Welcome!

We’re so glad you’ve joined us at Thrive Outside for a nature-based therapeutic group experience! 

We’ve put together this welcome packet to give you all the helpful info you need in one place.  Please let us know if there are questions that you still have after reading it. We can’t wait to meet you and we look forward to working together!

Warmly,

Dr. Diana, Dr. Erin, Claire, Liz, and our amazing Student Volunteer Team!

Welcome, Families!

We’re so glad you’ve joined us at Thrive Outside for a nature-based therapeutic group experience!  We’ve put together this welcome packet to give you all the helpful info you need in one place.  Please let us know if there are questions that you still have after reading it. We can’t wait to meet you and we look forward to working together!

Warmly,

Dr. Diana, Sheli, Claire, Liz, and our amazing Student Volunteer Team!

Our Approach to Therapy

Thrive Outside’s groups are based on a large body of multidisciplinary research.  Other models that are highly intertwined include Polyvagal Theory, Theory of Sensory Integration, Social Emotional Learning, Trauma-Informed, DIR/Floortime (Developmental-Individual differences-Relationship model, and Montessori Pedagogy.  

The ConTiGO Approach

Much of our work is inspired by the ConTiGO Approach. This stands for Connection & Transformation in the Great Outdoors.  The ConTiGO Approach is a practice model to help guide playful nature-based therapy practice with children.  It was created in the field of occupational therapy but is easily used within any pediatric therapy profession to guide nature-based therapy sessions with children who have challenges with coordination, mental health, sensory processing, self-regulation, and/or social connections.. 

In the ConTiGO approach, connection refers to facilitating children’s healthy relationships with themselves, others, and nature. Transformation refers to the therapist’s use of evidence-based therapeutic intervention combined with outdoor education principles to support children's development of motor skills (coordination), mental health (confidence), self-regulation (calmness), and social skills.  Great outdoors refers to wild nature as our setting for therapy sessions, and also to the role of nature as a co-facilitator in the therapeutic process.

Using the ConTiGO approach in partnership with nature during therapy sessions, we address:

• Coordination: fine and gross motor skills, visual-motor skills, strength, & endurance

• Confidence: trying new things, being OK with failure, learning from mistakes, being willing to take a risk, to be independent, to PLAY, to be positive, keep a growth mindset.

• Calmness: sensory integration and processing, emotional regulation, self-control.

• Happier: social connections, prosocial behaviors (empathy, compassion, perspective-taking), interactive play, connecting with others, and making friends.

What You Can Expect 

from Thrive Outside

Post-Session Update

You will receive a secure message from the therapist with pictures and sometimes a short description of the day’s adventures.  This will give you a picture of how we communicate with families and the general benefits of the activities we do during our sessions.  Your child’s “official” daily note will also be shared with you via our client portal.


Location details will be defined in detail by your therapist. General information: Services are provided at Elk Rock Island at Spring Garden Park Natural Area, and THPRD Parks Throughout Beaverton. 

Depending on the group you signed up for, your therapist will reach out with more specific information about your specified location, meeting spots, bathroom availability, and other necessary information. Stay tuned as the start date of your services approaches for more specific information on your group! 

Typical Schedule: Groups and Summer Intensives

• Arrive, Check-In, Say Goodbye to caregiver

• Walk to Home Base and Connection Circle

• Therapeutic Activities

• Supported Free Play

• Transition from Home Base to Pick up Location

• Pick Up 

We walk to the location and use that as home base for the day. All activities have therapeutic intervention embedded within, for each child.  This schedule is a general outline for the day, but may vary depending on exact group needs. 

Drop-Offs

Drop off can be a tricky transition for our younger kids!  Read on to learn how to help your child with transitions and a couple tips to make it easier for everyone.

We understand that during drop-offs it can be an adjustment for some. We want to provide some guidelines to help make everything run smoothly. This will help maximize our session time and provide a consistent and familiar routine for all the children. We encourage showing your children the pictures of the staff, as well as do a trial run to the park. This can help knowing what to expect on the first day of camp.

