Standards for private organizations

2020 Edition

Wilderness and Adventure-Based Therapeutic Outdoor Services (WT) 8: Health Services

Youth receive a health assessment, needed health services, and guidance that promotes good health.
2020 Edition




Youth who participate in Wilderness and Adventure-based Therapeutic Outdoor Services expand individual capabilities, develop self-confidence and insight, ameliorate symptoms, and improve interpersonal skills and relationships.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Initial health screening procedures
  • Procedures for the coordination and provision of healthcare examinations and services
  • Procedures for sharing health information with service personnel
  • Informational health and wellness materials
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Youth or families served
  • Review case records
  • Verify employment or agreement with physician or other qualified medical practitioner

Fundamental Practice

WT 8.01

An initial health screening is conducted by a qualified medical practitioner for all participants within 24 hours of admission to identify the need for immediate medical care and assess for communicable disease.


Qualified medical practitioner refers to a licensed physician, registered nurse, nurse practitioner, physician’s assistant, or other healthcare professional that is permitted by law and the organization to provide medical care and services without direction or supervision. For the purposes of this standard, qualified medical practitioners are distinct from other clinicians who are not permitted by law to provide medical care and services without direction or supervision (e.g., clinical social workers, licensed vocational/practical nurses, and medical assistants). To meet the standard, the initial medical screening must be administered by a qualified medical practitioner.

If the organization does not have a qualified medical practitioner on staff, it should research community resources and consider creating a formal arrangement or a memorandum of understanding (MOU) with a local physicians group, local health department, federally-qualified health center, urgent care clinic, community-based health clinic, or telehealth provider.

When possible, the screening should be performed by the youth’s primary care physician who has knowledge of the youth’s medical history or a physician that can serve as the youth’s medical home while in care. 


When a youth returns following a runaway episode, a health screen should be conducted within 24 hours of entry back into care to identify whether he or she was victimized or otherwise harmed while on the run.
Examples: Conditions that require immediate or prompt medical attention include, but are not limited to: signs of abuse or neglect, serious or accidental injury, signs of infection or communicable diseases, hygiene or nutritional problems, pregnancy, and significant developmental or mental health disturbances.

Fundamental Practice

WT 8.02

Each youth receives: 
  1. a comprehensive medical examination within three days after admission, unless the youth has received a medical exam within the last year; and
  2. dental, neurological, vision, hearing, and blood chemistry referrals if indicated.


A current medical examination must be completed if the prior medical examination is incomplete or cannot be substantiated with documentation.


The purpose of the medical examination is to identify and assess medical, developmental, and mental health conditions that require treatment, additional evaluation, and/or referrals to other healthcare professionals or specialists. The examination must be comprehensive, build on history gathered during the initial medical screening, and focus on specific assessments that are appropriate to the individual’s age and developmental level. Findings from the exam should be used to develop individualized treatment plans, as well as inform follow-up assessments and services.

Fundamental Practice

WT 8.03

The organization obtains and maintains in each youth’s case record:
  1. medical history; and 
  2. written medical authorization stating that the youth is physically able to participate in program activities.

Fundamental Practice

WT 8.04

Group leaders or other service personnel receive relevant medical or psychiatric information concerning youth including:
  1. immunizations and current health status; and
  2. pertinent medical information for off-site adventure-based activities.


WT 8.05

Youth receive appropriate support and education regarding:
  1. substance use and smoking;
  2. sexual development;
  3. prevention and treatment of diseases, including sexually transmitted diseases;
  4. family planning and pregnancy options;
  5. good health habits and healthy living;
  6. safe and healthy relationships; and
  7. pregnancy, prenatal care, and effective parenting.