conversation should be channeled toward the caller with regard to our interest in their activities, progress, etc.
3) Anyone conversing with a former student should be sure to guard the privacy and confidentiality of both current students and staff by not disclosing any information. A summary of the telephone call shall be developed in writing and reviewed with an HEC administrator to determine if any follow-up is required. The documentation of the telephone call, and the follow-up activities, if any, shall be placed in the former student’s file.

Mail:
1) Incoming mail from former students should be forwarded directly and unopened to the Program Director or his/her designee, who will determine whether a reply is in order and who should make that reply.
2) The principles noted above apply to mail as well as calls. The mail interaction should be cordial and professional, with ongoing interest about the student and their life expressed. Rules of confidentiality and privacy apply.

Unplanned Visits:
1) Unplanned, unapproved visits by former students are neither appropriate nor acceptable. As with any unauthorized visitor, the Supervisor should be immediately notified about the student’s presence and the Supervisor should intervene.

2) The visiting student must not be encouraged or allowed to “go visiting” on the campus without supervision. While on campus, they must be with a staff member at all times.

3) While being treated in a cordial and professional manner, the visiting student should receive a clear message that unplanned visits are not acceptable, and that all visits must be planned and approved. Without undue haste, the student should be directed to leave the campus in a timely fashion, and the Supervisor or his/her designee should ensure that the student has left. As with any unauthorized visitor or intruder, if the student refuses to leave in a timely fashion, despite the staff’s best encouragement, the police should be called.

(Also see HILLCREST policy on “Staff Contact and Relationships With Students”.)

INTRODUCTION

By its very nature, residential care and treatment with children and adolescents sometimes involves intense interpersonal dynamics and some intensely intimate aspects of the lives of students. The nature of our work can result in complicated emotions and strong personal feelings and/or relationships among staff and students. The familiarity that develops between staff and residential students also contributes to a relationship that may be so comfortable at times that feelings and responses may be more personal than professional. However, nurturance, acceptance, encouragement, and support can and must be provided by staff while still maintaining professional boundaries.

A student will interpret the staff’s actions based on the student’s own developmental level, on their cognitive ability to understand the parameters of the relationship, and on their level of emotional need and psycho-emotional condition. Abused, neglected and emotionally disturbed students frequently have issues or problems in interpersonal relationships. They often have inadequate sense of boundaries, and they sometimes interpret the staff’s actions in relation to their unmet needs and their experience in unhealthy relationships. Additionally, as caring adults, we are naturally inclined to reach out protectively to students who are showing distress or emotional pain. Without self-reflection, understanding and objective guidance (e.g., good supervision), the needs of a particular student and the needs of a particular staff can interact in such a way that the relationship moves in an unhealthy or inappropriate direction.

The work we do requires an ability to be meaningfully related to a student yet separate enough to distinguish one’s own feelings and needs. We owe it to our students to be introspective about ourselves and our own needs so that we do not blur or confuse relationships and send mixed messages.

These feelings and relationships, if understood, acknowledged and managed well, can have positive, beneficial, therapeutic impacts on students without causing harm to any student or staff. However, if misunderstood, unacknowledged or poorly managed, they have the potential to cause serious harm to students and/or staff. The challenge is to:
• understand, acknowledge and manage feelings and behaviors appropriately and professionally.
• develop staff – student relationships that are professional, therapeutic and in the best interests of Hillcrest students.

BOUNDARIES – DEFINITION AND FUNCTION
The term “boundaries” is a metaphor for the protective limits between the staff and the student. It refers to the psychological, emotional, interpersonal and even physical space that allows for a safe connection and relationship based on the student’s needs, not those of the staff. Boundaries, including such constructs as codes of ethics, professional standards and licensure, perform a number of important functions. For example, they:
• help to structure the staff – student relationship to be professional and therapeutic, not personal or social relationship.
• define appropriate behavior, and provide security and order.
• help to define roles and responsibilities, and set the parameters within which care, treatment and other services are delivered.
• allow students to get safely close to others, yet remain separate.

