by Linda Ebner Erceg, R.N., M.S., P.H.N.
Once upon a time there were two camps, Camp Ready-to-Go and Camp In-the-Moment.
Both camps were well established, both had decent enrollment, and both
had activity options that made kids drool with anticipation. Both "adequately
supervised" their campers and staff; both were ACA accredited.
But one thing wasn't the same. Ready-to-Go was on top of camper
issues. They even had it together for their staff. In-the-Moment struggled.
They'd get surprised, especially by information they wished parents
had told them ahead of time. Opening Day was a scramble at In-the-Moment,
a scramble that lasted all summer. While Ready-to-Go also had a busy
Opening Day, there weren't nearly as many surprises and everyone — including
the director — slept well at night (at least most nights!).
Why
the difference?
Essential Functions of Campers: Bedrock to Effective
Health Screening
A strategic difference stemmed from Ready-to-Go's
foresight to clearly articulate their campers' essential functions.
These functions resulted from answering this question: What does a child
have to be able to do in order to participate in the core elements of
our camp program? By stating the essential functions for campers, camp
staff had a baseline upon which they could function. They could assume
that all campers at Ready-to-Go demonstrated these essential functions,
abilities significantly linked to participation in the camp's core
program elements. These elements were, in turn, intimately linked to
the camp's mission. Examples of essential functions of campers
in use by today's camps include statements such as:
- Able
to move independently from place to place at camp.
- Capable of
effectively interacting in our camp's group-based program.
- Able
to effectively carry at least 25 pounds of gear over uneven, natural
terrain in all types of summer mountain weather.
- Capable of doing/meeting
their own personal cares (e.g., showering, eating, toileting, etc.).
- The
only essential function for our campers is that s/he wants to be here.
Essential functions lay a baseline from which everything else flows.
This is especially critical when one does health screening, the process
of assessing the fit between a given person's health profile and
a given camp's program and services. Ready-to-Go had this baseline
in place; Camp In-the-Moment did not.
Why Screen?
Both camps believed
that health screening was done (a) to assess the fit between an individual's
needs and the services available at camp and (b) to assess the individual's
health needs in relation to program elements. Some people — campers
and staff — arrived fully capable of participation; they need no
accommodation. They get to camp, and they are off and running — literally.
But others need assistance to varying degrees. At Camp Ready-to-Go,
these folks met the essential functions but needed ancillary support
from health services or other camp staff in order to participate in all
aspects of the camp program. Some, for example, needed a medication to
maintain their ability to participate. Others did a particular treatment
at given time. Some required a diet modification because of allergies
or food preferences, and others had personal styles that made their interaction
with others a bit more challenging.
An outcome of effective
screening is to identify these individuals, discern the scope of their
health need or program adaptation, and plan the camp accommodation that
results in getting those needs met. Ready-to-Go recognized that they
could wait for Opening Day to clarify things, but they also recognized
that the fray of Opening Day strains that process because time is limited
and the attention of critical people is fragmented. So Camp Ready-to-Go
started "prescreening" their health forms.
Prescreening:
Opportunity for Critical Conversations
A growing number of camps now
have two phases to their screening process. Phase one, triggered by the
arrival of a person's health history form, is done before the individual
arrives. The goal of phase one screening — called "prescreening" — is
to identify health needs that fall outside the camp's usual and
routine ways of doing business and then engage that prospective family — or
staff member — in a dialogue with a camp representative.
As long
as the information on the health history complements the scope of accommodations
already part of the camp routine, prescreening is complete. But for those
with atypical needs — needs that fall outside the parameters of
the essential functions or outside the typical accommodation patterns for
the camp — prescreening triggers a pre-arrival conversation between
a knowledgeable camp staff member and the individual (aka camper's
parents). The goals of this conversation, which require active listening
skills, are to (a) explore the scope of the person's health needs
and the camp's ability to support those needs; (b) discuss options
for meeting those needs; (c) make a decision about the "fit" between
the individual and the camp; and (d) make appropriate plans based on
that decision.
It is in these conversations that the essential functions
become critical. If the person can meet the essential functions, then
the camp has an obligation to accommodate the person's needs. If
the person cannot meet the essential functions, the camp has no obligation
to accommodate the person's need. This sounds crass; it sounds
harsh and "uncamplike." But using essential functions in
this manner is, in the opinion of this writer, using the bedrock of essential
functions to make good decisions about who should and should not be at
camp.