We are here to ensure that children feel welcomed, gain a sense of belonging and are helped to settle happily.

• When you arrive with your child before the starting time, this is free time to visit and play. It is also a time that you may have questions for staff. More in-depth questions can be emailed before to maximize the time. 

• Staff will have a friendly, child-centered strategy to signal when it is time for the children to join the group will be directed to return to the home base. This provides a clear visual threshold from family members, and when we are ready we will say goodbye to our family members (waving and saying goodbye).

We understand that drop off can present as big emotions that have bubbled up and can result in everything from clinginess to tears. We hope that providing a familiar routine and all parents doing their best to separate can provide clear expectations and not give mixed signals. 

Tips:

• Validating your child’s feelings, dispelling any fears and managing your own anxieties, as well.
  
  

• Ensure your child knows who will be dropping them off and who will be picking them up in advance.
  
  

• If your child is really struggling, a small item to represent you to hold on to until pick up time may be helpful.

Please reach out to us if you need any further advice for drop-off transitions.

Frequently Asked Questions

What if I’m sick and miss a day?

We know that people sometimes get sick (bummer). In this case, please notify a Thrive Outside team member with as much advance notice as possible before the session begins: Text or Secure Message us via Therapist Group Thread on Spruce at: (503) 782-6221

What should I wear? 

We recommend comfortable pants or shorts, socks, and closed-toe shoes.  If your child will wear a hat, this may be helpful as well. It can be a bit chilly in the morning and as the sun makes its way across the sky, the temperatures can rise to mid 70 to 100 degrees.

In hot weather, we recommend:

• Layers! A light jacket, long sleeve shirt, and a t-shirt can be a great set of layers that can be flexible with the multiple different temperatures throughout the day.

• Pants or shorts.

• Tall socks or ankle socks. 

• Closed-toed shoes, or shoes you don’t mind getting muddy and wet.

• A water-resistant outer layer, such as a rain jacket for the rainy days if forecasted.

What should I bring?

• A water bottle (we are not reliably near drinking fountains) - we will have extra water for refills.

• A snack

• A backpack for your child to carry their own things. 

• Small towel (we have several activities where we will be near large pools/puddles of water)

• Sunscreen and other sun protective layers

What if my child has to go to the bathroom? 

We will have a staff volunteer walk them to the nearest restroom. It is our policy that Staff will not enter the restroom with your child, but will call you if assistance is needed. If your child has specific support needs or you have concerns, talk with your therapist about this before group, as soon as possible. 

Managing Children’s Behavior

We offer this lengthy section to help you understand our approach to behavior in our groups. Managing children’s behavior is a lifelong learning process for all of us!  This is information we’ve gathered to remind us of the important things to keep in mind when managing any challenging behaviors in our camps.  Your lead therapist will be the one handling intense behaviors, should they occur, but we give you this information so you can understand our approach.

Our general approach to behavior is based on a relational and developmental approach to behavior outlined in the book "Behavioral Challenges in Children with Autism and Other Special Needs" by Diane Cullinane. When responding to challenging behaviors that arise, we seek to understand each child’s individual differences in sensorimotor and emotional regulation and attend to the child’s emotions and feelings in all situations, especially in those situations where negative behaviors occur.  The goal in dealing with any behavior is always to restore a relationship, which is very different than just extinguishing a behavior.  

Here's a 20 min YouTube video that outlines the approach: https://youtu.be/eTEst2BddGg We highly recommend watching this to get a good overview. 

The steps we use are:

1. Empathize with the child.

In this stage, you might name the child’s emotions for them to help them put words to feelings. (ex: “You are so mad!”) Seek to understand the child’s emotions.

2. Help the child calm down.

In this stage, you might suggest ways the child could self-regulate. (ex: Let’s take a walk. Let’s sit by the tree. Let’s run and hide in the fort. Let’s go on the swing. Let’s bang these sticks. etc.) The goal is to get their thinking brain back online, so they can problem solve in the next step.

