willray

Oh come on, it's too early in the day for blindsiding people with that kind wit. I now need to clean the coffee out of my keyboard. We've been on EPIC, I think pretty much from the start - probably 15? 17 years now? And our physicians still need to keep backup paper copies of their charting records because EPIC so reliably loses or corrupts them. My PCP, as well as a couple specialists, have been re-entering the same data about a cardiac event I suffered, at every visit for going on 4 years now, and the fact that I have a stent still comes as a surprise to every new clinician I interact with, because EPIC just keeps losing the data. Don't trust EMRs to provide accurate information. Not now, and probably not any time in our lifetimes. The bureaucratic purpose for EPIC is as a billing system, not as a system to enable clinicians to provide care. Unless you believe that some day bureaucrats are going to prioritize something other than their own interests, I wouldn't hold out much hope that it's going to improve. Will

I think the difference, is that generally at Church, Work, and your Children's School, there is an expectation that an essentially immediate medical response is available. Even on normal weekend campouts, even if they're car-camping, Scouts and Scouters are likely to end up far enough from an immediate response by emergency professionals that the unit adults/scouts may have to provide emergency care for 30 minutes or more. That care could require access to some health history information. I suspect you'll find that most organizations, Church, Work, School, etc, if they're going to put you in a situation where they are obliged to take responsibility for your health for any period of time, will also require that you give them the information that they'd need to do so, if necessary. At the end of the day, I do agree with the "minimum necessary" information requirement though - which, since Part B is filled out by the individual, really is all that you're required to provide. If it's irrelevant that you had your wisdom teeth removed, you probably don't include that in the history on Part B. If there's something that might actually affect whether we can keep you alive long enough for professionals to arrive, it's up to you whether you include it or not. At the end of the day it comes down to "A Scout is Trustworthy". If you don't trust me to maintain confidentiality with whatever information you choose to include on your Part B form, you probably shouldn't trust me enough to go on a campout, or let your child go on a campout with me anyway.

Don't just come back and read, tell me what works, or doesn't, with your unit!

I'm afraid I have to differ. Having had one of our adults go down, with what looked like a heart attack when we were on an overnight weekend campout, I'm grateful for the medical history details in our adult medical forms. We weren't at Philmont, we were just at a small state park campsite in Ohio, 20-minutes dead run from the nearest cell phone signal, and about an hour from the nearest emergency-response team that could launch an ambulance. You don't need to be in the backcountry to need information now, and for that information to be critical for keeping you alive. "They're an adult, they can tell you what you need to know if you need to know it" doesn't work, when they're unconscious.

I think there's room for differing opinions with respect to whether that's treating adults as adults, or as spoiled children who will take their ball and go home if they don't get their way 🙂 That aside, it sounds like you're suggesting that we add a requirement, in addition to the 2-registered adults, for an EMT to be present at all scout activities where health-forms are required? I think Scouting can probably survive with those adults who are unwilling to trust a unit leader with their medical form, staying home, better than it can survive a requirement that units have an EMT on-site at all campouts/etc. ... I'm also not sure why you think that an adult who omitted a detail that only they knew in their medical history from the voluntary-disclosure on Part B, would be barred from participation in a scouting activity.

Parts A and B, the only parts required for standard activities, do not require a signature by a health-care provider (except in a few states where apparently a health-care provider's signature is required to permit someone else to dispense medications to youth).

To the do-ers go the rights to decide how to do: "We have to do X for the Blue and Gold meal, that's how it's always been done!" -> "Great! Thanks for volunteering to take care of the B&G meal! Would you like any help with that?". Or, if you're planning on doing something different -> "Well, Jim has already volunteered to take care of that this year, and I think he's planning on doing Y instead, but if you'd like to do the meal for next year, we can put you down as our lead volunteer right now!"

I should actually say - a large part of the reason for HIPAA in the first place, is that you have very little control of what's in "your medical record" as your doctor accesses it. On the other hand, you have complete control over what goes on the Part A and Part B health forms. If there is something that you don't want anyone to know about, don't put it on the form. If you're absolutely certain that no-one has any legitimate need for the information, why include it on the form? Now, if you leave something off, and either you are harmed, or harm someone else because of the omission, that's clearly going to be on your head, but with the BSA forms that's a choice you get to make : are you more worried about someone knowing X from your medical history, or about you coming to or causing harm by them not knowing X?