A professional/therapeutic relationship is a planned and goal directed series of interaction between agency staff and a student for the purpose of providing care and treatment to the student. In a professional/therapeutic relationship:
• the needs of the student, rather than of the staff, are the highest priority.
• the roles are clearly defined, structured and they do not change or reverse; the focus of the relationship is on the student.
• the interactions, interventions and outcomes are periodically evaluated.

In a friendship or social relationship, on the other hand:
• mutual needs are met, rather than the needs of the student, and it is appropriate at times to put one’s needs first.
• roles may shift periodically and even dramatically.
• there is little emphasis on evaluation of the interaction or the outcome.

The primary concern and focus in therapeutic relationships, and when establishing and managing boundaries with current and former students, must be the best interests of the student, as well as associated Hillcrest policies and procedures.

The development of a trusting “connection” between staff and the student is essential because it allows the student to take the necessary risks involved in making change. It is the responsibility of the staff to simultaneously maintain the boundaries of this professional relationship while establishing and maintaining a therapeutic “connection” with the student. It is essential, though not necessarily easy, to balance a caring and supportive relationship with students with appropriate professional distance and boundaries. This task is particularly complicated, difficult and critical with children and adolescents whose needs, urges, impulses and boundaries are often confused and distorted.

Some staff rationalize and justify their friendship or boundary violations with a student as being “the kind of help the student really needs” and as “really caring”. However, students come to Hillcrest for care and treatment; the long-term goals and plans for the students are the primary consideration. Inappropriate relationships are a shift away from the needs of the student needs to the needs of the staff. Students have the right to professional and therapeutic care, and Hillcrest has a responsibility to insure that staff have caring, but professional relationships with students.

Regardless of their role or position, almost all Hillcrest staff come to know and have contact with students as part of their professional function and because of their Hillcrest employment. As Hillcrest staff, good practice and professional standards of conduct require us to treat and deal with all students in an unbiased, equal and professional manner, regardless of our personal feelings about them or our reactions to them. The role modeling of professional boundaries by all staff, regardless of role or function, promotes mutual respect and a culture of respect. It helps to insure proper care and treatment for students, and it protects the staff as well as the students.

There are potentially serious consequences to the blurring of boundaries and to unprofessional relationships. When this happens, neither the student nor the staff are able to respond objectively due to the “friendship”. When objectivity is lost, staff respond out of emotion, rather than out of therapeutic objectivity and professional judgment about a student’s best interests. There is a conflict of interest that interferes with student treatment, and with the group and Team process and relationships.

Additionally, staff put themselves at risk for liability because of inappropriate or unapproved contact. If a student or student’s family were to pursue litigation or other legal action against a staff member, the staff may not have legal support from Hillcrest because they were not acting according to Hillcrest policy or appropriately in the capacity of an employee.

IMBALANCE OF POWER
In any professional relationship there is an inherent power imbalance, and the staff – student relationship is one of unequal power. Staff have knowledge, access to privileged information, authority and influence. Staff provide daily care and assistance to students, and students often grow to trust staff and value their help and care, which adds to the imbalance in the power structure within the relationship. Staff provide information about student behavior and progress, and they have input into important decisions made about students’ lives. Whether they realize it or not staff have tremendous influence over students. Therefore, staff have a responsibility to act in the best interests of the student. We, and not the students, are ultimately responsible for managing boundary issues, and we are accountable should violations occur.

Given the power imbalance that exists in the staff – student relationship, students may find it difficult to negotiate boundaries or to recognize or defend themselves against boundary violations. For that matter, students are usually unaware of the need for professional boundaries, and they may frequently initiate behavior or make requests that could constitute boundary violations. When a relationship is strictly professional, it has checks and balances that help to insure that staff – student interactions are appropriate and in the student’s best interests. As soon as the relationship becomes emotional and personal, however, the professional relationship is lost. The checks and balances designed to protect the student and the staff break down, and the staff responds more personally rather than professionally to the student.

It is possible to maintain a compassionate, warm and caring professional relationship with students that helps them feel cared for and motivated to work in treatment without violating professional boundaries.