3. Restore/repair relationships.

Once the child is calm, then problem solve with them to fix whatever the problem was that caused the behavior. Write down solutions with them. Repair and restore relationships by talking to any people that were involved.

We love this infographic below that does  a nice job of representing how changing our mindset to reframe children’s behavior is key to children feeling supported and heard:

Establishing the “Rules”

1) On the first day, we will establish group agreements (rules) with the children. We always want children to feel safe in our care. We will facilitate a discussion with the children to help make our rules, so that they feel ownership of the rules- but in the end, there are two-three rules: BE SAFE and BE KIND (or HAVE FUN or BE RESPECTFUL).  The exact wording will be chosen by the children and will be our agreements. Specific behaviors may need to be made more explicit and this is part of the therapeutic process.

2) We will NOT tolerate: name-calling, hitting/poking with sticks, throwing sticks/rocks at people, obviously biting, kicking, hitting, pinching, or shoving.

3) It is OK if kids: wrestle and do rough-and-tumble play (monitor closely- may need to eliminate if a problem), “sword fight” with sticks at waist level, and act dramatic in their play. In all of these imaginative play situations, adults will constantly be monitoring facial expressions of children to make sure all involved are OK with the play. Children may be cued to “ask their friends” if they are OK with playing swords/etc. 

4) To make sure all children understand the rules, role plays may be used to illustrate.  The kids LOVE when we do these.

5) When a rule is broken, we remind the child (or children) of the group agreements/rules. If possible, we have the children come up with solutions to problems that arise.

Other Tips we use for Managing Behaviors

• As much as possible, we focus on positive behavior rather than negative.  Try to offer 3 positive feedbacks for every 1 negative. Dweck’s growth mindset research shows that our praise for children should be specific, genuine, and for EFFORT (not smarts).

• When you do run into challenges with a child or children, keep the following things in mind:

• Remember: “Kids do well if they can.” (This is a Ross Greene quote- we love his work!) We must look at the underlying needs the child has that are not being met when they have negative behaviors that affect the safety and culture at our therapy programs or camps.

• We often need to help children give WORDS to their physical responses and feelings. Simply naming what is happening “oh, you are talking fast and loud.” Getting curious about the child’s feelings may be helpful: “oooh, I wonder if you are MAD!” or “ugh, you sound frustrated, I get that.” 

• When noticing conflict arising between children, we might say: “It looks like we have a problem here. How are we going to solve it?”

• When children are really upset, we limit our verbal directions, focus on our own regulation and presence, and can use other visual cues for next steps. Movement is a good strategy to try with children to get their thinking brain back online. Some children like to run, jump, swing, or spin in order to feel better.

Hazard Prevention

Elk Rock is situated along the Willamette River in Oak Grove and the natural areas are managed to ensure ecological health and integrity. Pacific Poison Oak is native to Oregon. Poison oak produces an oil that causes irritation to skin. As a team, this is a risk that we are taking and have done our best to ensure the awareness and ability to identify this plant. We will make a point to identify and make all participants aware of it if it is in our surroundings. As part of our first aid kit, we have a specific scrub to stop the oil spreading on the skin. 

Here is a link to the product we have found most successful:

https://www.amazon.com/dp/B0007IOVZK/ref=cm_sw_em_r_mt_dp_K9EB15JATRKXNNZEK525 

Let’s Thrive Outside! See you there! 

www.thriveOutside.net 

(503) 782-6221

Practice Policies

Here is a copy of all the policies and procedures you signed in the registration: 

Behavior Policy

Children who attend Thrive OuTside! Groups  are receiving therapy services in a small-group setting.  Our therapists use positive discipline and natural consequences, as well as offering sensory strategies, when helping children learn to regulate their behaviors. In order for all children in the camp to receive therapeutic benefit, we require children at Thrive OuTside to maintain expected behaviors that do not significantly detract from the experience of other children in the camp.  Children who attend Thrive OuTside must be able to stay with the group, follow directions (most of the time!), and have basic safety awareness to be in wild nature settings with an adult nearby but not always within arm’s reach.  We operate with approximately 1 adult to every 2 children. We are not staffed to provide 1:1 support for children who have significant behaviors that consistently require the full attention of a staff member.  If a child has disruptive behaviors that impact the therapy of the other children in the camp, we will discuss this immediately with the parent to determine if Thrive OuTside is right for the child at this time. Should it be decided that Thrive OuTside is not a good fit for the child, no refunds will be given. By signing below you agree that your child can meet these behavior expectations.