Oh, my no. You can't even get Medical doctors and nurses to up to full compliance with regular mandatory trainings and a giant cudgel to bash them if they step out of line.😖 And yes, you absolutely do train the janitors and receptionists regarding data safeguarding - at least up to the level of "under no circumstances may you ever do X". A janitor who snaps a selfie with a patient, or a receptionist who tweets "guess who just walked in the door", is going to be in for a world of hurt. 20 minutes of training would be perfectly fine for "don't be an idiot, the medical forms are private and should only be divulged to emergency personnel, etc when absolutely necessary", which BSA has already done in the form of the quoted policy. To actually "make BSA HIPAA compliant" would require treating BSA, its units, and presumably the scouters and scouts, as covered entities, which would turn a scout at a troop meeting saying "Wow, you should have seen how well scoutTom bandaged up scoutJim's finger last weekend!", into a legally actionable statement with mandatory reporting and disciplinary consequences.

It doesn’t appear to me that the current system costs anything for exactly that level of service? You you do understand that if BSA literally required HIPAA compliance, your out-of-pocket cost to participate in any BSA event would increase by probably at least $50, more likely considerably more, per person, per event? Unless you actually know what you’re asking for there, I would caution against you recommending it. You would like medical records to be more private - I don’t disagree with that at all - but your comments suggest that you have no idea of either the required burden of HIPAA compliance, or the dramatic changes that HIPAA compliance would enforce upon the scouting program.

Your doctor probably spends 20% to 40% of the total insurance-billed-cost of your exam, exclusively on HIPAA compliance. Would you like to pay an additional $50 or so per BSA event that you attend, to have BSA handle your medical information similarly?

I guess I'll carp about a couple other things as well: One is that the lack of specificity of things like "show evidence" leads to people being willing to sign off on requirements like that, without the scout actually doing what the requirement intends. I can "show evidence" of 10 different kinds of native plants with a handful of soil and leaf-litter from the forest floor. I can actually do what the requirement intends, and explain something about why the evidence supports there being at least 10 different kinds of native plants represented too, but the typical scout or adult signing off, isn't going to ask me to demonstrate that I actually have some knowledge of the topic, they're just going to say "yup, that's evidence" and sign my book. We can't "require more than the requirements", but we can darned well require that they actually can convince us that they've met the requirements. Second, neither you, nor your senior scouts need to be able to do the requirements, for your scouts to satisfactorily complete the requirement. Part of the meta-requirement inherent in the requirement, is that they learn the material necessary to complete it. That doesn't mean that you need to teach it to them. In fact, it's almost certainly better if you don't. It's also almost certainly better if your senior scouts don't. What your senior scouts should be teaching them, is "this is how you go learn the material", not the material itself. If you, or your senior scouts teach them the material, you deprive your scouts of the opportunity to learn how to learn. Teach them how to learn, and then let them come back and convince you that they learned. You'll know it when they've learned enough to complete the requirement, whether you can do it yourself or not.

