Risk Management: Parents and Camp Health Services - Creating a Sane Partnership

Linda Ebner Erceg, RN, MS , PHN

Camp professionals have long talked about forming a partnership with parents. First articulated by Bob Ditter, the concept has moved deeply into various policies, practices, materials, and conversations. But it has not been specifically discussed in relation to camp health services — until now. It's time our camp community becomes more strategic in our relationship with parents regarding the health services provided to their child(ren).

In general, parents should be informed about the scope of care provided by the camp so their expectations are appropriate. And camp professionals need adequate health information from parents to provide that care. Everyone wants to avoid misunderstandings. Indeed, failure to meet these objectives has the potential to impact the health of campers.

Yet things happen. Calls from health center staff to parents, calls from parents to the camp director, and comments from campers — things like, "But Mom said I don't need to take that pill if I don't want to" — are part of our experience. What might we do to minimize these pain points?

Lay the Groundwork for a Sane Relationship Prior to Enrollment

I often ask camp professionals to look at their camper recruitment materials and spot the place that tells parents what a child should be able to do in order to participate in the camp's program. We often describe our great facilities, stellar staff, unique and fun programming — and don't say a thing about what a child should be able to do in order to participate. This kind of information — referred to as the essential functions of a camper — provides parents with a framework to determine if their child is indeed ready for a given camp's experience. For some camps, the only essential function is that the child wants to be at camp. But other programs might require that the child has certain skills, such as:

  • The ability to meet his or her own self-care needs
  • The ability to independently move from place to place at camp
  • The ability to effectively interact in camp's group-based and community-living environment
  • The ability to carry at least a thirty-pound backpack over rugged terrain in all weather conditions

These essential functions, linked specifically to the camp program, are related to a child's health and readiness for camp. Yes, parents unfamiliar with the camp may be able to infer or "guesstimate" their child's readiness and abilities, but such inferences also open the proverbial door to misunderstandings. Be explicit; state what a child needs to be able to do in order to participate in the camp program and state that information in recruitment materials.

Some readers may wonder about the impact of the Americans with Disabilities Act (ADA) on their essential functions for campers. In general, essential functions of campers should be tied to those elements of the camp program that every camper experiences. ADA does not require that one changes the core experience(s) of a program; rather, it requires that we accommodate based on the parameters of that program. Entire articles could be written on this topic; consequently, readers are reminded to consult their legal counsel when determining their camp's essential functions of campers.

Interestingly, an essential function that addresses mental, emotional, and social health (MESH) factors can be especially beneficial. Consider that living at camp is quite different from how children live at home. Bedrooms and bathrooms are shared with many people. Street lights give way to flashlights. Vegetation along paths isn't cut back, but people aren't waiting in those bushes to grab anyone either. The survival skills taught to today's youth — skills like not talking to strangers, not taking things from strangers, and certainly not undressing in front of them — get changed at camp. The bottom line is that even stable, well-adjusted children may short-circuit when plunged into the wonderful world of camp without some discussion about the differences between camp and home life.

Youth with MESH challenges may be even more susceptible. Parents of these youth generally appreciate a straightforward discussion about their child's behavior of concern, especially when the camp proactively provides the name and contact information of the camp professional willing to talk with the parents. These discussions are often triggered by the essential function, which lays a baseline for what a child needs to be capable of for effective interaction in the camp's group-based and community-living environment. Hosting such conversations means that the camp professional needs a good understanding of the camp program's impact upon the behavior(s) of concern. For example, some kids with attention challenges may do quite well at a given camp because the camp's structure complements their natural style of interfacing with the world, thus making the possibility of a "medication holiday" more realistic. But that may not be the case at another camp.

Reinforce a Sane Relationship by Explicit Policy Statements

Social changes in eating patterns and food preferences have raised a variety of issues. Not only are vegetarians at camp, but there are different kinds of vegetarian profiles (e.g., lacto-ovo, pasco, vegan) and often an expectation that a camp respond to these. And food preferences such as selecting almond milk for today's cereal but cow's milk tomorrow or wanting organic foods have influenced people's expectations. To a certain extent, parental expectations surrounding food may be influenced by demographic. The extent to which a camp responds is something that should be considered and communicated to parents with an instruction that they talk with their child so the camper is appropriately informed. Interestingly, this discussion is facilitated when framed as "nutrition" rather than "diet" needs.