BOUNDARY VIOLATION
“Boundary violation” means “outside the limits of the therapeutic and professional relationship”. Most boundary violations are unwitting, subtle, and largely unconscious. The history and plight of some students may persuade some staff to respond in a therapeutically inappropriate way. The seductive pull of helping can sometimes make the distinction between appropriate and inappropriate unclear. Boundary violations may occur with either current or former students, and they may occur even after staff have left employment with Hillcrest Educational Centers.

The following are examples of the types of professional boundaries violations that may occur between staff and students.:
Role boundaries:
o Doing things for the student that are not a part of job responsibilities (e.g., buying clothes for a student with your own money).
o Treating a student as a “friend” or confidant.
o Interacting with coworkers in a “social” manner with students present (e.g., discussing a date or a night out” in front of students).
o Having “rescue fantasies” about or “over-identifying” with a student or students.
Time, Place and Space boundaries:
o Spending more time or unusual time (e.g., during staff’s time off) with a student.
o Spending free time or private time with a student to the exclusion of other students.
o Having unapproved contacts with students in settings other than approved settings (e.g., during a community outing, bringing students to one’s own home).
o Violating the ‘rule of three”.
Money, Business and Service boundaries:
o Having any type of business, financial or service transaction with a student (e.g., borrowing or lending money; giving or taking personal money, buying or selling items).
Gifts and favors boundaries:
o Accepting or giving personal gifts, including personal photos (as opposed to giving or receiving gifts between staff and the Team).
o Allowing/encouraging the student to do favors for the staff (e.g., wash a staff’s car), or the staff for the student (e.g., make an unauthorized purchase for the student).
Fair and Equal Treatment boundaries:
o Treating students on the basis of your “like” or “dislike”.
o Favoring one student over others.
o Treating a student unfairly or differently from others; giving special attention/treatment to a student that differs from that given to other students, or refusing to provide normal or prescribed care and treatment to a student for personal reasons (e.g., dislike).

Clothing boundaries:
o Dressing in a way that is unsuitable for work or in a seductive manner or in any way that blurs, confuses or distorts the relationship with the student.
Language boundaries:
o Using too familiar or inappropriate names or nicknames in addressing each other, use of inappropriate or suggestive humor or language (e.g. profanity).
Self-disclosure boundaries:
o Sharing with a student personal or intimate information, work concerns or private information about other staff or students;
o sharing any sort of secrets with a student.
Physical Contact boundaries:
o Having a type of physical contact, or more physical contact than is appropriate or necessary, or than is allowed by campus policies, or than is reasonably required for a situation.
Abuse boundaries:
o Physical, verbal, emotional abuse; inappropriate or unnecessary use of restraints.
o Having any sort of sexual contact with a student.

The list above is not all-inclusive. It is intended for use as a guideline and to provide examples of unprofessional behavior and boundary violation.
Staff are expected to observe appropriate and professional conduct, including boundary maintenance, at all times. Failure to maintain professional conduct and to observe appropriate and professional boundaries will result in disciplinary action up to and including termination from employment.

Similarly, during any form of contact with a student’s family, guardian, or advocate, or with any representative an outside agency, staff are expected to act in a professional manner. For example, at no time during a professional contact may staff violate professional boundaries, form personal relationship or share personal information.
 