Attendance and Pick-up Policy

Our groups rely on the consistent attendance of all group members to have a fun and therapeutic experience together.  Since we know life happens, you are allowed one reimbursed visit for sickness, schedule for conflict or travel.  Late pick-ups in excess of 5 minutes after group ending time will be charged $2/minute, invoiced monthly.

Insurance Policy

Regretfully, we cannot accept insurance.  Your insurance plan must have out-of-network benefits in order for you to be reimbursed for services provided by Thrive OuTside, as we are not part of any insurance network.  Further, SOME insurance plans will reimburse for occupational therapy services if a physician has prescribed them as medically necessary PRIOR to treatment.  If requested, Thrive OuTside can provide an invoice with CPT codes that insurance companies use to identify procedures; this "superbill" can ONLY be generated at the END of a session after services have been provided.  The CPT code for our therapy group is 97150. Please directly contact your insurance provider with this information prior to group, to establish your eligibility and clarify the insurance plan’s requirements and specific procedures for reimbursement.  You will be responsible for payment to Thrive OuTside for services provided, and will be responsible for submitting the superbill (paid-in-full invoice) to the insurance company to be reimbursed for services you have paid for out-of-pocket.  If you will be requesting a superbill for submission to your insurance, please do so after the session is over so we can give you a comprehensive paid-in-full invoice with accurate treatment dates. 

Payment Policy

Payment for all sessions are billed before the session, and are due upon receipt of invoice.  PLEASE NOTE: Late payments (more than 2 weeks past invoice date) will have a 5% late payment fee added to the total due for every 2 weeks late.

A la cart Therapy Sessions and Therapy Consultation

Our group session cost includes some post-session on-site consultation with the therapist leading the group.  The therapists will arrive and stay 10-15 minutes after the group at the drop off/pick up location to have brief discussions with parents about the day's therapy session.  You may schedule additional individual consultation time with your therapist at a rate of $90/30-minute consultation (billed at end of session) to privately discuss your child's individual needs if necessary.  

Medical Waiver Authorization

In submitting this form electronically, you agree to have your typed signature serve as a legally binding signature on the following Consent for Medical Treatment of a Minor: I certify I have notified staff of Thrive OuTside of any and all medical conditions that Thrive OuTside should be aware of in case of emergency. If I cannot be reached in case of emergency, I give permission for staff of ThriveOutside who are certified in CPR and first aid to provide treatment as deemed medically necessary.  I give permission for potentially life-saving care to be provided immediately, without any delays to seek my permission, provided that camp staff attempts to notify me at the first available opportunity. In case of emergency, I give permission to Thrive OuTside staff to arrange necessary related transportation for my child.  Further permission is given to allow medical services to be performed by doctors, hospitals or other qualified medical providers as deemed necessary in an emergency, including, but not limited to, x-rays, tests, or surgery if reasonably necessary. I understand that the cost of all emergency services is my, or my health insurance company's, responsibility.  

Participation Waiver

Thrive OuTside staff members make every effort to conduct safe programs, to orient and support children, and to inform families of inherent risks. Some activities may involve risks that children do not routinely encounter at home. Risk management is an essential element of all the activities that we offer. While we make all efforts to ensure the well being of each child, we are also aware that it is neither possible to foresee every contingency nor to eliminate all risk. By typing your name below as your electronic signature you agree to the following:  I understand that program activities may include, but are not limited to: hiking on uneven terrain, playing active games, participating in activities near water, and other outdoor activities as well as using a camp stove, and being near insects and animals. Other risks may be inherent in program activities. I acknowledge that such risks exist, and I hereby agree on behalf of my child to assume such risks. Further, on behalf of my child, I hereby release and forever discharge, and agree not to sue, and agree to indemnify and hold harmless Thrive OuTside and its officers, directors, employees and volunteers and each of them, from and against any and all liabilities and obligations of every kind and description, which I shall or may have against them or any one or more of them arising out of, or in connection with, my child’s participation in Thrive OuTside and its activities, including, but not limited to, for any personal injury that my child may suffer while participating in the group and its activities. I understand and agree on behalf of my child that my child shares the responsibility for safety during group activities, and I personally assume on behalf of my child that responsibility. I understand and certify that my child’s participation in Thrive OuTside and its activities is completely voluntary.