Heh - it's all helpful from my point of view. In an economics sense, your tootsie-roll-box at the campsite is a form of trust game, so it's possibly helpful to think about other formulations of the same underlying principle. Usually (in the economics sense) in a competition, trust-games are better at pointing out sub-optimal behavior, than at encouraging good behavior, but It's additionally (possibly only academically) interesting to think about whether there are trust-game based competitions that positively reinforce good behavior. At the end of the day, my goal is to collect ideas that units could try, to increase the day-to-day living of Scoutly values, and to catalog some specific implementation details that empirically work, or that should be avoided. "Use the patrol method" is great, at least for relationships with the patrol-team, but it's not terribly specific, and it's obvious that a lot of units struggle with it. "If you're going to do year-long inter-patrol competitions, provide daily feedback on the points awarded and the standings" is specific, and while some might think it's obvious, clearly, at least my troop hasn't figured that out. I'd bet that others are in the same boat. So, I'm happy to hear, and discuss any thoughts anyone has regarding what has worked with their units. This is a bit afield of the idea-harvesting, but, I'm curious what advice you have for dealing with expectations that aren't met. I'm styling my particular experiment here in terms of Scoutly Values reinforcing activities such as campfire-program content, scoutmaster-minute-and-thirty discussions, and games/competitions that could be embedded in the normal program (even if it doesn't look like a game, like your Tootsie Pops), but, I'm also generally interested in how to maximize the utility of the normal program/methods as well. One challenge that I see (and for which our boys troop has a couple specific exemplars) are scouts (and patrols) that "just don't care". You set the expectation that they will be up at 7:00AM, prepare their meal, break camp and be on the trail by 8:00, and you get a scout who simply refuses to get up. No amount of talking to, etc, from his patrol leader, SPL, or even SM, gets him out of his tent. When he finally does get up, he goes over to where his patrol is just finishing cooking breakfast, grabs the plate of pancakes and takes one bite out of each one. When he finishes eating, he just stuffs his dirty dishes into the patrol mess-kit (that the rest of the patrol just finished washing). By the time the rest of the patrol and troop have broken down camp and are ready to move, he hasn't even started to pack. This is an extreme example, but it's one of the things that I, personally, really struggle with. Professionally, I do a lot of mentoring (slightly older) youth, but I get to do it in a capacity where my expectations have teeth. I'm not sure how to implement teeth in most Scouting expectations, and the teeth that are the most readily available, don't seem entirely appropriate. The scouts that have the most trouble being good patrol members, are the ones who need scouting the most, so saying "you blew it, you don't get to X" just deprives them of whatever growth they could have gained. You seem to have some wisdom in this area that I lack, so I'd appreciate your insights into how to push patrols to meet uncomfortable expectations and actually have the scouts try to achieve them.

The fact that everyone, youth and adults alike, seem to have devolved into thinking that the rank-patch/merit-badge/etc. is the reward, rather than it being a symbol that they've mastered the material. "I want to earn 2nd-class, because then my father will let me ..., but I don't want to have to learn all these stupid ...", rather than understanding that the learning itself is the reward. Couple this with the scouts who have advanced through this system of "first class first year!", and "Eagle by 14!" patch-bling-based "advancement" now being the senior scouts doing the mentoring, and you've got a perfect storm of scouts who have never been given a reason to appreciate actually having skills, being mentored by scouts who don't think that learning the skills is actually important for their mentees. I had the exquisite displeasure of having a recently aged-out "Eagle" scout in my GreenBar patrol, who could not set up his own tent, and (as close to verbatim as I can get) said "Why should I know how to tie the rope to this tent? Knots are all the same, and they're all stupid". He's the problem with skills instruction. He may have the patch, but he's never going to actually be an Eagle, and everyone he "mentors" is going to be tainted by his horribly attitude. The same problem I have with committee members on graduate-student dissertation committees: They're not willing to let the scouts "fail", and instead insist on "passing" them, despite the fact that "passing" someone who hasn't mastered the material, is a bigger failure than sending them back to actually learn and do it right. This resistance to letting the scouts "fail" extends everywhere from places where the adults are actively evaluating the scouts in some fashion (for example merit-badge counselors), to where they're refusing to stand back and let a patrol struggle with their dining-fly, or cooking their breakfast, and instead the adults opt to jump in and "fix" things for them.

I'm painfully familiar with win-all-you-can (and for anyone who's not, please don't go look it up). Still, I don't think I'd argue that all trust-games are inappropriate for youth. The spider-web is a trust-game*, and really, most good patrol-forming activities are forms of trust games as well. The "force struggle, so that they can grow out of the struggle by seeing where they could have better-applied Scouting values" is a version of this as well. Most of the advice in this area is just tossed out as a "just do it", without much guidance regarding what works and what doesn't, and some people clearly latch on to the wrong bits of the idea and generate abominations like win-all-you-can. I think there's room for better ideas that build up and reinforce, rather than tear down. Will [*] only quite loosely in the economics sense