QUESTIONS TO CONSIDER IN EXAMINING POTENTIAL BOUNDARY ISSUES
In some cases, boundary issues may pose dilemmas for a staff, and there may not seem to be any clear or obvious answers. In determining how to proceed, in addition to discussion with one’s immediate supervisor, consideration of the following questions may be helpful.
o Is this in the student’s best interest?
o Whose needs are being served? Does this action benefit me rather than the student?
o Am I dealing with this student (or student’s family) differently than I would another student (or family) under similar circumstances? Am I treating this student differently (better or not as well) than I treat other students?
o Does my behavior with this client differ from my usual professional behavior (e.g., dressing differently, being more concerned about appearance)?
o How would this be viewed by the student’s family, guardian or custodial agency?
o Would I say or do this particular thing if a coworker were present? How would I feel telling a coworker or supervisor about this?
o Will this have an impact on the student’s care, treatment or emotional condition?
o Should I discuss my feelings, concerns or questions with my supervisor?
o Does this student mean something ‘special’ to me?
o Am I taking advantage of the student or allowing the student to take advantage of me?
o Would I be comfortable documenting this decision or this behavior in the Team Log or student’s file?
o Would this (or does this) decision or behavior violate state regulations, the Hillcrest Code of Ethics, Hillcrest Policies and Procedures, or any other common or reasonable standard for appropriate behavior?
The answers to these questions may provide some indication that professional boundaries may be at risk.
In order to prevent compromising the best interests of a Hillcrest student or staff job security, it is best to discuss potential boundary violations with one’s immediate supervisor before performing any questionable behavior. Remember, when in doubt, ask for help. Sometimes a staff will have a vague sense that something is not quite right with a particular student relationship but may be unable to put into words exactly what the problem or difficulty is. By talking with a supervisor the staff may gain a new perspective on the issue and perhaps develop some options and alternatives to deal with the issue or concern.

WARNING SIGNS
There may be times in residential care work when staff in any job or role could feel drawn toward a student, or experience feelings of attraction to a student. Similarly, staff could feel unjustified negative feelings toward or “bad chemistry” with a student. It is important that staff recognize these feelings as early as possible and take action to prevent the relationship from developing into something other than a professional one. The obligation is always on the staff, rather than on the student, not to cross the line.

Before actual physical or sexual contact or abuse occurs there may be a number of warning signs, or changes in the staff’s behavior. Additionally, this type of misconduct often follows a pattern wherein minor boundary violations (e.g., subtle favoritism or negative bias) gradually shift into major boundary violations (e.g., sexual contact or physical abuse). Staff should be alert to such signs that suggest he/she or a coworker may be starting to treat a particular student differently.
The following indicators should be considered as possible warning signs:
• frequently thinking (positively or negatively) of the student while away from work.
• Having rescue fantasies about or over identification with a student.
• spending time with the student away from other students or staff.
• planning or arranging the care of other students around the student.
• self-disclosure of personal information, or confidential or personal information about other students or staff to a student.
• undue concern about meeting the expectations or demands of the student, or disregarding the student’s legitimate needs or requests.
• inability to accept alternate opinions from colleagues about the student’s condition, progress or treatment goals.
• believing that only you truly understand or care about the student.
• feelings of personal responsibility for student’s progress, or a lack of caring about the student’s condition or progress.
• awareness of, or desire for more (or for less) physical contact and touch than with other students.
• flirtatious or overt sexual content in interactions with the student, regardless of who initiates that behavior.

WHAT STAFF CAN DO
When a staff recognizes any of these indicators or warning signs in their own behavior, or finds himself or herself having a problem with how he or she is treating or feeling about a student or how students are feeling about them, they should:
• get assistance as soon as possible.
• reflect and review their feelings and motivations.
• consider talking about the indicators, feelings or behaviors with their supervisor.
• adjust their behavior accordingly.

When staff recognize any of these warning signs in the behavior of a coworker, staff should:
• make the coworker and/or supervisor aware of the behavior,
• encourage and support reflection and review of behavior.

SUMMARY OF KEY POINTS
• The best interests of the student, and associated Hillcrest policies and procedures, are the highest priorities, and the deciding factors in relationships between current/former staff and current/former students, and in possible boundary violations.
• It is our responsibility, not the student’s, to maintain appropriate boundaries in our professional relationships with students.
• Initiation and or consent by the student for behavior that constitutes a boundary violation between staff and student is not an excuse or justification.
• It is important that staff maintain a professional and personal support structure that provides for feedback and advice on the management of boundary issues as it impacts on their work with students and coworkers.
• A staff’s termination of employment with Hillcrest, and/or the transfer or discharge of a student from Hillcrest Educational Centers’ care and treatment does not absolve staff’s responsibility to observe and respect professional boundaries and ethics.