In all honesty, these pre-arrival conversations most often result
in figuring out what needs to be done so that child — or staff
member — can, indeed, have a camp experience. A plan gets developed
that includes elements such as educating staff about particular needs — something
that's particularly important when dealing with atypical learning
patterns or unique ways of interacting with others — and monitoring
the person's adjustment to camp based on that plan. This prescreening
conversation should also include what to do if the plan fails or something
unanticipated arises.
The process of prescreening gives both parties
time, time to talk and time to consider what's in the best interests
of the person involved. It puts two parties — one that knows camp
and one that knows the needs of the individual — in dialogue. It
provides time to educate staff and adjust cabin and activity life to
complement individual needs. In essence, prescreening minimizes the potential
for surprises on Opening Day and increases the likelihood that everyone
will have a better camp experience.
Areas that can be addressed in the
prescreening process include:
- Medication assessment related to
when a medication is taken. Some AD/HD medications, for example, are
given to meet school day parameters but may need adjustment to the
camp schedule.
- Medication assessment related to environmental factors.
The therapeutic effect of a medication may be affected by altitude
or hot, muggy weather.
- Assessing the medications listed with chronic
conditions (why is the person taking this medication?) and then determining
what impact — if any — this has on activity and/or cabin
life.
- Assessing mobility.
- Identifying health challenges
that impact specific activities or cabin life. Knowing where a child's
rescue inhaler is at night, knowing whose medication is not adequately
controlling seizure activity, knowing who sleepwalks, and who can't
hear or see within normal limits makes a difference in some activities
and/or cabin life experiences.
- Identifying behavior challenges
that, if the person is handled in a given manner, will have minimal
impact upon that person's cabin experiences.
Whether at a day or resident
camp, a prescreening process more closely aligns what one anticipates
arriving on Opening Day with what actually does arrive. As experience
has taught, the more closely expectations match reality, the less likely
one will have to cope with unanticipated surprises and the better camp
will be for everyone.
This discussion about prescreening would be incomplete
without acknowledging that a person's health status can change
between sending in a health history form and arriving at camp. As a result,
a growing number of camps are giving clients and employees a contact
name and phone number. Should change occur, clients and employees initiate
contact so up-to-date information is at camp. This simple strategy allows
one to capture updates without slowing the check-in process of a busy
Opening Day.
Camp Ready-to-Go prescreened their health forms; Camp In-the-Moment
did not.
Health Screening on Opening Day
The purpose of Opening Day's
health screening — and the screening for staff (yes, staff should
be screened, too) — is to establish a record of each individual's
health status upon arrival. Because that arrival status may have impact
down the proverbial road, it should be documented. The ACA standards
speak to this by directing a written record of the screening process
(American Camp Association, 2007) — in other words, documentation.
An emerging trend is the use of digital photos to record the status of
physical findings that arrive with the individual, things such as wounds,
rashes, and burns. This is an interesting option, one that may be impactful
if recovery doesn't progress as expected.
Because time is generally in
short supply, the screening process should be concise and focused on
indicators of health. Screening is not diagnostic. That's why, for example,
an emerging case of head lice may be missed; there simply wasn't enough
of a nit load to be noticed during screening. In addition, because time
is limited and screening elements are generally based on indicators of
health status — not
objective data — it is not foolproof. That's an important point
to remember.
So what should be screened? Experienced people often start
by asking if there are any updates to the health history form. Document
the response to this question. A question about what medications were
brought to camp typically follows and, if so, is accompanied by a process
that transfers the medication(s) to the camp's medication administration
system. Remember to check what the parent listed on the health history
form with what, specifically, arrives with the individual. There may
be good reasons for these lists being different — maybe the person
no longer takes that daily vitamin — but there can also be reasons
with more negative impacts (like forgetting the psychotropics at home).
Verify discrepancies with parents, something that may wait until that
evening or the next day should Opening Day be extremely busy.
Following
health form changes and processing medications, most people then ask
the person about how they are feeling right now. This is the point at
which one often finds out about the little things: sniffles, slight sore
throat, or a nagging headache. While one can't necessarily do a full
exam at this point, the screener can make a note for follow-up. This
is also the point at which many experienced screeners ask about exposure
to communicable disease and may do a head lice check.
A few words about
communicable disease screening specific to day camps may be appropriate.
The day camp population comes and goes from camp on a daily basis. Doing
a communicable disease screening on Opening Day may establish a baseline
but, because day campers move between camp and their at-home world, there
is no assurance that the individual will remain disease-free during their
time at camp. Day camps have a greater risk exposure related to communicable
illness than resident camps. Consequently, day camps often educate their
staff to notice signs associated with illness and refer the camper for
health center follow-up.