I believe I have reasonable evidence that at least some of what I'm trying to do, resonates with the scouts. We'll know more after a year or so of testing ideas and seeing how our PLC morphs them into their own creations. That being said, like Le Corbusier, I could design grand and perfect schemes for Scout Values-reinforcing activities in my head all day long, but it's the details of implementation and practicality of whether the scouts actually find them interesting and valuable to engage in, that makes any of this worth doing. That's why I think it's worth looking at other's experience for ideas that actually work (and for pitfalls) with their scouts. I'm overall quite pleased with how well my troop does, and even if this is seen through somewhat tinted glasses, think we generally come up smelling like roses when we're put in the context of interacting with most other troops. Still, we can do better, and if we can do better, maybe we can help others do better by cataloging ideas that help us get there. Will

So -- We also have a year-long interpatrol competition, and it's part of the reason that I decided that some principled research in this area was warranted. I'm convinced that as we implement it, a year-long competition does almost nothing to reinforce any Scoutly habits/mindset that we'd like it to. To be sure, we have one campout where the competition is a primary focus, and the scouts have fun. Unfortunately, the potential reward is separated from the actions by such a large period of time (days, is really too much) that it doesn't really trigger the reward-satisfaction biochemistry loop that's really helpful for reinforcing behavior. Also, as @The Latin Scot pointed out, the foregone-conclusion front-runners separate from the rest of the patrols so early that everyone else pretty much takes a "why should we bother" attitude for most of the year. It's deeply embedded in our troop's culture, but, in many respects I think it actually works against our interests in developing thoughtful young citizens. I'm convinced that there are more effective ways to do the competition, recognition and reward, and I'm hoping that units with ideas that work well for them will chime in with what they're doing successfully, or unsuccessfully. At the worst, if we can identify the kinds of pitfalls my troop has encountered with our year-long competition, that could be useful for other units trying to navigate their way to the best outcomes. I can say, in addition to the time-scale, I think one of the largest things that works against our year-long competition being effective, is that our "scorekeeper" only reports scores to the troop/patrols on a quarterly basis. I think possibly if there was immediate (same day/same campout/maybe weekly troop-meeting) feedback, this would improve the effectiveness of our competition, but, I haven't managed to nudge things in that direction yet. I also think that possibly, scoring "little stuff" at each event/meeting/etc, but then doing an electoral-college thing and aggregating the "little stuff" scores into a single "one point for the winning patrol" score for each event, might balance things against the frontrunner running away with a guaranteed win so early in the season. Our current scheme of scoring everything, for an entire year, almost guarantees that the largest patrol will always win, since they're going to be the most consistent performer event-to-event, even if they're not the best performer at any event. Again, I haven't been able to test alternatives, so I'm hoping to get insight from other troops that might be doing this better.

I'd like to talk about this a bit: Does anyone have thoughts on the potential or value of "meta competitions", where the actual point isn't winning the competition, but rather is to make the right choices and avoid the non-scoutly gaming of the system that's possible? Some of you will have experience with one specific, particularly ham-handed version of this idea. It's clear that this can be done in a fashion that's blatant, painful, and gets old real fast, but I'm wondering if anyone has experience with, or ideas for versions that would be fresh and interesting, and would help the scouts get fresh insight into the choices that they make according to (or not according to) Scoutly values. For those who don't know what I'm talking about, as a horribly bad example, it would be fairly easy to develop a game that had a "trust based" component - for example you draw a card and then you record your card without anyone else being able to verify - and then the rules and cards are set up so that it's actually impossible to win. An Honest scout will not fudge the results, and so will lose the game. Anyone who wins, cheated. This is a horrible idea because it specifically calls out and shames the ones who cheated. It seems like there should be more clever solutions that produce more positive reinforcement and less negativity, but I don't have any experience with these, so I'm curious if anyone else does, how you use them, whether they're transparently obvious to the scouts, etc.