General Guidelines
The pattern of staff supervision of students is determined by the program.  HEC utilizes both individual student and a team approach to supervision.  Staff members are assigned to a Student or a Team of students who are under their supervision.  All activities require consistency and routine.  When students are not involved in one-on-one instruction, Team participation and membership are stressed. Clinical strategies are outlined for each student in his/her individual CTP/IEP.
Students are not permitted to be alone and out of staff eyesight except when the need for privacy dictates.  Every attempt is made to engage each student in a positive way through a variety of educational, social and recreational experiences.
Students may be allowed a reasonable degree of privacy, for example, in bathrooms or in their bedrooms.  However, privacy can only be allowed if rooms have been checked to assure that no potentially harmful/dangerous objects or materials are present, if the student’s behavior and level are appropriate to the granting of privacy, and when no other students are in the room.   Even so, staff must be present outside the door of such areas and make checks at intervals to be determined by the Treatment Team and good child care practices.  If there are 2 or more students in the same room/area, then staff must be in a position to ensure all students in that area are in eyesight and ear shot.
Whenever students leave their campus, they must be accompanied by staff unless the student is being taken off-campus by an authorized visitor for an approved visit.
When supervisory responsibilities of a student are passed to another staff, it is mandatory that the staff turning over supervision and the staff taking on supervision * clearly acknowledge this transfer to one another so that misunderstandings can be avoided and student safety be maintained.
Teamwork and communication are necessary to provide close, effective supervision.  Any problems encountered in the supervision of students should be reported to the Child Care Supervisor.

Special Circumstance Guidelines

The Treatment Team, with the expressed documented permission of the Program Director, may develop a supervision structure which permits the student to engage in “non-direct supervised” On- or Off-campus academic, life-skill, and/or vocational experiences which are consistent with the student’s IEP and which are provided with the informed consent of the Parent/Guardian, School District and other funding agencies. This “supervision structure” should be time-limited, consistent with the student’s Treatment Level, subject to frequent routine reviews, and contain safeguards and conditions for the ultimate protection of the student.

These guidelines are designed to maintain the safety of the students. Full cooperation is expected from staff. Failure to supervise students properly may result in suspension and even termination from employment.

1. Students: HEC students, regardless of their age, are not permitted to smoke or use tobacco products (e.g., chewing tobacco), and students are not allowed to possess smoking or tobacco related materials or items, including fire related items such as lighters or matches.
2. Staff: All HEC sites are tobacco free. For more information, please see Chapter 16, Human Resources.

Hillcrest Educational Centers has clear and strict policies prohibiting sexual harassment of any kind between staff, between students and staff, and between students. Regardless of the intent, the creation of a hostile work environment for staff or living environment for students will not be tolerated.
For more information, please refer to the Personnel Policies in Section 8, Human Resources.

A. Definitions:
Age-appropriate sexual behavior: Behavior considered appropriate to a person’s chronological age and developmental stage and level.
Private place: Those areas identified by the Treatment Team at each campus providing a reasonable degree of privacy including, but not limited to, bathroom areas.

B. Health Education and Human Sexuality:
Depending on the age and developmental level of the students, classes offered at HEC help students understand the scope of sexuality and its place in human relationships. The classes provide opportunities for open discussion and are intended to help students make appropriate and informed decisions.
The structure of the Health Education classes, usually small groups, is flexible in order to meet the needs of individuals according to their ability to comprehend information and concepts. Students are assessed as to knowledge and understanding of health/sexuality issues before class structure is finally determined.
The Health Education classes are facilitated by teachers and staff trained to provide sex education. Staff who work with the class participants in other settings are encouraged to attend and participate in the classes. Depending upon the ages and developmental levels of the students to be involved, the content of the education program may include: defining appropriate expressions of affection; public vs. private places; sexually transmitted diseases; communication and human relationships; anatomy and physiology; contraception and reproduction; personal hygiene; health concerns; human sexual response; acceptable and non-acceptable sexual expression; understanding, preventing and coping with victimization.