Resident camps, on the other hand, assume 24/7 care for campers. The
in-residence experience allows more intimate contact among campers, consequently
increasing the potential for a nuisance like head lice to move from person
to person. Consequently, head lice screenings are more common in the
resident camp setting than they are in the day camp population.
Up to
now, four elements have been addressed in the Opening Day screening process:
(a) capturing changes on the person's health history form; (b)
getting medications worked into the camp's administration process;
(c) establishing how the person currently feels; and (d) assessing that
individual's exposure to communicable disease. Document each element
even if the response is negative and make note about needed follow-up.
Some camps also do discrete physical assessments, especially if the
population serves special needs or when campers will be at camp four
or more weeks. Documenting a person's arrival weight illustrates this.
While camp sessions up to two weeks typically have minimal impact upon
weight, it may be beneficial to establish a baseline of this variable
for those who stay longer. This can be especially important if the population
is at risk for disordered eating or if the camp is interested in determining
the impact of camp activity upon weight. Establish the baseline using
the camp's scale since weight often varies from scale to scale.
Some camps also take each person's temperature. Interpreting these
results can be tricky because Opening Day usually puts campers under
stressors that may pop their temperature up a degree or two without pathology
being present. For example, getting dehydrated or being over-tired can
trigger moderate increases in body temperature. It is this writer's
opinion that one should assess temperature only if other symptoms or
signs are present. The person may actually benefit more from settling
into camp, drinking some water, and having a meal.
Another screening
practice, more common at long-term resident camps, is a brief head-to-toe
visual assessment that's conducted when campers are in their bathing
suits. Whether done at the health center or the waterfront, the visual
appraisal scans for cuts, rashes, bruises, and other indicators of arrival
status. Sometimes feet are examined for signs of athlete's foot.
Some camps have cabin counselors scan for these indicators as campers
get ready for bed the first night, followed by referral to the health
center if need be.
Challenges to Consider
Things usually go as anticipated
on Opening Day, especially if prescreening is part of the routine, but
every once in a while something unforeseen happens. These "Now
what?" situations occur often enough that health center staff and
camp administrators should have contingency plans in hand. Talk through
the following situations; pre-plan how each would be handled should it
happen as Opening Day is in progress:
- Scratch Bugsby feels fine
even though his little brother has chicken pox at home. Scratch has
never had chicken pox.
- Stella Breatheasy hands over her routine daily
medications in a zip lock baggie with a note from Mom that directs
"one of each color at breakfast."
- Joe Scalpercin has nits.
- Dee
Pendency, a nineteen-year-old arts and crafts counselor, tells you
that she usually goes to AA meetings once a week but doesn't think
she'll need that while at camp.
- Ari Travelite's luggage will arrive
tomorrow (maybe); it got delayed on the overseas flight. His seizure
medication is in the luggage.
- Betty Balkan tells you that her
only problem is that she's been losing weight and often wakes up
at night sweating. No, a Mantoux test was not required to get her visa.
Putting Closure to the Screening Process
While the hands-on screening
process concludes once people have arrived, screening also has a closure
element. The first step is to determine that everyone was, indeed, screened.
Sometimes campers believe they don't need to go through screening
because "there's nothing wrong with me." It's
fairly common that the camp nurse catches up with stragglers the next
day.
It's also important to review follow-up notes from the screening
process. Maybe someone's diet profile needs updating for the kitchen
staff, or cabin counselors need to know about a camper's new tendency
to sleep-walk when overtired. Perhaps additional EpiPens and inhalers
will be with certain campers. Maybe there's need for a quick staff
in-service so everyone understands how a camper will present when his
blood sugar gets too low. Visually scanning everyone's health form
after Opening Day helps catch the loose ends, those bits of information
that may not be life-threatening but certainly make a difference to the
person's camp experience.
As you might suspect, Camp In-the- Moment
continues to flounder. Its Opening Day remains harrowing, especially
for staff who scramble in a valiant effort to effectively help campers.
Meanwhile, Camp Ready-to-Go continues to practice many of the techniques
described in this article, giving their screening process its own booster
shot by adding prescreening and providing closure to their routine. As
new techniques emerge, this camp considers those ideas and shapes the
good ones to complement their program.
May many ready-to-go moments fill
your upcoming summer!
References
American Camp Association (2007). Accreditation
Process Guide. Monterey, CA: Healthy Learning.
Originally published in the 2008 May/June
issue of Camping Magazine. |