I agree that the idea of a competition for "doing the right thing" sounds weird. However, "doing the right thing" is a skill that can be (and needs to be!) developed and honed, just like any other. I would suggest that the reason that competitions for "doing the right thing" sound weird, is because it's so much easier to do competitions for simple skills, and so we gravitate towards taking the easy road and setting up competitions that don't require much thought. To take that as a reason to avoid "doing the right thing" competitions doesn't sound too Scoutly to me. The "doing the right thing" skills are far harder to learn than knot tying, and it doesn't seem too Helpful or Friendly to say "sure, we can help you plan competitions that will improve your knot tying, but for the harder stuff, you're on your own". To be sure, there are always going to be those who "game the system". And pretty much everyone knows who they are, and when they're doing it. That's hardly a reason to not use competition as a method of encouraging people to improve their skills. In fact, it's entirely possible that highly "gameable" competitions are the best way to do reinforce "doing the right thing" through competition. They're excellent generators of situations where the participants get the opportunity to choose the harder, righter thing. It's also entirely possible that the best way to reinforce "doing the right thing" through competition, is to embed more "doing the right thing" evaluation in traditional skills competitions. You might say "but this is why we do skills competitions already", but when is the last time your troop's knot-tying or cooking competitions were judged based on the points of the scout law? You could you know - the knot-tying scoring could be entirely based on whether or not the scouts help each-other. The cooking competition could be judged based on how well the patrol works together on KP and how clean and neat the dishes and campsite are afterwards. ..But I bet you don't. I bet you judge knot-tying competitions based on time, and cooking competitions based on some kind of holistic review where cleanliness is a component, but, where a clean campsite with a tasteless meal is never going to beat a tasty meal and some dirty pans. Anyway - just because it's hard, doesn't mean we shouldn't do it, and it seems worth discussing how to do it well. If we can figure out some ideas and guidelines, my observations suggest that a lot of troops could benefit from a well-thought-out collection of strategies to help their scouts learn to develop better Scoutly habits. I would argue that the fact that every scout will grow differently, is one of the primary reasons to have some well-thought-out and codified guidelines. Not because there needs to be some universal threshold applied to every scout or every situation in every troop, but because it's blatantly obvious that not all scouters see and understand the differences between the scouts. As @The Latin Scot pointed out, an uneven playing field can turn even the best-intentioned ideas into a minefield of misunderstanding and resentment. Well-thought-out guidelines/best-practices need to help level the playing field, and raise the awareness of the diversity of paths through the Scouting experience. At the same time, it's worth spending time thinking about how to structure competitions and rewards so that everyone is rewarded appropriately for where they are. In a sense, I think I'm suggesting (and if you knew me in real life, you'd wonder if I was smoking something if words like this came out of my mouth) that these competitions probably should not have "losers". It seems abhorrent to me to say "Meh, you're the 3rd most helpful scout, you get bupkis". As such, in my troop's experiment, so far we've tried things like structuring inter-patrol "do the right thing" competitions such that the whole troop is rewarded for "doing the right thing" based on some scale of how they did overall, and the winning patrol gets to choose the specific reward for the troop. I definitely would like to hear other ideas for alternative approaches to doing this all-positive-reinforcement variety of reward. Regarding randomness, absolutely! There is copious research demonstrating that consistent rewards are mentally processed as "purchases of behavior", and when you run out of jolly-ranchers, the behavior does in-fact stop, while occasional "random" rewards function much more to cement the behavior as habit, and the behavior is much more durable in the absence of reward. Again, well-thought-out guidelines here would be really helpful for units that don't have embedded behavior psychologists, so that they can achieve the best outcomes with their scouts. I should probably add - the guidelines should also probably suggest that any evaluation of Scoutly Reverence in such a context is right out.

Heh - I'm going to have to pick your brain for ideas on how to deal with some of this, probably in some other thread, so we don't dilute this one - we've got one patrol with a scout who is /really/ struggling with learning to be a helpful member of his patrol, and so far he has been, let's say resistant, to any attempts to motivate him in the right direction, whether from his patrol leader, SPL, or any of the adults...

The patrol-flag bit still mystifies me, but... Exactly right on the competition, but traditional scout competitions revolve around scout skills (cooking, knots, etc), while this needs to revolve around Scout Values. There's lots of literature on good skills-competitions, let's build some on how to do Values competitions well!