1) Student Responsibilities
Students are expected and encouraged to:
a) Receive education regarding various components of health care and sexuality through the Health and Human Sexuality program, appropriate to the student’s age and developmental level.
b) Attend and cooperate with all routine medical appointments such as eye, gynecological and routine physicals with staff assistance, as needed.
c) Discuss any health concerns, routine and otherwise, including matters pertaining to sex and sexuality, with staff, their Clinician and/or the appropriate nurse or doctor.

2). Staff Responsibilities
Staff are expected and encouraged to:
a) Assist students in receiving and accepting all necessary medical care provided by both HEC and community health care providers, i.e., making appointments and accompanying them, if necessary.
b) Act appropriately as an advocate to help ensure quality health care.
c) Assist medical professionals in discussing health concerns with the student.
d) Be informed about the content of classes in which their students participate in the area of health/sexual education.

C. Questioning and curiosity
a) Definitions:
Questioning and curiosity are when individuals, through gesture or word, ask questions about various aspects of sexuality.
b). Student Responsibilities:
Student are expected to ask questions or discuss health/sexuality appropriately and discreetly, in appropriate places, at appropriate times.
c) Staff Responsibilities:
It is understood that discussing issues related to sex and sexuality with students is a sensitive and delicate task. Not all staff will feel comfortable in doing so, and staff must be aware of the scope and limitations of their own personal knowledge, experience and values.
Even while attempting to help a student with valid and genuine questions and concerns about this very human matter, staff must also remain consistently aware of professional boundaries and their role. Similarly, many HEC students have serious sexual issues; many have been victims of sexual abuse; and many are highly sexualized. Therefore, staff should be sensitive to indicators, both objective and intuitive, of the student’s motivations in raising issues of sex and sexuality. With many HEC students, questions regarding sex and sexuality may best be referred to the student’s Clinician.
1) Staff should respond to questions to the best of their ability, and in an objective and non-judgmental manner, being careful not to interject personal values or personal information. Staff should respond specifically to the question asked or the issue raised by the student, and should not expand the discussion or respond too widely.
2). If staff are not comfortable with subject matter, issue raised, or question asked staff should assist the student in finding the answer or information from someone else (e.g., clinician, nurse).
3) If staff do not know the answer, staff should offer to help the student look up the answer, i.e., Family Planning agencies, library, Human Sexuality program or assist the student in discussing the issue with someone else (e.g., clinician, nurse).

In all above instances, staff should follow-up to make sure students’ questions are answered and understood by the student.

D. Body Exploration, Masturbation
1) Definitions:
Body exploration occurs when a person, out of curiosity, observes or touches his or her own body.
Masturbation involves fondling/stimulating one’s own sexual areas for the purpose of sexual arousal.

2). Student Responsibilities
If a student chooses to engage in self exploration or masturbatory behavior he/she is expected to:
a) Stay in a private place so that the privacy rights of others are not violated.
b) Not let the behavior interfere with living, work or treatment responsibilities.
c) Not engage in the behavior to the extent or in a way that causes self injury.
d) Exercise good personal hygiene and appropriate care for his/her surroundings).

3) Staff Responsibilities
Staff are expected to:
a) Help the student understand that body exploration and masturbation are normal means of human sexual expression, and that it is important to consider time and place before one engages in these behaviors.
b) Assist in defining public vs. private places, and appropriate times for body exploration and masturbation.
c) If student engages in these behaviors in a way that is inconsistent with stated expectations and responsibilities, it is suggested that staff intervene as follows:
1] Discreetly interrupt the behavior by addressing the inappropriateness (e.g., time or place).
2] If the student continues to engage in the behavior, staff should explain that it appears the student is engaging in masturbatory behavior and ask the student to stop, and then engage in collaborative problem solving as appropriate.
3] During this intervention, staff should protect the individual from embarrassment, humiliation or feeling punished, i.e., shield them or cover them with a coat and/or redirect them to an appropriate time and place for this activity.
Excessive or inappropriate body exploration or masturbation should be referred to the Treatment Team for the development of a management plan.