Photo Release

We send secure messages to families to share photos (& occasionally videos) of the children's adventures. We also love sharing our experiences with the community, so with your permission we use Thrive Outside group photos & videos on our website, in marketing materials, and on social media. We will NEVER identify your child by name or release any personal information.  If you do not give permission, we will not photograph or video your child at all.    

Clinical Information Release: 

Thrive Outside is a practice focusing on interventions with children. Additionally, this practice is involved in the education of future therapists as well as clinical mentoring and collaboration with therapists across the country. This clinical information, therapy goals, objectives, activities, and health information may be gathered through interviews, assessments, interventions, and/or other clinical activities pertaining to occupational therapy services. I understand that this information may be used for educational purposes and/or intervention purposes including educational training programs, mentoring, collaboration, and further support of your child. I understand that the information will not include your child’s name. 

Electronic Communication & Cell Phone Communication Policy

Cell phones are not considered confidential or secure.  Your use of text messaging with Thrive Outside Staff  constitutes your acknowledgement of these confidentiality and security limitations.  All text messaging and telephone communications initiated by Thrive Outside  will attempt to keep any protected health information of its clients confidential and will not share, sell, rent, or distribute in any way the contact information, including email addresses, of its clients or affiliates. No identifying information or Protected Health Information will be used by any member of our staff.  Email communication and secure group messaging via Spruce  is through a secure platform and HIPAA compliant.  

Notice of Privacy Practices (HIPAA)

This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information.  “Protected Health Information” is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Uses and Disclosures of Protected Health Information:  Your protected health information may be used and disclosed by your physician, therapist, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your healthcare bills, to support the operations of the practice, and any other use required by law.

Treatment:  We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  This includes the coordination or management of your health care with a third party.  For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Healthcare Operations:  We may use or disclose, as needed, your protected health information in order to support the business activities of our practice.  These activities include, but are not limited to, quality assessment activities, employee review activities, training of occupational therapy students, licensing, and conducting or arranging for other business activities.  For example, we may disclose your protected health information to occupational therapy students that are working in conjunction with Thrive OuTside staff.  In addition, we may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We may use or disclose your protected health information in the following situations without your authorization.  These situations include: as Required by Law, Public Health issues as required by law, Communicable Disease Health Oversight,  Abuse or Neglect, Food and Drug Administration requirements, Legal proceedings, Law Enforcement, Coroners, Funeral Directors, and Organ Donation, Research, Criminal Activity, Military Activity and National Security, Workers’ Compensation.  Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

Other permitted and required uses and disclosures will be made only with your Consent, Authorization or Opportunity to object unless required by law.  You may revoke this authorization, at any time, in writing, except to the extent that your physician, provider, or the provider’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS – Following is a statement of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information

You have the right to request a restriction of your protected health information.  This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician/ provider is NOT required to agree to a restriction that you may request.  If the physician/ provider believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted.  You then have the right to use another Healthcare Professional.

You have the right to request to receive confidential communication from us by alternative means or at an alternative location.  You have the right to obtain a paper copy of this notice from us upon request, even if you have agreed to accept this notice alternatively (i.e. electronically).

You may have the right to have your physician/ provider amend your protected health information.  If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you via mail of any changes.  You then have the right to object or withdraw as provided in this notice.

Complaints:  You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying your provider of your complaint.  We will not retaliate against you for filing a complaint.