First, THANK YOU for the cautionary tale! I suppose I should have solicited cautions, as well as ideas in my original post - I certainly do want to hear where people have experienced difficulties with trying to implement varieties of recognition schemes, and the variety of lopsided "foregone conclusion" outcome that you've just recounted is one of the many ways I've considered that a "physical rewards" system could go wrong. I figure for every one that I've thought of, there are probably a dozen that I haven't, so the more people thinking about the pitfalls and helping me to see them, the better! Second however, I will push back agains the assertion that there's no need to go beyond the system that's already in place. As I mentioned in my original post, the system that's in place does not provide well-defined methods for recognition - some form of saying "thank you"/etc - in a timely fashion to optimize the reinforcement of behaviors into habits. Moreover the data from surveying scouts indicates that _they_ aren't hearing much positive feedback. Additionally, while the mantra "scouting should be its own reward" is nice, and I'd hope that most scouts eventually get there, it's quite clear that JimmyTenderFoot takes quite a long time to begin feeling like most of the Scoutly parts of Scouting are actually a reward. As evidenced by EagleDad's experience with Tootsie Pops and litter around the campsite, giving JimmyTenderFoot a bit of an incentive to develop a scoutly habit like cleanliness (picking up litter), helps immensely with developing that habit. In addition, Ad-hoc methods like "you, as scoutmaster, just say something nice", have failure modes that are similar to that of your cautionary tale. There's only one of "you", and your eyes aren't on all the scouts all the time. If we spread an "ad hoc" "just say something nice if you see something scoutly" across multiple people, there will be differences in what's perceived as Scoutly, differential rewards/nice-things said, and I anticipate similarly dissatisfied scouts who end up at the wrong end of a differential outcome for identical actions. Because of this, I'd like to codify specific ideas/methods that people have found that work, and that are universally applicable without requiring an individual scoutmaster's discretionary judgement. Finally, ideally, the system should be primarily scout-run/scout led. I really like the "fireballs box" idea because it looks like it would work perfectly for this. I would love to identify a half-dozen ideas of that nature, and possibly a few ideas for patrol-level ideas that can be hashed-out and armored against bad-outcome failure modes. Will

I really like this way of thinking of the process. It’s excellent shorthand for the mental model and process, and will really help with explaining it to people! I wonder if there’s a way to extend the idea into some kind of inter-patrol competition. Or maybe better, to do something simultaneously that functions as a “scout values” inter-patrol competition, so that you get the benefits of patrol -members working to support each-other to “win”. What I've been trying to come up with in the inter-patrol arena, are things like awarding ribbons to hang on their patrol flag for “good deeds, and then letting them “buy” rewards by turning in some number of ribbons. “Rewards” in this context being things like them getting to pick a desert for the adults to cook for the troop, or camping/cooking supplies for their patrol box. the ribbons idea though doesn’t work if the scouts are doing the giving out ribbons, because they don’t want to give another patrol a leg-up at winning. Somehow that needs to be offset so that both the giving patrol and receiving patrol are rewarded. Maybe 2-part ribbons that get separated and half kept, half given out (friendship-necklace style)? Any thoughts? Will

I'd like to analyze this a little more: I'm curious - does anyone else have the general feeling that this scenario would function as a reward more for the fireball/thanks giver, than the fireball/thanks recipient? I want to reward both/turn both into habits, so it's not a bad outcome, but somehow it feels differently focused than other "reward" methods we've tried. Will

I suppose it depends on what you mean by "learn". Youth definitely absorb a great many ideas and concepts through observation, but they're far better at learning "doing" by doing. This is why Scouting is activity-based, rather than lecture/presentation based. Habits, in particular, are learned by repetitive doing: No-one learns to play the piano well by observation, and likewise no-one learns to _habitually_ bend over and pick up litter, to habitually help beyond their own dishes with KP, or to habitually say "Thank You", by observation either. People learn to do these things habitually, by doing. One might argue that the best way to generate the "doing" is simply by setting the example and waiting for the youth to start "doing" by osmosis and possibly peer-pressure. I would counter that I see no compelling reason to wait for osmosis, if we can prime and accelerate the process by doing a bit of clever incentivizing. Most of Scouting's program is designed around this kind of incentivizing -- "fun, with a purpose". I don't think Scouting would be nearly as successful as it is, if the primary method was "have the scouts sit around and observe the adults being decent people"... Will