E. Dating
Given the ages of our students, it is natural and normal that they should be interested in other students. However, dating and/or “going out” between students is prohibited at all HEC programs.

Hillcrest Educational Centers recognizes that our students and their parents / guardians and / or families have a wide range of spiritual and / or religious beliefs, values and practices. HEC understands that spiritual and / or religious beliefs, values and practices may be a significant and valuable source of comfort, support, strength, hope and guidance for our students and their families. Furthermore, the agency recognizes the importance of trying to understand, respect and support the student’s spiritual and / or religious beliefs, values and practices do not undermine essential care and treatment.

The agency recognizes that, as part of attempting to understand and support our students as completely as possible, it is important to assess the spiritual and / or religious beliefs, values and preferred practices, if any, of our students and the preferred practices of the student’s parent / guardian.

CONTACT POLICY: Telephone, Mail, Electronic Communication, and Visitation Policy for Family Members and Community Resources

Hillcrest Educational Centers (HEC) believes that ongoing connection, contact, and visitation must occur between the students in our care and their family members and important community resources. In order to provide the most beneficial treatment, students’ families must be collaborative partners with HEC and the student themselves in the treatment process.

Overview
Ongoing contact with family members of students in support of treatment and permanency goals must be prioritized. Any restrictions on contacts with family members/community resources, or type of contact, must be prescribed by the student’s guardian, the court, and/or by the HEC treatment team or treatment policy, due only to therapeutic or safety concern. When restricted by HEC, the rationale and specific restriction must be discussed with the student’s guardian, documented in the student’s treatment plan (CTP) and the student’s contact sheet, and the family member(s) affected by the restriction must be notified. If it is believed that an immediate safety or treatment concern exists, an immediate restriction may be made to address it. The rational and specific restriction must then be clearly documented on a student contact sheet, and any resulting restriction of future contact must be documented according to this policy. No restrictions are allowed for the purpose of punishment or creating motivation.

Mail
• Students may send and receive mail to and from all approved parties as indicated on the student’s contact sheet.
• Student’s incoming and outgoing mail must go through the student’s clinician or designee to help ensure that the proper support is provided to the student reading it, and to be sure that the mail is according to the student’s contact sheet and contact restrictions.
• Mail is not to be read by staff unless invited by the child to do so, or there is documentation authorizing staff to read the student’s mail.
• Boxes and packages, or envelopes that seem to have items enclosed in them will be required to be opened in the presence of staff and may be searched by staff to ensure that no contraband items are enclosed.

Telephone Calls
• Students may call and receive calls from all approved parties as indicated on the student’s contact sheet.
• Students must have the opportunity to make outgoing phone calls on a daily basis.
• Students may call and receive calls when the student or phone is available.
• We encourage families to make calls after school so as not to interrupt student academic instruction. We recognize that there may be occasions when a service provider or family may need to speak to them during the school day about an urgent matter, or to help the student cope with a pressing issue.
• There are some times when it may be difficult for a student to get to the phone. These include after bedtime, while off campus on a community trip, when another youth is using the phone, or in the midst of a severe behavioral problem. If a student is unable to take a call, efforts should be made for the student to make contact as soon as possible.
• Student phone calls may not be conferenced (listening to both sides) or monitored (listening to one side) unless invited to by the student and the family member to do so, or the treatment team has considered it necessary.
• When conferencing is necessary, the family member must be aware that their conversation is being conferenced.
• Staff will provide supervision of the student’s behavior, emotional state, voice tone, and volume during all phone calls.
• Staff will dial the phone for all student calls.
• Staff will document all phone contact, including the family member contacted, the length of the call, and any observations of note (from above) on a student telephone contact sheet.
• If a student or their family would like special privacy for a phone call, the program will try to make that possible.
• Because of the number of students needing to use the phone and the limited amount of time to make calls, staff may limit the number and length of phone calls made by students. Students and family members are asked, as a general rule, to aim for calls of approximately fifteen minutes, in order to allow others the opportunity to make calls as well.
• Staff, students, and their families are asked to use problem-solving, social/interpersonal, and teamwork skills to negotiate the struggles with sharing phone call times and resources on the campuses.