Food allergies can also be challenging. Ranging from mild intolerance to significant anaphylaxis, a camp's ability to support individuals with food allergies should be described. Some camps use phrases such as "medically verified allergies" to separate bona fide allergies from food preferences. Other camps, recognizing that they are limited in their ability to keep allergens away from extremely sensitive campers, have added language such as, "Campers whose food allergy is so sensitive that they cannot be around others eating or using that item are probably not a good fit for our program." Notice that such statements typically use words such as "generally" and "probably," and they are supported by the name and contact info of the camp professional who parents can talk with should they be concerned.

Also discuss the inherent risks of camp. Parents/guardians may not have a camp background, so they may not realize that poison ivy, mosquitoes, and ticks — as well as other things — are part of most camp settings. It's usually not practical for the camp to remove or reduce the prevalence of these risks because they are inherent, so address the topic in policy. Granted, one can discuss this in a way that inflames people or in a more tactful yet straightforward manner. One camp used language that described some of its inherent risks and then simply stated that it follows recommended Department of Health policy in these matters. That went a long way when the camp found itself providing prophylactic rabies injections when a wayward bat flew through a cabin in which people were sleeping — and the bat defied capture for rabies testing.

Address Often- Neglected Topics

It's understandable that parents are more likely to work with us when they feel fully informed about a camp's health services. With that in mind, here are some of the "little things" that camp professionals often neglect to articulate:

  • The point at which a camp assumes and then relinquishes responsibility for camper care. This may be as simple as "after going through our Opening Day procedures" and "when the camper leaves camp at the end of his or her stay." Camps that provide transportation to and from camp will want to discuss the scope of care — if any — provided during the transportation process and inform parents accordingly.
     
  • The expectation that campers arrive healthy and ready to engage in the camp program. No one should be coming to camp ill. Indeed, the Healthy Camp Study included interesting comment on this topic and provides ACA members with access to a parent handout on the topic in the Healthy Camp Toolbox (www.ACAcamps.org/research/ healthy-camp-toolbox).
     
  • Telling parents that the camp reserves the right not to admit a person who poses a communicable illness threat. This isn't saying the camper will not be admitted, but rather that the camp reserves the right to make that decision, including one that provides a "delayed start" for a child who may need a couple more days at home to fully recover from whatever.
     
  • Define "medication." Camps often consider non-FDA products such as vitamins, herbal remedies, homeopathic preparations, and supplements as "medicine." Parents may not. So provide them with camp's definition of "medication," perhaps something as simple as "anything a person takes/uses to maintain and/ or improve his or her health."
     
  • Describe how the camp supports kids with chronic health concerns. More and more campers are enjoying camp because their chronic health concern — allergies, asthma, diabetes, seizure diagnosis, and so forth — is well controlled by their management plan. But camp's healthcare professionals may not have expertise in all these areas. Stating that "children with chronic health concerns should be capable self-managers" may be appropriate for some camps. If not, describe what services the camp provides for the various diagnoses so parent expectations are appropriate.
     
  • The camp's stance regarding nits in hair. Some schools, because youth were missing so many "seat days," now allow kids to return to class even though nits remain in their hair. For some camps, however, such a policy has a significant impact because of the number of items that are shared among campers, items such as riding/climbing helmets, hats and wigs in the drama activity, and/or bedding (pillows). So state/ explain your camp's nit policy.

Prescreen Health History Forms

Make sure an appropriate person is scanning health history forms as they arrive and making preliminary calls to parents to clarify questions. This makes Opening Day run much smoother and gives both the camp and parents lead time to make adjustments for health-related concerns. It also reinforces the camp-parent relationship so, should something happen later, that relationship can be supportive.

Improving camp health processes with an eye toward making the parent connection "more sane" is worth the effort. Yes, there will still be calls, and more ideas for improvement will surface over time, but expectations from both parties will be clarified. The impact is a better camp experience for campers, parents who understand what the camp can and cannot provide, and less worry for camp professionals. Perhaps even better sleep at night?

Linda Ebner Erceg, RN, MS, PHN, is the associate director of Health & Risk Management for Concordia Language Villages and executive director of the Association of Camp Nurses in Bemidji, Minnesota.

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