Electronic Communication
• Hillcrest’s policy for use of electronics is found under a separate heading. Please refer to the full policy for information about use of electronic on the campus.
• For purposes of supporting contact, clinical staff can work with families to explore a variety of options including Skype and email communication.

Visitation
• The student, approved family members, and the treatment team should determine a visitation plan for the student with family members for the first 6 weeks (through the diagnostic period) of placement.
• Visitation during this time is usually on-campus and supervised as a part of the assessment and acclimation process for students and family members to campus rules, expectations and procedures.
• Visitation planning should continue at CTP and Treatment Team Meetings, and should be planned in a minimum of 6-week periods to ensure that the needs of the student, the family member(s), and the program are being met. Visitation can take a variety of forms including on campus, off campus in the local community, off campus in the home community, and off campus in the home. Visit types are determined based on safety and treatment needs.
• Hillcrest provides travel support once per month for all students who are safe for a visit to their home or home community and have approved family resources to visit.
• People on the student’s sheet may visit on campus. We recognize that families sometimes cannot plan far in advance. We as that whenever possible, the visitors provide 1-2 weeks’ notice to ensure that the student is not off-campus on a trip, to ensure that we can provide any required staff supervision, and to ensure any medical treatments (i.e. medication passes) can be accommodated. If adequate notice is not given, and we cannot provide the needed staffing, we will have to ask the visitor to reschedule the visit. Visits can be scheduled by contacting the clinical staff assigned to the student.
• If a family or visiting resource cannot afford to visit, the Hillcrest agency may be able to help. They can speak to the student’s clinical staff to discuss this.

At Hillcrest students have access to a range of on and off-campus recreational activities based on age and populations served. Extensive use of facilities the campuses occur on a regular basis. Facilities that are routinely used include: the gymnasium, game room, outdoor athletic facilities, including ball fields, basketball court, NYPUM training and riding course, Certified Ropes Course and various hiking and biking trails that are easily accessible from the campus. Other recreational, historical, cultural and entertainment activities are readily accessible within the Berkshire County area providing a wide range of options for varied student interests and abilities.

NYPUM is a youth development program sponsored by the Honda Corporation, which provides minibikes to Hillcrest and other agencies across the country. Students at participating Hillcrest campuses must meet stringent academic and behavioral criteria related to self control, and must demonstrate respect for safety conditions in order to enter and remain in the program. NYPUM students are carefully taught the rudiments of motorcycle maintenance and operation, and gradually engage in more challenging group riding and skill building activities. NYPUM students also have the opportunity to participate in the NYPUM Rodeo where they can demonstrate their skills and share experiences with students from other NYPUM programs.

Activity Therapies
All Activities are Hillcrest Educational Centers are based on being therapeutic with the ultimate goal of developing skills to include emotional management, empathy, teamwork and good sportsmanship. The development of healthy skills is included in every student’s Comprehensive Treatment Plan

1. HEC students are provided with necessary articles for personal grooming and hygiene based on the age, developmental level, and needs of the individuals served. Obtaining the articles is not contingent upon behavior, is not part of any level or privilege system. The articles are for the personal use of each student and are never shared with others.
2. Staff educate students on grooming activities based on the needs of the student.
3. Staff assist students in learning good self-care practices, with the goal of the students assuming the long-term responsibility for self-care.
4. All students bathe or shower daily. Additionally should students have issues with incontinence they would bathe immediately with all due regard for their privacy.
5. Students are encouraged to brush their teeth at least twice a day, and are assisted if help is needed. When applicable, the nursing department provides instructional information on how to practice proper oral hygiene from technique to storage of dental supplies. Finally, students are routinely seen at Hillcrest Dental Care for treatment preventive dentistry.
6. Students receive haircuts and styling according to their wishes and the requirements for good health. Both on-campus and community resources are available.
7. Students are expected and encouraged to take responsibility for their bedrooms and dormitories. Daily housekeeping chores are assigned and completed routinely.